Maternal Work Absence: A Longitudinal Study of Language Impairment and Behavior Problems in Preschool Children
| Author | Petter Kristensen,Markus A. Landolt,Tom Kornstad,Ragnhild B. Nes,Lars J. Hauge,Lorentz Irgens,Margarete E. Vollrath,Leif Eskedal |
| Date | 01 October 2015 |
| DOI | http://doi.org/10.1111/jomf.12210 |
| Published date | 01 October 2015 |
R B. N L J. H Norwegian Institute of Public Health
T K Norwegian Institute of Public Health and Statistics Norway∗
M A. L University Children’s Hospital Zürich and University of Zürich∗∗
L I University of Bergen∗∗∗
L E Sørlandet Hospital∗∗∗∗
P K National Institute of Occupational Health and Institute of Health and
Society∗∗∗∗∗
M E. V Norwegian Institute of Mental Health and Institute of Psychology∗∗∗∗∗∗
Maternal Work Absence: A Longitudinal Study of
Language Impairment and Behavior Problems in
Preschool Children
Division of Mental Health, Norwegian Institute of Public
Health, Sandakerveien 24C, 0403 Oslo, Norway
(ragnhild.bang.nes@fhi.no).
∗Division of Mental Health, Norwegian Institute of Public
Health, Sandakerveien 24C, 0403 Oslo, Norway; and
Statistics Norway, Pb.8131 Dep., 0033 Oslo, Norway.
∗∗University Children’s Hospital Zürich, Department of
Psychosomatics and Psychiatry, Steinwiesstrasse 75,
CH-8032 Zurich, Switzerland; and University of Zurich,
Institute of Psychology, Department of Child and
Adolescent Health Psychology, Binzmuehlestrasse 14,
CH-8050 Zurich, Switzerland.
∗∗∗Department of Global Public Health and Primary Care,
University of Bergen, Kalfarveien 31, NO 5018 Bergen,
Norway.
∗∗∗∗Department of Research, Sørlandet Hospital, Pb. 416,
4604 Kristiansand, Norway.
∗∗∗∗∗Department of Occupational Medicine and
Epidemiology, National Institute of Occupational Health,
Pb. 8149 Dep., 0033 Oslo, Norway; and Institute of Health
and Society, Universityof Oslo, Pb. 1130, 0318 Oslo,
Norway.
∗∗∗∗∗∗Division of Mental Health, Norwegian Institute of
Public Health, Sandakerveien 24C, 0403 Oslo, Norway;
and Institute of Psychology, Universityof Oslo,
Forskningsveien 3A, 0373 Oslo, Norway.
Combining work and family responsibilities
is challenging when children have spe-
cial needs, and mothers commonly make
employment-related adjustments. In this study,
the authors examined associations between
maternal work absence and child language
impairment and behavior problems in preschool
children. Questionnaire data at child age 3
years from 33,778 mothers participating in
the prospective population-based Norwegian
Mother and Child Cohort Study were linked
to national register data on employment and
long-term physician-certied sick leave at child
age 3–5 years. Mothers who reported having
a child with language impairment had a con-
sistently higher risk of not being employed
and were at increased risk of taking long-term
sick leave at child age 5 years. Co-occurring
problems were associated with excess risk.
Language impairments in preschool children,
in particular when they are co-occurring with
behavior problems, are likely to have a range of
KeyWords: caregiving,child care, child health, employment,
sick leaves, work absence.
1282 Journal of Marriage and Family 77 (October 2015): 1282–1298
DOI:10.1111/jomf.12210
Maternal Work Absence and Child Disability 1283
negative short- and long-term consequences for
the nancial and overall health and well-being
of mothers and their families.
The dual-earner family has been a central
political ambition in Norway and other
welfare-oriented countries since the early
1970s, and the past few decades have seen an
unprecedented increase in maternal employment
throughout Europe and the United States. Still,
mothers have lower employment and higher
sick leave rates than fathers across most of these
countries (Laaksonen et al., 2010; Melchior,
Niedhammer, Berkman, & Goldberg, 2003),
including Norway (Mastekaasa, 2000). Chil-
dren’s disabilities or special health care needs
(McPherson et al., 2004) might constitute an
important risk factor for this maternal work
absence, forming the nucleus of much work–
family conicts
Caregiving constitutes a normal part of being
a mother but is likely to take on a different
signicance when a child has special needs and
might become a “fertile ground for persistent
stress” (Pearlin, Mullan, Semple, & Skaff, 1990,
p. 583). Over time, additional stress factors
might lead to compromised health and neces-
sitate various employment-related adjustments.
The notion that child health and behavior affect
maternal behavior is central within transactional
and family systems theories (Bronfenbrenner
& Morris, 1998; Lazarus & Folkman, 1984),
and a number of theoretical models describe
the impact of stress on caregivers. Extensive
caregiving commonly requires rearrangement of
priorities and redirection of energy to optimally
manage the child’s disability and to juggle
the caregiver role within the requirement of
everyday life, personal, and contextual (e.g.,
social support, nances, health care, and edu-
cation facilities) resources (Raina et al., 2005).
Although extra care (e.g., special education,
supervision, medical visits) might constitute
an important ingredient in promoting optimal
development for the child, it is likely to divert
resources from other purposes and might result
in stress, compromised health, exhaustion,
absenteeism, reduced work hours, or cessation
of paid work altogether (DeRigne & Porter-
eld, 2010). Because mothers are typically the
primary caregivers, they are likely to shoulder
the bulk of these added responsibilities (Baker
& Drapela, 2010; DeRigne, 2012). Empirical
evidence has also demonstrated associations
between caregiving and both maternal health
and employment outcomes. A majority of moth-
ers tend to adjust their work participation to meet
family goals, making employment decisions in
response to an intricate web of interconnected
relational issues (Holmes, Erickson, & Hill,
2012; Mainiero & Sullivan, 2005), including
their children’s health and behavior (DeRigne,
2012; Gordon, Rosenman, & Cuskelly, 2007).
A number of studies have also documented
associations between children’s special care
needs and lowered maternal employment rates
(DeRigne, 2012), with more mothers working
part time (Gordon et al., 2007) or leaving work
altogether (Nes et al., 2013), despite not having
a weaker desire for work (Gordon et al., 2007),
with the more severe child care conditions most
strongly related to lower employment rates
(DeRigne, 2012; Montes & Halterman, 2008),
and the employment differences becoming more
pronounced with child age (Hauge et al., 2014).
Extensive caregiving is also likely to inu-
ence both maternal mental and somatic health.
Mothers of children with special needs have
been shown to be more likely to suffer from
anxiety and depressive disorders than fathers
or mothers of typically developing children
(Brehaut et al., 2009). These differences com-
monly ensue from the chronic strain involved
in the caretaker role as well as from emotional
reactions and concerns evoked by the child’s
condition. The cumulative effect of multiple
daily caregiving stressors has been shown to
adversely affect wound healing and to promote
elevations in inammatory markers associ-
ated with depression, cardiovascular disorders,
frailty, and mortality (Gouin, Glaser, Malarkey,
Beversdolf, & Kiecolt-Glaser, 2012; Mausbach,
Patterson, Rabinowitz, Grant, & Schulz, 2007).
Despite the fact that care responsibilities are
closely associated with these health conditions,
which are major reasons why people in the gen-
eral population take sick leave, few researchers
have examined sick leave rates for mothers
of children with special needs, and, to our
knowledge, none have used physician-certied
register-based information. Previous studies
have typically been characterized by major
shortcomings such as the data being based on
self-report only or on cross-sectional data, and
the investigation of the impact of specic child
diagnoses of very low prevalence (e.g., autism,
Down syndrome). Other studies have included
heterogeneous samples of children with widely
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