Date of Award

Spring 2010

Document Type


Degree Name

Doctor of Philosophy (PhD)




Clinical Psychology

First Advisor

Kaugars, Astrida

Second Advisor

Heffelfinger, Amy

Third Advisor

Grych, John


Children impacted by neurological insult or disorder are at risk for impaired neuropsychological functioning; however, there is substantial variation in outcome, with many affected children doing very well. The factors that explain the variation in outcome in children with compromised neurological functioning are poorly understood. The present study examined the nature of relationships among family factors, including primary caregivers' appraisals of stress (i.e., primary caregivers' injury/medical condition-related stress, parenting stress, psychological distress, and relationship quality) and the primary caregiver-child relationship, and neuropsychological outcomes (i.e., intellectual functioning; language skills; adaptive, socio-emotional, and behavioral functioning). A clinical sample of 72 preschool children whose neurological development had been compromised and their primary caregivers participated in the study. Primary caregivers completed rating scales and a structured clinical interview about perceived stress as well as their child's behavioral, socio-emotional, and adaptive functioning. Children were administered standardized measures of intellectual and language functioning. Primary caregiver-child dyads participated in a semi-structured play interaction. Results revealed significant associations among primary caregivers' appraisals of stress and children's internalizing and externalizing behaviors. Significant associations were not found between primary caregiver's appraisals of stress and children's language or intellectual functioning. Primary caregivers' appraisals of stress were related to ratings of primary caregiver intrusiveness in the primary caregiver-child interaction. Several characteristics of the primary caregiver-child relationship were related to children's outcomes. After controlling for the severity of a child's neurological insult, the quality of the primary caregiver-child relationship accounted for a significant amount of unique variance in predicting children's overall intellectual functioning, verbal reasoning ability, total language, receptive language, and expressive language but not nonverbal reasoning ability. Significant interaction effects between primary caregivers' appraisals of stress and the quality of the primary-caregiver child relationship were found when examining predictors of language abilities. Results underscore the value of assessing multiple dimensions of family functioning to better understand how the factors that influence children's outcomes.