Parenting styles

The child-parent findings revealed a range of typologies that represent different parenting approaches in relationship to sharing responsibility of the asthma management (Miller, 2009). A detailed overview of different parenting styles was presented inChapter 2, Section 2.3.3. In summary, parents usually adopt one of four parenting styles: ‘authoritarian

parenting’, ‘authoritative parenting’, ‘permissive parenting’ and ‘uninvolved parenting’ (Maccoby and Martin, 1983:p39-49; Baumrind, 1967:p44). These parenting styles were developed from observing child-parent interactions in a natural environment; these typologies were applied to the child-parent findings presented. Chapter 5 presented a family specific map for each child-parent dyad in order to illustrate the direction of the control of asthma management decisions within the dyads. Three of the four parenting

styles were identified during the stages of data analysis. None of the participating parents adopted the ‘uninvolved parenting’; these parents typically provide minimal care and are not involved in their child’s life (Maccoby and Martin, 1983; Baumrind, 1967). The majority of the parents appeared to adopt an authoritative parenting style, enabling children to

contribute and participate within some asthma management decisions resulting in increased confidence to contribute to asthma management decisions albeit the control of the decision remained with the parent. An authoritarian parenting style was evident with two of the parents, where they dominated the decisions allowing the child little or no control over the decision-making process. Consequently, the child had little control in relation to decisions about them. The findings highlight a child living within an authoritarian parenting family did not want to be involved in decisions about their asthma (Amanda and Kirsty). This parenting style typically results in low independence and low self-esteem in the child and a lack of control in relation to participating in the management of their asthma (Maccoby and Martin, 1983; Baumrind, 1967). Permissive parenting style was also evident within the findings; typically these parents facilitated the child to gain control of asthma management decisions, regardless of the child’s decision preferences. The family specific maps in Chapter 6, Section 1. illustrated that parenting styles influenced the control of asthma management decisions. For example, Kirsty, mother of Amanda 9 (page 149) demonstrated an authoritarian

parenting style dominating the majority of asthma management decisions. Interestingly, the child reported not wanting to be involved in decisions regarding her asthma management suggesting a lack of confidence. Yet, the extracts (page 126) identify Amanda had the capacity to make decisions. For example, she could identify that a cough is a symptom of asthma and requires treatment, but responded by alerting her mother or teacher relying on them to administer the inhaler. None of the studies reviewed in Chapter 3 discussed how parenting styles may affect a child’s participation within the decision-making for their asthma management. Although, one study highlighted parenting styles may influence collaborative decision-making but did not explore this in any detail (Miller, 2009). 7.3.4 Child’s cognitive development

Previous research highlighted a child’s cognitive development influences their ability to participate within the decision-making processes in relation to health decisions (Taylor et al.,

2010; Miller etal., 2008; Myant and Williams, 2005). Piagetian (1969) theoretical

perspectives about how a child’s cognitive development influences their own participation within the decision-making (Chapter 2, Section 2.2) suggests limited decision-making involvement of a child within the seven to eleven year age range, although they are beginning to develop causal relationships between health and illness (Alderson et al., 2006b). Piaget’s (1969) concrete operational stage (between seven and eleven years) would suggest that the children within this study would only just be beginning to apply logical thought and reasoning skills to concrete problems, suggesting limited participation within decisions as asthma management issues arise. However, the findings illustrated that a child of seven years of age has the ability to make autonomous management decisions, for example understanding his asthma symptoms will reduce if he modified his running pace (page 127). These findings resonate with previous research undertaken with children of a similar age that also demonstrated autonomous decision-making skills to reduce asthma symptoms through the reduction or avoidance of asthma triggers (Meah et al., 2009). These types of asthma management decisions require the child to apply complex thought processes to different situations and then make an autonomous management decision. Findings of this present study and previous research (Meah et al., 2009), suggest the application of complex thinking by children when undertaking self-management strategies. Piaget (1969) suggested a child of seven years of age is unable to achieve such complex thinking, supported by the findings of Pradel et al. (2001), where some children aged between seven and twelve years did not recognise the warning symptoms and relied on parents to manage their asthma. However, other children could respond to acute asthma symptoms and reduce asthma symptoms through the reduction or avoidance of asthma triggers (Table 13).

Piaget’s (1969) cognitive developmental stages and Buford’s (2004) transfer of asthma management responsibility from parents to their school-age children model do not capture or account for the variability in decision-making capabilities for children of similar ages. Each child has different experiences and therefore different perspectives on their participation with asthma management decisions. One explanation for the differences may be attributed to societal factors and the interaction with other individuals (Vygotsky, 1978). If a parent and