1. Disclosure, family communication context, and child outcomes after infertility treatment Martha A. Rueter, PhD a, Jennifer Connor, PhD b, Lauri Pasch c, Kayla Anderson, MA a, Ascan F. Koerner, PhD d, Mark Damario e a Family Social Science, University of Minnesota, b Community Psychology, Counseling, and Family Therapy, St. Cloud State University, c University of California, San Francisco, d Communication Studies, University of Minnesota, e Obstetrics, Gynecology and Women’s Health, University of Minnesota Disclosure, family communication context, and child outcomes after infertility treatment Martha A. Rueter, PhD a, Jennifer Connor, PhD b, Lauri Pasch c, Kayla Anderson, MA a, Ascan F. Koerner, PhD d, Mark Damario e a Family Social Science, University of Minnesota, b Community Psychology, Counseling, and Family Therapy, St. Cloud State University, c University of California, San Francisco, d Communication Studies, University of Minnesota, e Obstetrics, Gynecology and Women’s Health, University of Minnesota Background Method Results Disclosure of assisted reproductive technology (ART) conception to children may involve parents discussing personal, sensitive topics with their children like parents’ infertility, sexual reproduction, and the child’s conception occurring in a laboratory. Parents who conceived using donor gametes have the added challenge of telling children about their genetic origins (Scheib et al., 2003). Understandably, parents often report uncertainty about raising these topics with children (Blake et al., 2010; Daniels et al., 2011; Gross et al., 2004; Rauscher & Fine, 2012). Most ART research does not consider family communication context when examining disclosure outcomes. Yet, theory (Petronio, 2002) and empirical findings (Caughlin & Afifi, 2004; Caughlin & Petronio, 2004; Merrill & Afifi, 2012) suggest that a parent’s approach to discussing personal information could moderate the effect of disclosure on parent and child outcomes. E.g., some families allow an open flow of personal information among family members. Others strictly control access to private information, sharing infrequently in limited amounts. Available research suggests that in this kind of restricted communication context disclosure may negatively affect parent-child satisfaction and child adjustment. (Caughlin, 2003; Caughlin and Afifi, 2004; Petronio, 2002). Research also shows that relationship satisfaction is a proximal outcome of disclosure (Collins and Miller, 1994) and parent-child relationship satisfaction predicts child adjustment (Overbeek et al., 2007). Therefore, we hypothesized that, among families with a restricted communication context, disclosure of ART conception relates negatively to parent-child relationship satisfaction and through this association, has an indirect, negative effect on child adjustment. Disclosure of assisted reproductive technology (ART) conception to children may involve parents discussing personal, sensitive topics with their children like parents’ infertility, sexual reproduction, and the child’s conception occurring in a laboratory. Parents who conceived using donor gametes have the added challenge of telling children about their genetic origins (Scheib et al., 2003). Understandably, parents often report uncertainty about raising these topics with children (Blake et al., 2010; Daniels et al., 2011; Gross et al., 2004; Rauscher & Fine, 2012). Most ART research does not consider family communication context when examining disclosure outcomes. Yet, theory (Petronio, 2002) and empirical findings (Caughlin & Afifi, 2004; Caughlin & Petronio, 2004; Merrill & Afifi, 2012) suggest that a parent’s approach to discussing personal information could moderate the effect of disclosure on parent and child outcomes. E.g., some families allow an open flow of personal information among family members. Others strictly control access to private information, sharing infrequently in limited amounts. Available research suggests that in this kind of restricted communication context disclosure may negatively affect parent-child satisfaction and child adjustment. (Caughlin, 2003; Caughlin and Afifi, 2004; Petronio, 2002). Research also shows that relationship satisfaction is a proximal outcome of disclosure (Collins and Miller, 1994) and parent-child relationship satisfaction predicts child adjustment (Overbeek et al., 2007). Therefore, we hypothesized that, among families with a restricted communication context, disclosure of ART conception relates negatively to parent-child relationship satisfaction and through this association, has an indirect, negative effect on child adjustment. Participants Families (n = 216) were recruited from a university reproductive endocrinology clinic in the Midwest. Eligible families had at least one parent with at least one child born between 1998 – 2004, who was conceived via IVF, ICSI, or IUI. Parents were mostly heterosexual (96.8%) and mostly White (95.8%), with median annual household incomes of $100,000 – $150,000. Participating families included n = 312 children (M age = 8.48 years, SD = 1.43). Measures Disclosure of conception method. Parents reported disclosure of conception method by responding “yes” or “no” to the question, “Does your child know that s/he was conceived by ART?” Communication context. Communication context was defined as a parent’s tendency to avoid talking about topics s/he disapproves of or sees as inappropriate for discussion. Parents reported how much they agreed with two items (1=disagree completely, 7=agree completely): (1) If I don't approve of it, I don't want to know about it and (2) I often say things like “There are some things that just shouldn't be talked about”. Parent-child relationship satisfaction. Measured using an adapted version of the Huston Marital Opinion Questionnaire (Caughlin & Afifi, 2004; Huston & Vangelisti, 1991) which consists of 11 semantic differential-type items beginning with “I would describe my relationship as...” and ending with two opposing options (e.g., rewarding vs. disappointing) scaled from 1 to 7. Child behavioral adjustment. Parents reported children’s behavioral adjustment using the Child Behavior Checklist (Achenbach & Rescorla, 2001). The child behavioral adjustment variable was created by summing two CBCL subscales (rule-breaking behavior, aggressive behavior; α =.75). Parent emotional state. Method bias from using parent self-report for all variables was addressed by controlling for parents’ emotional state. Feelings of depression and anxiety were reported using the Internalizing subscale of the Adult Self Report (Achenbach & Rescorla, 2003). Child demographics. Parents reported the child’s age, sex (female = 1, male = 2), and donor status. Donor status was coded as 1 for children conceived using donor egg, donor sperm, or both donor egg and donor sperm (n = 41). Nondonor children (donor status = 0) were conceived using the intended parents’ gametes. Participants Families (n = 216) were recruited from a university reproductive endocrinology clinic in the Midwest. Eligible families had at least one parent with at least one child born between 1998 – 2004, who was conceived via IVF, ICSI, or IUI. Parents were mostly heterosexual (96.8%) and mostly White (95.8%), with median annual household incomes of $100,000 – $150,000. Participating families included n = 312 children (M age = 8.48 years, SD = 1.43). Measures Disclosure of conception method. Parents reported disclosure of conception method by responding “yes” or “no” to the question, “Does your child know that s/he was conceived by ART?” Communication context. Communication context was defined as a parent’s tendency to avoid talking about topics s/he disapproves of or sees as inappropriate for discussion. Parents reported how much they agreed with two items (1=disagree completely, 7=agree completely): (1) If I don't approve of it, I don't want to know about it and (2) I often say things like “There are some things that just shouldn't be talked about”. Parent-child relationship satisfaction. Measured using an adapted version of the Huston Marital Opinion Questionnaire (Caughlin & Afifi, 2004; Huston & Vangelisti, 1991) which consists of 11 semantic differential-type items beginning with “I would describe my relationship as...” and ending with two opposing options (e.g., rewarding vs. disappointing) scaled from 1 to 7. Child behavioral adjustment. Parents reported children’s behavioral adjustment using the Child Behavior Checklist (Achenbach & Rescorla, 2001). The child behavioral adjustment variable was created by summing two CBCL subscales (rule-breaking behavior, aggressive behavior; α =.75). Parent emotional state. Method bias from using parent self-report for all variables was addressed by controlling for parents’ emotional state. Feelings of depression and anxiety were reported using the Internalizing subscale of the Adult Self Report (Achenbach & Rescorla, 2003). Child demographics. Parents reported the child’s age, sex (female = 1, male = 2), and donor status. Donor status was coded as 1 for children conceived using donor egg, donor sperm, or both donor egg and donor sperm (n = 41). Nondonor children (donor status = 0) were conceived using the intended parents’ gametes. Parents reported high parent-child satisfaction (M = 6.42, SD =.65) and few child behavior (M = 3.03, SD = 4.33). Also, parent-child satisfaction and behavior adjustment were correlated (r = -.53, t = 7.31, p <.001), and disclosure was unrelated to parent-child satisfaction and child behavioral adjustment in the full sample (Table, 1). We estimated the hypothesized associations using structural equation modeling. Model results supported the hypothesized moderator effect (b = -.18, 95% CI = -.27 - -.09, b = -.24, t = -3.37, p =.001). As shown in Figure 1, in families with open communication, disclosure positively related to parent-child relationship satisfaction and negatively related to parent-child satisfaction in families with restricted communication. The hypothesized indirect effect was also supported (b =.59, 95% CI =.25 -.93, b =.12, t = 2.85, p =.004). This indirect effect means that in families with restricted communication, disclosure negatively related to child adjustment, through its association with parent-child satisfaction. Conclusion Using our full sample, this study’s findings replicate research showing that disclosure of ART conception has little effect on family relationships or child adjustment (Golombok et al., 2011; Lycett et al., 2004; Nachtigall et al., 1997). Our results depart from earlier research by revealing subgroups of families whose experience differs from the majority. In doing so, our findings demonstrate the importance of considering family context when determining outcomes of disclosure. Outcomes tend to be positive in families with an open communication context. Outcome may not be positive in families with a restricted communication context. We interpret these findings not to mean that disclosure should be encouraged in some families, those with open contexts, and avoided in families that prefer a restricted context. Rather, we argue that parents who have strong reservations about discussing private information may benefit from additional support because when disclosure of ART conception occurs in a restricted communication context, topic avoidance may bring to light an unwillingness to discuss the child’s conception, leading to accumulating frustration that erodes family relationships (Petronio, 2002). Using our full sample, this study’s findings replicate research showing that disclosure of ART conception has little effect on family relationships or child adjustment (Golombok et al., 2011; Lycett et al., 2004; Nachtigall et al., 1997). Our results depart from earlier research by revealing subgroups of families whose experience differs from the majority. In doing so, our findings demonstrate the importance of considering family context when determining outcomes of disclosure. Outcomes tend to be positive in families with an open communication context. Outcome may not be positive in families with a restricted communication context. We interpret these findings not to mean that disclosure should be encouraged in some families, those with open contexts, and avoided in families that prefer a restricted context. Rather, we argue that parents who have strong reservations about discussing private information may benefit from additional support because when disclosure of ART conception occurs in a restricted communication context, topic avoidance may bring to light an unwillingness to discuss the child’s conception, leading to accumulating frustration that erodes family relationships (Petronio, 2002). Research Question & Hypotheses Research Question & Hypotheses Research Question Does family communication context moderate the association between disclosure of ART conception and parent-child relationship satisfaction, and does this interaction indirectly relate to child adjustment? Hypotheses H1: Communication context moderates the association between disclosure and parent-child satisfaction such that, in a restricted communication context, disclosure of ART conception negatively relates to parent-child satisfaction. H2: In a restricted communication context, disclosure of ART conception indirectly and negatively relates to child adjustment, through is association with parent-child satisfaction. Research Question Does family communication context moderate the association between disclosure of ART conception and parent-child relationship satisfaction, and does this interaction indirectly relate to child adjustment? Hypotheses H1: Communication context moderates the association between disclosure and parent-child satisfaction such that, in a restricted communication context, disclosure of ART conception negatively relates to parent-child satisfaction. H2: In a restricted communication context, disclosure of ART conception indirectly and negatively relates to child adjustment, through is association with parent-child satisfaction. Figure 1. Association between disclosure and parent-child satisfaction in a restricted compared to open communication context Figure 1. Association between disclosure and parent-child satisfaction in a restricted compared to open communication context Table 1. Correlations among study variables Measure12345678 1. Communication Context __ 2. Child’s age-.07 __ 3. Child’s sex-.03.08 __ 4. Child’s donor status.02.03.01 __ 5. Parent’s emotional state-.02-.01-.04-.00 __ 6. Parent-child satisfaction-.18.01-.01 -.32 __ 7. Disclosure status-.08.21.03.18.03-.05 __ 8. Child behavioral adjustment-.02.04.08.34-.53.07 __ r =.18, p =.04 r = -.33, p =.02