How mothers parent their children with behavior disorders: Implications for unintentional injury risk David C. Schwebel * , J. Bart Hodgens, Samantha Sterling Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham AL 35294, USA Received 12 July 2005; accepted 30 November 2005 Available online 3 May 2006 Abstract Introduction: This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury. Method: Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a ‘‘hazard room’’ environment that housed several items that appeared dangerous but actually were altered to be safe. Results: Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children’s externalizing behavior patterns, children’s injury history, and mother’s parenting styles. Maternal ignoring of children’s dangerous behavior in the hazard room was the strongest correlate to children’s injury history. Conclusions: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury. D 2006 National Safety Council and Elsevier Ltd. All rights reserved. Keywords: Injury; Supervision; Behavior disorders; Attention Deficit Hyperactivity Disorder (ADHD); Oppositional Defiant Disorder (ODD) 1. Introduction Unintentional injury is the leading cause of pediatric mortality, killing more children than the next 10 leading causes of death combined (National Safety Council, 2004). Clinicians and researchers have long hypothesized that children with behavior disorders are at elevated risk for unintentional injury compared to peers without behavior disorders (Davidson, 1987; Dunbar, Wolfe, & Rioch, 1939; Krall, 1953), and recent work confirms early hypotheses empirically using large, representative samples and sophisticated quantitative analyses (Brehaut, Miller, Raina, & McGrail, 2002; Rowe, Maughan, & Goodman, 2004; Schwebel, Speltz, Jones, & Bardina, 2002). Several critical issues concerning the link between behavior disorders and injury risk remain unresolved. Among the unresolved issues, and the focus of this study, is identification of particular mechanisms that might lead children with behavior disorders to have increased risk for injury. DSM-IV lists injury risk as a trait associated with Attention-Deficit/Hyperactivity Disorder (ADHD; Ameri- can Psychiatric Association, 1994), a link supported by some empirical work (Brehaut et al., 2002; DiScala, Lescohier, Barthel, & Li, 1998; Swensen et al., 2004). In a review of hospital charts, DiScala and colleagues (DiScala et al., 1998) found children with ADHD had increased risk of pedestrian and bicycling injuries, as well as more severe overall injuries, when compared to their peers. In a population-based study of children in British Columbia, Brehaut and colleagues (Brehaut et al., 2002) found children treated with methylphenidate (and therefore likely to have ADHD symptomatology or diagnosis) had increased risk for injury in their history after controlling for known demo- graphic mediators. Similar results have been reported with studies focused specifically on risk for burn injuries among children with ADHD (Mangus, Bergman, Zieger, & Cole- man, 2004; Thomas, Ayoub, Rosenberg, Robert, & Meyer, 0022-4375/$ - see front matter D 2006 National Safety Council and Elsevier Ltd. All rights reserved. doi:10.1016/j.jsr.2005.11.004 * Corresponding author. Tel.: +1 205 934 8745; fax: +1 205 975 6110. E-mail address: schwebel@uab.edu (D.C. Schwebel). Journal of Safety Research 37 (2006) 167 – 173 www.elsevier.com/locate/jsr www.nsc.org