Journal of Applied Developmental Psychology 33 (2012) 189–196

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Journal of Applied Developmental Psychology

Unintentional injury risk in school-age children: Examining interrelations betweenparent and child factors

Melissa Wells, Barbara A. Morrongiello ⁎, Alexa KanePsychology Department, University of Guelph, Ontario, Canada

⁎ Corresponding author.E-mail address: bmorrong@uoguelph.ca (B.A. Morro

0193-3973/$ – see front matter © 2012 Elsevier Inc. Alldoi:10.1016/j.appdev.2012.05.003

a b s t r a c t

a r t i c l e i n f o

Article history:

Received 10 December 2010Received in revised form 2 May 2012Accepted 18 May 2012Available online 29 June 2012

Keywords:ChildrenUnintentional injuryParentsBidirectional processes

Objective: Research on children's risk of injury reveals that parent and child factors are often interrelated. Thisstudy examined relations between children's risk taking, parent appraisal of this risk taking, and children'srate of injury in youth 8 and 9 years old.Methods: Responses to questionnaires and laboratory tasks were used to examine whether extent of consis-tency in children's physical risk taking related to mothers' accuracy in predicting children's risk behaviors,and if mothers' accuracy scores, in turn, related to rate of unintentional injury for their school-age children.Results: Child consistency in risk taking predicted parental accuracy in judging children's risk taking, and de-gree and direction of accuracy predicted children's injury rates.Conclusions: Parents' judgments about their children's likelihood of risk taking are influenced by children'sbehavioral consistency and have implications for children's frequency of injury.

© 2012 Elsevier Inc. All rights reserved.

In most industrialized countries, including Canada and the UnitedStates, unintentional injuries are the leading cause of death for childrenover 1 year of age (Canadian Institute of Child Health, 2002; Centers forDisease Control, 2009; World Health Organization, 2008). Unintentionalinjuries also result in substantial disability, medical expenses, school ab-sences, and emotional trauma (Farchi et al., 2006; National Safe KidsCampaign, 2004; National Safety Council, 2001; Rodriguez, 1990). The di-rect and indirect costs of such injuries are staggering and confirm theneed to reduce their occurrence (SMARTRISK, 2006). Importantly, child-hood injuries are often both predictable and preventable (Dowd,Keenan, & Bratton, 2002; Rimsza, Schackner, Bowen, & Marshall, 2002;Roberts, 1993). There has been considerable interest, therefore, in identi-fying risk factors that lead to injury so that effective prevention strategiescan be developed.

Past research reveals that numerous child attributes influence risk ofinjury. For example, children aremore likely to be injured if they: (a) aremale (Morrongiello, Midgett, & Shields, 2001; Rosen & Peterson, 1990);(b) have behavior problems, such as hyperactivity, aggression, and “dif-ficult” temperaments (Schwebel, 2004a, 2004b; Schwebel, Hodgens, &Sterling, 2006; Schwebel, Speltz, Jones, & Bardina, 2002); (c) are “sensa-tion seekers” (i.e., seek novel, behaviorally intense and emotionallyarousing risk activities; Bijttebier, Vertommen, & Florente, 2003; Speltz,Gonzales, Sulzbacher, & Quan, 1990); (d) are less compliant with paren-tal demands (Morrongiello & Dawber, 1998; Morrongiello, Ondejko, &Littlejohn, 2004a, 2004b; Morrongiello et al., 2001); (e) overestimatetheir physical abilities (Plumert, 1995; Schwebel, 2004a); and (f) have

ngiello).

rights reserved.

sustained previous injuries (Jaquess & Finney, 1994; Morrongiello &Dawber, 2000).

A number of characteristics of parents also have been associatedwithincreased risk of injury to children. For example, parents of childrenwhoexperience injuries are more likely to: (a) use ineffective teaching strat-egies and show permissive styles of parenting (Morrongiello, Corbett,Lasenby, Johnston, & McCourt, 2006; Schwebel et al., 2006); (b) engagein ineffective supervision practices (Morrongiello, Corbett, McCourt, &Johnston, 2006a, 2006b; Morrongiello et al., 2001; Morrongiello et al.,2004b; Schwebel & Brezausek, 2004; Schwebel et al., 2006); (c) enforcefewer safety rules (Peterson & Saldana, 1996); and (d) attribute injuriesto bad luck or other external causes, as opposed to their child's behavior(Damashek et al., 2005;Morrongiello & Dayler, 1996). Notably lacking inpast research aimed at identifying parent factors that influence children'srisk of injury is a focus on examining the extent to which parents can ac-curately predict their children's risk taking. Additionally, a noteworthyaspect of most past research on child injury risk is that it has focusedon either child or parent characteristics. Few studies have consideredinterrelations between child and parent variables, despite calls for suchresearch (Morrongiello & Schwebel, 2008; Schwebel & Barton, 2005)and evidence that injury risk often arises from an interaction of childand parent factors (Damashek et al., 2005; Morrongiello, Klemencic, &Corbett, 2008). The current study addressed these issues by examiningrelations between children's risk taking, parent accuracy in estimatingtheir children's risk taking, and children's rate of unintentional injury.

Interest in investigating mutual influences within child–parentdyads is relatively recent in child development research. Historically,the parent–child relationship was seen as unidirectional, with influ-ence flowing from parent to child (e.g., research on types of parenting

190 M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

styles: Baumrind, 1971; Bandura's work on social learning: Bandura,1977; Bandura & McDonald, 1963). However, consistent with emerg-ing notions that parental responsiveness is a key indicator of ‘good’parenting, there has been increasing recognition that parents showdifferential treatment of their children based on perception of individ-ual children's needs and attributes (Grusec & Goodnow, 1994). Thus,parenting behaviors have been shown to be influenced and directedby child behaviors, and not just vice versa. Furthermore, parentingbehaviors that result from this ongoing interactive parent–childprocess have been shown to later impact the child's development,confirming these are bi-directional effects (Kuczynski, 2003).

Although the notion of mutual parent–child influences has not yetbecome popular in research on childhood injury, support for thisapproach is bolstered by findings that injury risk is influenced by an in-teraction of parent and child behavioral characteristics. For example, re-search has shown that for children high in behavioral intensity, theirfrequency of injury depends on level of parent supervision(Morrongiello, Corbett, & Bellissimo, 2008; Morrongiello, Klemencic,et al., 2008). At high levels of supervision, children experience fewer in-juries, whereas when parents do not actively supervise then childrenexperience elevated rates of injury. For children low in behavioral in-tensity, however, frequency of injury is low and unaffected by level ofsupervision. Thus, the impact of a child attribute that typically elevatesinjury risk (e.g., behavioral intensity) can be effectively moderated by aparent behavior (i.e., parent supervision). Similarly, Schwebel and col-leagues found that positive parenting could moderate the impact of dif-ficult temperament characteristics (e.g., hyperactivity) on children'srisk of injury (Schwebel, Brezausek, Ramey, & Ramey, 2004), and par-ent presence moderated the risk taking judgments of temperamentallyimpulsive and undercontrolled children (Schwebel & Bounds, 2003).Finally, in a longitudinal study of home injury, it was found thatmothers altered their level of supervision in response to behavioral at-tributes of their children 2–3 years old (Morrongiello et al., 2004a,2004b). Moreover, the appropriateness of this response to child attri-butes then predicted children's future injury rates.

Present study

Building on past findings, the current study usedmultiple parent andchildmeasures to examine parents' accuracy in assessing their children'srisk taking behavior across different contexts and how this level of accu-racy related to children's rate of injury. Specifically, children's propensityfor risk taking (i.e., extent of consistency in risk taking across contexts)was related to parents' accuracy in predicting their child's risk behaviors,and, in turn, parent accuracy was related to rate of injury for school-agechildren. We reasoned that the accuracy with which parents can predicthow their childwill behave in risk situationsmay be an especially impor-tant determinant of injury risk for school-age children because they aregaining in independence and, therefore, are less likely to be routinelydirectly supervised by adults (Morrongiello, Corbett, & Kane, 2011;Morrongiello, Kane, & Zdzieborski, 2010). Similarly, accurately predictinga child's risk behaviorwould allowone to take steps tomoderate this risktaking. Hence, accuracy might influence children's injury risk.

Two specific questions were addressed in this study. First, doesconsistency of children's risk taking across situations relate to paren-tal accuracy in predicting children's risk taking, and is this relationpossibly a nonlinear one such that parental accuracy is differentiallyimpacted by low versus high levels of child consistency in risk taking?For children who are highly consistent in risk taking decisions acrosssituations (either consistently risk avoidant or risk takers), parentsmay be more accurate in their predictions than those of childrenwho are less consistent in risk taking decisions.

Second, does greater accuracy in predicting children's risk takingby parents predict fewer injuries among their children, and does thenature of parental inaccuracy (overestimating versus under-estimating children's risk taking) differentially relate to children's

rate of injury such that parental underestimation of risk taking pre-dicts more injuries to children and overestimation predicts fewer in-juries. Surprisingly, there is virtually nothing known about theaccuracy with which parents can judge their school-age children'srisk taking behavior, although epidemiological research has shownthat injury rates peak at points when young children are acquiringnew milestones in motor development, which could be explainedby parents not having anticipated these new behavioral competen-cies (Agran et al., 2003). For parents who are highly accurate intheir predictions about their children's risk taking, their childrenmay be less likely to be injured because parents would be able to im-plement precautions to prevent injury. On the other hand, for par-ents who are highly inaccurate in their predictions, the nature ofthis inaccuracy probably impacts injury risk. Overestimating a child'slevel of risk taking may lead parents to be more cautious and theirchildren to experience fewer injuries, whereas underestimatingrisk taking may lead parents to be inappropriately lax and their chil-dren to experience more injuries. Thus, it was hypothesized that anonlinear relation would exist between parental inaccuracy inpredicting their child's risk taking and their child's rate of injury.

Measurement of children's risk taking was computed based onthree types of indices: (1) children's general orientation to risk tak-ing (i.e., extent of sensation seeking or tendency to seek out new andintense experiences that are emotionally arousing and risk takingpropensity or an individual's general tendency to take risks acrosslife domains); (2) extent of risk taking in response to everydayhome and play-related hazards; and (3) actual physical risk taking.An index of consistency of risk taking across tasks was computedbased on children's responses across all seven risk taking measures.A comparison of parent judgments with child responses on thesevarious indices of risk taking resulted in a discrepancy score thatindexed extent of parental accuracy in judging the child's risk takingand revealed the nature of inaccuracy (overestimation vs. underes-timation) in predicting their child's risk taking. This accuracy scorewas then related to children's rate of injury, as reported in daily di-aries completed by children (cf. Morrongiello, 1997; Peterson,Harbeck, & Moreno, 1993) over a four week period before the risktaking tasks were introduced, and to children's recent (previousthree months) frequency of injuries as reported by parents on an in-jury history questionnaire.

Method

Participants

The sample included 79 children (39 males, 40 females) 8- and9 years old (M = 8.44 years; SD = 0.50 years) and their mothers.The participants were randomly selected from a database of over13,000 local families who were interested in participating in re-search on child development; participation rate was 89% of thosephoned with children who met age criteria. Mothers reportedtheir highest level of education as: 5% completed high school, 68%completed a degree or had some college or university courses, andthe remainder had completed some graduate school training.Annual gross household income for participants was reported as:4% earning less than $20,000, 4% earning between $20,000 and$39,999, 10% earning between $40,000 and $59,999, 15% earningbetween $60,000 and $79,999, and 67% earning more than$80,000. With respect to ethnicity, 96% of the participants describedthemselves as Caucasian, 3% described themselves as Asian, and 1%chose “other” to describe their ethnic background. All participantswere fluent in English and reported no difficulty understandingthe methods or procedures. Children and their mothers indepen-dently granted written consent prior to participation, and all proce-dures and measures had approval from the Research Ethics Board atthe university.

191M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

Measures

Parent questionnairesMothers completed five questionnaires. A Demographic Information

Sheet provided information on education, ethnicity and family income.An Injury History Questionnaire (IHQ) assessed the frequency withwhich the child had sustained injuries requiring at-home treatmentby a parent in the past three months. Prior research has establishedthe reliability of maternal reporting of medically-attended injuriessince birth, and reporting of minor injuries over short intervals suchas three months (Cummings, Rivara, Thompson, & Reid, 2005; Pless &Pless, 1995). Three questionnairemeasures of risk takingwere complet-ed by parents. The Injury Behavior Checklist (IBC; Speltz et al., 1990) wasused to assess the typical level of physical risk taking the child dis-played. The IBC obtained parent ratings (5-point Likert scale, 0 = Notat all, 4 = Very often) of how often their child engaged in each of 24risky behaviors (e.g., jumping down steps). Potential scores rangedfrom 0 to 96, with higher scores indicatingmore risk taking (Cronbach'salpha = .87 for this sample). The Sensation Seeking Scale for Children(SSSC, Morrongiello & Lasenby, 2006) assesses parental understandingof their child's attitude toward new and intense experiences (i.e., thrillseeking and novelty seeking). For each of 15 items parents indicatetheir child's preference for a high risk (e.g., My child would like swim-ming in deep water) or low risk (e.g., My child would prefer to swim inshallow water) experience, with each option assigned a score of 1 or 0,respectively. Scores ranged between 0 and 15, with higher scores indi-cating greater sensation seeking (Cronbach's alpha = .77 for this sam-ple). A modified version of the Risk Propensity Scale (RPS), describedby Meertens and Lion (2008), assesses parental understanding of theirchild's general attitude toward risk taking. The wording in some itemswas modified to increase applicability to this age group. For each ofthe eight items, parents were asked to rate (1 = Not at all true, 5 = Al-most always true) how consistent that statement applied to their child'sapproach to risk taking (e.g., My child prefers to avoid risks if s/he can).Scores ranged between 8 and 40, with higher scores representing agreater tendency toward taking risks (Cronbach's alpha = .77 for thissample).

Child questionnairesChildren completed the same three questionnaires about risk tak-

ing (IBC alpha = .82; SSSC alpha = .76; RPS alpha = .79) to allow forcomparison with their mother's scores on the analogous measures,with wording changed to reflect self-reports. Children's scores onthese were computed in the same way as reported above for mothers.

Child daily diariesChildren also completed daily diary forms in which they recorded

injuries and other activities over a four week period. Although parentreport can be very useful in studying injuries to children, parents canbe unaware of injuries that don't require treatment by a parent or med-ical professional and are sustained by older childrenwhen not attendedto by a parent (Morrongiello, 1997; Peterson, Ewigman, & Kivlahan,1993). Past research has shown that school-aged children can be veryaccurate in their reporting of injury experiences and can provide ahigh level of description and detail for both minor and more serious in-juries (Morrongiello, 1997; Peterson, Brown, Bartelstone, & Kern, 1996;Peterson, Harbeck, et al., 1993). Moreover, Hogan, Etz, and Tudge(1999) argue that child reports should be used more commonly in re-search because their accounts are often different from the reportsgiven by their parents. A child's perspective of an experience is neces-sary to fully understand that event and its meaning to the child(Backett-Milburn & Harden, 2004; Kelley, Mayall, & Hood, 1997), andsince injuries often occur outside the home at this age, it is clear that achild's understanding is particularly relevant. For all of these reasons,therefore, it was felt that collecting information on injury events direct-ly from children was valuable and appropriate.

The ‘injury diary forms’ were child-friendly and involved circlingresponses or locations on a figure to indicate the site of an injury,and answering a few short questions about the injury, with ‘injury’defined as damage to the body that might not be seen (e.g., headacheafter banging the head) or that might be seen (e.g., bump, bruise,burn, cut, scrape) and that produced effects that lasted at least 1 h;there was no requirement regarding experiencing pain. To encouragethe habit of completing diary forms each night, forms to be completedon days when injuries were not sustained were also created. These‘non-injury forms’ also were child-friendly and simple to complete.They asked about daily activities (e.g., weather, attendance at school)and did not involve any questions related to injuries. Having forms tocomplete on days when injuries were not sustained was expected todecrease the likelihood of children reporting injuries simply to beable to complete the activity, or not reporting injuries in order toavoid completing the sheets. Both sets of forms (injury and non-injury) were pilot tested on a separate sample of children and foundto be easily understood (i.e., parental assistance was not needed)and quickly completed in five minutes time.

Hypothetical risk taking situations taskThree types of hypothetical risk taking situations that have been

used in prior researchwere presented to parents and children indepen-dently. The first was a Path Selection Task (cf. Morrongiello & Matheis,2004), which consisted of six black and white line drawings of sex-ambiguous children participating in common play activities (bicycling,roller-blading, sledding, ice skating, crossing a river, and rolling downa hill at the park). Each drawing included three possible paths thechild in the drawing could take to get from their current location to an-other desired location, each path depicting varying levels of conve-nience (length of path) and risk (presence of hazards). Shorter pathswere more hazardous and longer paths were less hazardous, so conve-nience was pitted against safety. For each drawing, parents were askedto predict which of the three paths their childwould choose to take, andeach child was asked to choose the path they would take. Parents andchildren received a score of 0 for choosing the least risky path, 1 forchoosing the moderately risky path, and 2 for choosing the most riskypath, for each of the 6 drawings. Thus, scores ranged from 0 to 12 onthis task, with higher scores indicating greater risk taking.

In the Playground Task (cf. Morrongiello & Matheis, 2007) childrenwere presented photos (8 × 10 in color/laminated) of actual childrenengaged in various behaviors on a playground, including no risk be-haviors (using equipment as it was intended), moderate risk behav-iors (inappropriate use of equipment that could lead to a fall), andhigh risk behaviors (inappropriate use of equipment that had or al-most had led to a fall when naturalistic observations were conducted)for each of four types of equipment (swings, seesaws, slides, andclimbers). For each type of equipment, there were two photos fromeach risk-level category (no, low, high) for a total of six photos pertype of equipment and 24 photos total. Children were asked to sortthe pictures by assigning each behavior to one of two piles, accordingto whether they would or would not engage in that behavior. Parentswere asked to predict how their children would categorize each of thepictures. For each no risk activity that the child categorized as some-thing they “Would do”, a score of 0 was assigned. For each low risk ac-tivity that they endorsed, a score of 1 was given. Finally, for each highrisk activity that was endorsed, a score of 2 was assigned. Thus, scoresranged from 0 to 48, with higher scores representing higher levels ofrisk taking.

Finally, children were exposed to a contrived hazards room (cf.Morrongiello & Dawber, 1998) in the laboratory. This room was setup to resemble an office, but had hidden audio and video recordingequipment present. Twelve items that appeared to be dangerousbut had been modified to eliminate injury risk (i.e., contrived haz-ards) were located throughout the room and represented a varietyof different types of injury, including three each for burns, poisons,

192 M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

cuts, and falls. Some child-friendly non-hazardous items were also in-cluded in the room to provide opportunities for children to interactwith more appropriate items if they chose to do so. Table 1 providesa listing of items that were present in the room. Recordings of childsessions in the roomwere reviewed to assess howmany of the 12 po-tentially dangerous items the child touched. Parents were taken tothe room alone and asked to predict which of the 12 hazards theirchild would touch if left alone in the room.

Physical risk taking taskTo assess a child's level of physical risk taking, a balance beam task

was used (cf. Morrongiello & Matheis, 2004). Crossing a balance beamat a self-chosen height is a measure of physical risk taking that hasbeen successfully used in the past and previously validated as relevantto other aspects of risk taking (Hagan & Kuebli, 2007; Morrongiello,2004; Morrongiello & Lasenby, 2006; Morrongiello & Matheis, 2004;Morrongiello & Sedore, 2005). The beam was 4 ft long and 8 in wideand attached at either end to a set of stairs that comprised eight steps,each 8 in in height (range: 8–64 in above the ground). Children wereasked to choose on which of the eight steps to place the beam, andbased on their decision they were assigned a score between 1 and8 (with 1 representing the lowest height and the least risk, and 8 rep-resenting the highest height and themost risk). At the time they select-ed height they believed they were going to have to cross the beam oncethe height was selected. Parents also examined the different stepheights and then predicted at which height their child would chooseto place the beam to cross.

Procedure

An initial 1.5 h home visit was conducted duringwhich timewrittenconsent was obtained. Parents and children completed questionnaires(randomized order) on a laptop and expectations related to the child'sdaily diaries were reviewed (i.e., parents could assist in remindingtheir children to complete the diaries but children should completethese independently). A date for a lab visit, approximately four weekslater, was also established. Children were taught to complete the dailydiary sheets and were provided with all materials necessary for a fourweek period. During the period between the initial home visit and thelaboratory visit, children were phoned weekly to remind them to com-plete the diaries and to provide an opportunity for them to ask ques-tions about these. Contact was made with nearly all children eachweek and those that were not spoken to directly were left a voicemail message.

Table 1Items present in the contrived hazards room.

Potential Hazards

1. Burna) Lighter that was not workingb) “Hot” cup of tea that was actually at room temperaturec) Coffee pot full of “hot” coffee and the light on, which was not actually hot

2. Poisona. Window cleaner bottle filled with colored blue waterb. Medication bottle filled with small candiesc. Imitation cigarette butts

3. Cuta. Dulled pair of scissorsb. Wooden letter opener that was shaped like a knifec. Dull chisel

4. Falla. Stepladder with an interesting mobile hanging aboveb. Stack of boxes against the wall with pictures abovec. Open briefcase that was rigged to appear to be likely

to fall upon the child if he/she reached for an object inside of it12 Non-hazardous Items• children's books, a child's alarm clock, an interesting key ring, some cases fromchildren's videotapes, and a box with a number of small toys

After the four-week recording interval, mothers and children com-pleted a lab visit lasting approximately 1.5 h. During the lab visit,children and parents completed each of the risk taking tasks indepen-dently, with ordering randomized. Once completed, the child wastaken back to his/her parent and both were fully debriefed and askedto grant consent for viewing of the video of the child in the contrivedhazards room. Children then received a token gift for participating.

Results

Calculating an index of risk taking consistency

Preliminary analyses were performed to examine interrelationsamong the various risk taking measures completed by children (seeTable 2). An intercorrelation matrix with all of the risk taking mea-sures included indicated that each of the seven tasks significantlycorrelated with other measures of risk taking, but not with all othertasks. The same pattern of significant effects was obtained based onparent data, although the absolute magnitude of correlations varied.Thus, the tasks were interrelated, but not redundant. For the primaryanalysis, therefore, a composite risk taking score based on all of therisk taking measures was computed (see below) and used to indexchildren's level of risk taking, with a similar approach applied to theparent data.

Did extent of child consistency in risk taking relate to parental accuracyin judging their children's level of risk taking?

The first step in examining the relationship between child consis-tency and parental accuracy was to calculate a consistency and accu-racy score, which involved creating a composite risk taking score forthe child and parent separately. To compute the composite score sev-eral steps were taken. First all scores were standardized across allseven risk taking tasks so that they could be directly compared onthe same metric. Hence, each standard score indicated a child's devi-ation from the mean level of risk taking on that task, with positivescores indicating higher than average risk taking and negative scoresindicating lower than average risk taking. Second, a constant wasadded to each standard score to eliminate negative values before fur-ther calculations. This composite risk taking score was then used tocompute a risk taking consistency and parent accuracy score.

To compute the risk taking consistency score, the coefficient of co-variance was then calculated for each child's standard scores acrossall tasks. This measure was chosen because it accounts for the meanwhen determining each individual score, which eliminates the possi-bility of scores being inflated by higher means. Each of the scores wasinitially a proportion (standard deviation/mean) and was convertedto a percentage before further analyses because of the desire to elim-inate decimal values. Higher coefficients of covariance represented

Table 2Intercorrelations for the seven child risk taking measuresa.

1 2 3 4 5 6 7

IBC – − .02 .50** .44** .28* .14 .40**PATH − .02 – .29* .08 .20 −.01 .10PLAY .50** .29* – .42** .26* .29* .36**RPS .44** .08 .42** – .30** .23* .46*BEAM .28* .20 .26* .30** – .32** .31**CH RM .14 −.01 .29* .23* .32** – .18SSSC .40** .10 .36** .46** .31** .18 –

*pb .05, **pb .01.Note: IBC= Injury Behavior Checklist, PATH= Path Selection Task, PLAY= PlaygroundTask, RPS = Risk Propensity Scale, BEAM = balance beam task, CH RM = contrivedhazards room task, SSSC = Sensation Seeking Scale for Children.

a The same pattern of significant correlations was obtained for the parent data.

1.00

0.00juri

es

193M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

less consistency (i.e., more variability) in how children behaved withrespect to risk taking. In other words, asmore variabilitywas detectedin scores across the seven tasks, the coefficient of covariance increasedand consistency in risk behavior decreased.

To examine parental accuracy the goal was to create a variable thatwould take both degree and direction of inaccuracy into account. Thefirst step was to create a difference score by subtracting the meanchild risk taking score from the mean parent score across the seventasks. With scores computed in this way, positive (higher) differencescores were found when parent inaccuracy reflected overestimatingtheir child's level of risk taking and negative (lower) difference scoreswere found when parent inaccuracy reflected underestimating theirchild's level of risk taking. A constant was then added to all scores be-fore further calculations to eliminate negative values. With this ad-justment, as scores decreased from higher to lower (approachingzero) values parents engaged in greater underestimation of theirchild's level of risk taking.

The first set of analyses was conducted to test for a relation be-tween child risk taking consistency score (M= 27.52, SD= 8.63;with M representing the mean level of consistency across the seventasks and SD indicating the degree of spread in these consistencyscores) and parental estimation of risk taking (M= 2.99, SD= 0.64).A correlational analysis was conducted and results revealed that therelationship between consistency and accuracy was significantly pos-itive, r(79) = .33, pb .01. Thus, as children became less consistent intheir risk taking behavior (i.e., higher consistency score reflectingmore variation in extent to risk taking across tasks), mothers adopteda cautious approach and were more likely to overestimate theirchild's likelihood of taking risks, whereas as children became moreconsistent in their risk taking, mothers were more likely to underes-timate their child's risk taking.

A multiple regression analysis was then conducted to examine thepossibility of a nonlinear relationship between accuracy and consis-tency (i.e., parental accuracy might be differentially impacted bylow versus high levels of child consistency in risk taking, ratherthan having a stable relation across all levels of consistency). Ageand sex were entered in the first step to control for their potential in-fluence, followed by consistency in Step 2, and then the quadraticconsistency term in Step 3, with extent of accuracy as the outcomeor dependent variable. Results indicated that adding the quadraticterm did not improve the fit of the model, ΔF change (1, 74) =1.77, p> .05. The best model controlled for age and sex and comprisedthe linear consistency term (Step 2: F (4, 74) = 3.41, pb .05), whichwas the only variable to significantly predict parental accuracy, β=.35, t(74)= 3.18, pb .01. Thus, extent of child consistency in risk tak-ing was the single best predictor of parental accuracy in judging theirchild's level of risk taking and as this score increased so too did paren-tal accuracy.

-1.00

-2.00

-3.00

-4.00

-2.00 -1.00 0.00 1.00Parental Accuracy

Sta

nd

ariz

ed P

red

icte

d In

Fig. 1. Curvilinear relationship between predicted injury values (Z scores) and parentalaccuracy. In this sample, 0% of parents were completely accurate (0 score), 53% under-estimated (negative score), and 47% overestimated (positive score) their child's risktaking.

Does parental accuracy relate to child injury rate?

With regard to relations between parental accuracy in estimatingtheir child's level of risk taking and rate of injury experienced by theirchild, it was hypothesized that parents who could more accurately pre-dict how their children would behave in injury-risk situations wouldgenerally have children who were injured less often, but that the linkbetween accuracy and injury-risk would be influenced by the directionof inaccuracy observed (i.e., whether parents tended to over- or under-estimate their child's level of risk taking). For parents who were lessaccurate, those who tended to underestimate their child's level of risktaking were expected to have childrenwho experiencedmore frequentinjuries, whereas children whose parents tended to overestimate risktaking were expected to experience a lower rate of injuries because itwas assumed that parents would act on this expectation for risk takingand take steps to prevent injury.

The overall parent accuracy score, as calculated above, and children'srate of injury as determined by children's completion of the injury diarysheets,were used to test these hypotheses. Injuries reported by the chil-dren were all minor in nature (i.e., none required medical treatment).Rates of injury were computed by dividing the number of injuriessustained during the recording period by the number of days the childrecorded in their diary before coming to the laboratory. The desirednumber of recording dayswas 28, but this varied slightly sometimes be-cause of illness or scheduling difficulties (M=31.8 recording days, SD=7.10). Support for the validity of child reports was provided by a posi-tive significant correlation between the rate of child-reported injurieson the daily diaries (M= 0.22 per day, SD= 0.20) and frequency ofparent-reported home-treated injuries during the 3 months precedingthe study (M= 1.92, SD= 2.02) as reported on the IHQ [r(74) = .64,pb .01]. This correlation was not expected to be perfect because of theamount of time that children spend independently at this age and thefact that parents are often unaware of minor injuries children sustain(Morrongiello, 1997; Peterson, Harbeck, et al., 1993).

To assess for the possibility that child injury rate would differdepending on whether the parent was overestimating risk taking orunderestimating risk taking (i.e., that child injury rate and parent ac-curacy scores would show a nonlinear relation) it was necessary totest for a quadratic relation between accuracy and child injury. A mul-tiple regression with accuracy and the quadratic accuracy term en-tered as predictors was carried out, with these variables centeredbefore they were entered into the analysis. Results revealed that thequadratic accuracy term accounted for 15% of unique variance, F(1,70) = 3.70, pb .05, and was a marginally significant predictor of inju-ry rates, β= −1.45, t(74) =−1.92, pb .06, after controlling for thelinear effect, which was nonsignificant. To examine the precise natureof this nonlinear relationship between parental accuracy and child in-jury rates, the coefficients in the final regression equation were exam-ined and revealed the presence of a downward concave shaped curveto the data, as depicted in Fig. 1. Note that zero on accuracy wouldmean perfectly accurate and as the curve progresses left parents areunderestimating risk taking, and as the curve goes to the right theyare overestimating risk taking. Consistent with expectations, parentswho overestimated their child's risk taking tended to have childrenwith fewer injuries. Contrary to expectations, however, parents whounderestimated their child's risk taking also had children who wereinjured less often, and those who were extremely accurate in

194 M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

predicting their child's risk taking behavior had children who experi-enced the highest rates of injury.

Discussion

In order to better capture the complexity of risk processes thatresult in children being injured, it is essential that researchers designstudies that examine interrelations between parent and child factors(Morrongiello & Schwebel, 2008). Recent research on younger childrenand their parents provides evidence that parent and child characteris-tics interact to influence injury risk and lead some children to experi-ence more frequent injuries than others (Morrongiello, Corbett, et al.,2008, Morrongiello, Klemencic, et al., 2008; Schwebel & Bounds, 2003;Schwebel et al., 2004). The current study examined the interplay be-tween child and parent variables for older school-age children andassessed if children's level of consistency in risk taking predicted paren-tal accuracy in judging how children would react in injury-risk situa-tions and if parental accuracy predicted children's rate of injuryduring the study. Although the cross-sectional aspect of the data limitsdetermination of what causal factors lead to what outcomes directly,the general pattern of results support the notion that there are impor-tant bidirectional processes involving parent and child characteristicsthat operate to influence school-age children's risk of injury.

Links between child consistency, parental accuracy, and child injury

Children's consistency in how they reacted in risk situations relat-ed to parental accuracy in predicting child risk taking behavior. Chil-dren who were more consistent in their responses to risk situationshad parents who underestimated their child's level of risk taking.One possible explanation for this pattern of results is that consistencyin child behavior, regardless of level of risk inherent in that behavior,leads parents to believe they can predict and thoroughly know theirchild's behavioral tendencies, which reduces their level of actualmonitoring of children's behaviors and results in them under-estimating their child's actual risk taking. On the other hand, as chil-dren became less consistent in their approach to risk, parents shiftedto overestimating their child's risk taking. These parents presumablyhave come to realize they need to be more vigilant in order to keeptheir children safe because of their children's less predictable behav-ior. This need for vigilance may lead parents to recognize how oftentheir child does something risky, resulting in them adopting a morecautious approach that includes overestimating their children's risktaking and risk of injury. A necessary next step to test these interpre-tations requires tracking relations between parent supervision andchildren's risk taking longitudinally to determine if knowledge oftheir children's risk taking leads to parents implementing changesin supervision and adjusting their judgments of children's likelihoodof engaging in risk behaviors.

A relation between parent ability to predict their child's risk takingand that child's rate of unintentional injury also emerged. However, as-pects of that relationship were different than predicted. As expected,when parents inaccurately overestimated their children's risk takingbehavior, their children were less likely to be injured. A likely explana-tion of thisfinding is that parentswhobelieve their children are likely torisk take adopt a cautious approach and act in a manner that is highlyprotective. Consistent with this interpretation, past research hasshown parental beliefs about their children's behavior impacts theirparenting practices (Davidov & Grusec, 2006a, 2006b) and negativefeedback loops often arise such that when parents realize how theirchild is behaving they take steps to bring their child's behavior backinto an acceptable range (Cook, 2003).

Contrary to expectations, however, parents who were very accuratein predicting how their children would behave tended to have childrenwho experienced more frequent injuries. Possibly, frequent injury pro-vides parents with greater opportunity to learn about their child's risk

taking tendencies, resulting in parents becoming more accurate inpredicting their child's behavior. This explanation is consistent withGrusec and Ungerer's (2003) argument that parental knowledge comesfrom a variety of sources, including past experience and interactionswith that child. Furthermore, this explanation is supported by the resultsfrom parents who underestimated injury risk and had children with lessfrequent injuries. Children who are injured less often provide parentswith fewer opportunities to learn about their risk taking decisions.Thus, these parents may not have enough information upon which tobase their predictions about their child's risk taking, resulting in greaterinaccuracy in prediction. Examining how parent accuracy changes overtime and is impacted by children's injury events, and vice versa, is a nec-essary next step to confirm the temporal patterning of these relations.

One implication of the findings from this research is that caregiversof school-age children (parents, babysitters, etc.) should be encouragedto err on the side of overestimating, rather than underestimating, thelevel of risk behavior the child might attempt. Past research hasshown that parents often underestimate risk taking and assume that ifchildren know rules the parent has taught that they will therefore com-ply with these and not require close monitoring (Morrongiello et al.,2001). However, both of these assumptions have been shown to be in-accurate and to lead to children experiencing more frequent injuries.Hence, there are important negative consequences to children whenparents erroneously underestimate children's likelihood of risk taking.Of course, the alternative extreme of overestimating children's risk tak-ing can also produce negative effects if caregivers mandate so manyprecautions as to preclude children from engaging in active play thatpositively contributes to development. Thus, while overestimatingchildren's risk taking is better than underestimating this, decisionsabout restrictions on children's behaviors need to be carefully consid-ered in order to balance maintaining children's safety with providingthem opportunities for active healthy living.

Limitations and directions for future research

Despite the contributions of this study to our understanding of in-jury risk for school-age children, there are several limitations thatmerit consideration in the design of future studies. First, the samplecomprised primarily Caucasian, well-educated, and middle class fam-ilies and the findings, therefore, may not generalize more broadly.Given that cultures differ in views related to child independence, par-ent–child boundaries, and disclosure of information, examining pa-rental monitoring and accuracy in different cultures may provideunique and important information on how parental accuracy impactschildren's injury risk. Similarly, extending the research to lower in-come and less educated families may reveal unique findings com-pared to those obtained in this study.

Second, the current study focused exclusively onmothers, and resultsmight have differed if fathers were the focus. Although research typicallyfinds no differences between mothers and fathers in supervision beliefsand practices (Morrongiello & Dawber, 1998; Morrongiello, Walpole, &McArthur, 2009), children believe their parents differ in risk taking(Morrongiello, Corbett, et al., 2008) and fathers can be less strict regard-ing safety practices and more accepting of risk taking (Hagan & Kuebli,2007). Hence, children may be more likely to disclose or engage in riskbehaviors with fathers compared to mothers, leading fathers to have amore accurate view of children's risk taking, and this could impactchildren's injury rates differently. Including both mothers and fathersin future research on this topic would be an important next step.

Finally, extending this research tomeasure children's risk taking andinjuries and parent injury-prevention practices over time is importantso that direct examination of the causal nature of relations can bedetermined. The pattern of findings in this study is consistent with abidirectional perspective (i.e., the notion that parents not only influencetheir children's behavior but children also shape and elicit differentialparenting behaviors based on their own behaviors, needs, and

195M. Wells et al. / Journal of Applied Developmental Psychology 33 (2012) 189–196

characteristics) for which there is increasing support with regard tomany aspects of children's development (Clark, Kochanska, & Ready,2000; Kuczynski, 2003; Lengua & Kovacs, 2005; Lollis & Kuczynski,1997). Nonetheless, in future research it would be useful to test for bi-directionality directly by using a longitudinal design and directlyassessing for causal relations between child risk taking, parental super-vision, and child injury rates.

Conclusion

The present study reveals relations between children's consisten-cy in risk taking, parent accuracy in predicting their children's risktaking, and children's rate of injury. For children at these older agesparents are unlikely to directly supervise (Morrongiello et al., 2010)and child self-disclosure gains in importance as a way for parents tostay informed of children's behaviors. Hence, as children age, the par-ent–child relationship context may play an increasingly importantrole with regard to child injury prevention. Conducting longitudinalstudies to examine how parent and child characteristics are inter-related over time is a necessary next step to advance our understand-ing of school-age children's risk of injury.

Acknowledgment

This research was supported by grants to the second author fromthe Canadian Institutes of Health Research. The authors thank thechildren and their parents for participating, Professor Ian Newby-Clark and Mike Corbett for assistance with data analysis, and Profes-sor Leon Kuczynski for providing feedback on this manuscript andguidance during the design of the study. Reprint requests should bedirected to the second author: bmorrong@uoguelph.ca.

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