Valid and reliable outcome measures are needed to assess the impact of interventions to improve parent–child relationship quality and there is an age gap in validated measures in the pre-school years. This paper evaluates the performance of a new measure of parent–child relationships in this age range, an adaptation of MORS-SF a measure developed for babies. It also validates the C-PRS in two year olds.
The MORS-SF instrument was developed for use in primary care practice, usually by health visitors, and in research, as a unique tool designed to assess the nature of a mother’s internal working model of her infant in the months following the birth. It has been used in a number of contexts in England, Hungary and Australia as a component in screening to identify concerns about the developing dyadic relationship, and to assign mother-infant dyads to a relevant care pathway . The assessment of attachment quality between parent and child is commonly a central concern when determining the need for interventions to improve parent–child relationships, and in tracking change during and following the intervention, not only in the post-partum, but also through later years of childhood. Given that the parent’s internal working model of their child is a core component of the attachment relationship, the use of an instrument that taps into elements of this model is clearly of potential value for practitioners.
The English government is moving to outcomes based management of health services. As parenting, particularly parenting in the first three years, is seen as key to public health improvement a new indicator has been proposed to measure the quality of parent-infant relationships which promote secure attachment .
This validation suggests that the MORS would be a good candidate for such an indicator; we have demonstrated that the MORS (Child) is psychometrically sound in 2–4 year olds and that parents find acceptable and easy to complete. On the other hand, validation of the C-PRS presented some issues in this age group. One item relating to ‘child avoiding physical contact and affection’ did not factor as expected from validation in older age groups. This may be because the item means different things at different ages. It is much less common for a 2–3 year old to avoid physical contact than an older child. The C-PRS was marginally more difficult for our sample of parents to complete than the MORS (Child), with some parents indicating that some items were worded in a way which was not as simple as could be and that some items did not apply as the child was not old enough.
The negative skew in the MORS (Child) warmth subscale and the C-PRS closeness subscale scores is not unexpected since low scores on both these subscales represent a relative lack of warmth and affection from the parent towards the child, which one might expect to be relatively infrequent in a general population sample. However, it could represent a social desirability bias, where parents are reluctant to portray themselves in a bad light by reporting low levels of these obviously positive behaviours. The correlation between the comparable scales of the two measures was, however, high.
MORS-SF has its basis in attachment theory; it aims to provide an assessment on two key axes of mother’s internal working models of their infants. Working models are generally considered to have a high degree of stability over time, because they are established as an outcome of many successive experiences and serve to regulate a person’s expectations of and behaviour towards their attachment figures . Since the parent-infant attachment relationship is established largely during the first 18 months of the infant’s life, it is to be expected that the internal working model that a mother forms of her infant’s thoughts and feeling towards her will by then have become relatively stable. Hence the axes of perceived ‘warmth’ and ‘invasion’ can be expected to have on-going validity, even if the mother’s perceptions on these axes modify somewhat. The data from the current study confirm this, showing a factor structure in MORS (Child) that is virtually identical with that of MORS-SF .
We took advantage of data already collected using the MORS (Child) in the setting of an RCT to assess its factor structure as part of a composite measure of parenting. We were able to compare this with the factor structure of the C-PRS in the same composite setting using data published on the evaluation of Sure Start. The similarity in factor weightings of the two measures used in this way provides some evidence of the external validity of the MORS (Child) and confidence that it appropriate to use the MORS (Child) in this way. Further investigation of external validity would be valuable.
On the basis of this data we can safely recommend the MORS (Child) for assessment of the quality of the parent–child relationship in children aged 2–4 years. Given the very similar factor loadings with the MORS-SF in infants, and the theoretical expectation that working models do not change greatly in this age range without intervention, it seems very likely that this scale would also be valid in one year olds. Relationship quality in this age group where both ‘baby’ and ‘child’ are appropriate may be measurable using either of the MORS scales.
Our findings suggest that in the under 5 age group the MORS (Child) is a more robust measure than the C-PRS. This is perhaps not surprising as the C-PRS was developed in the US with primary school age children. Further work needs to be undertaken to evaluate the performance of the MORS (Child) in children of one year of age and to assess performance in children over four years. The likelihood of continuity between the MORS (baby) and the MORS (Child) needs confirming or refuting. If the MORS (Child) is to be used as an outcome measure to evaluate interventions, it will also be important to demonstrate sensitivity to change.
One limitation of this study is the question of generalising from our sample, which was confined to two areas, north Warwickshire and south Wales.