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Aging & Mental Health

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The Parent Adult-Child Relationship Questionnaire (PACQ): The

assessment of the relationship of adult children to their parents
C. Peisah; H. Brodaty; G. Luscombe; J. Kruk; K. Anstey

Online publication date: 09 June 2010

To cite this Article Peisah, C. , Brodaty, H. , Luscombe, G. , Kruk, J. and Anstey, K.(1999) 'The Parent Adult-Child
Relationship Questionnaire (PACQ): The assessment of the relationship of adult children to their parents', Aging &
Mental Health, 3: 1, 28 — 38
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 Aging & mental Health 1999; 3(I): 28± 38

ORIG INA L ART ICLE

The Parent Adult± C hild Relationship Questionnaire (PAC Q):

the assessm ent of the relationship of adult children to their parents

1 1,2 1,2 3 4
C. PEISAH, H. BRODATY, G. LUSCOM BE, J. K R UK & K. ANSTEY
1 2
Academic Department of Psychoger iatrics, Prince H enry Hospital, Sydney, School of Psychiatr y, University of N ew
3 4
South Wales, Formerly Neuropsychiatric Institute, Prince Henry Hospital, Sydney, Formerly Academic D epartm ent
of Psychoger iatrics, Prince H enr y Hospital, Sydney, Australia

Abstract
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We review current understanding of the parent adult± child relationship, describe the development of an instrument to
measure this relationship and propose key themes which de® ne the relationship. A 97-item self-report questionnaire was
administered to two convenience samples (N = 302, N = 100) comprising primary care patients and comm unity residents.
The m ost interpretable solutions to Principal Com ponents Analyses of a reduced pool of items were, for the mother, an
orthogonal two-factor solution (regard and responsibility , comprising 13 items) and, for the father, a three-factor solution
(regard, responsibility and control , comprising 13 items). The Parent Adult± Child Questionnaire (PACQ) was found to be valid
and reliable as a self-report m easure of the ® lial relationship. We suggest that PAC Q has both clinical and research utility.

Introduction choice, close ness, power and statu s (M an cin i &

The role of early child± parent relationships in the
genesis of adult psychopathology has been extensively
investigated, yet the im pact of parent adult± child
relationships on adult m ental health has been little
explored. Relationships with parents are often a focus
of psychiatric treatment, whether in the context of
psychotherapy, in the treatment of depression or anxiety,
or in suppor ting the fam ily of an elderly patient with
psychiatric problems. D espite the frequency with which
the relationship is ad dressed in ever yday clin ical
practice, and the acknowledgement that interpersonal
relationships have an im pact on mental health (Hend-
erson et al., 1981), little research has focused speci® -
cally on the parent adult± child relationship. D e® nable
and measurable characteristics of the parent adult±
child relationship have yet to be determ ined and,
im portantly, no instrum ent exists to measure the parent
adult± child relationship per se. This paper will review
brie¯ y the parent adult± relationship in adulthood and
relevant m easures and describe the development of a
new instrument quantifying the relationship.
T he evolution over m any years of the child± parent
relationship, together w ith the natural diversity of
hum an relationships, have m ade it difficult to de® ne
m odels or a typology of fam ily function in adult-
hood. K ey constructs appear to be obligation and
Blieszn er, 1989) , bu t these var y g re atly am o n g
fam ilies. D e Vaus (1994) identi® ed four broad types
of parent adult± child relationships: `attached’ , char-
acterized by m utual interest, support and autonomy;
`remote’ , characterized by m utual disinterest; `parent-
centred’ , w he re parents, pe rceive d as excessively
demanding, expect attentiveness and conform ity from
their adult children who struggle to individuate; and
`child-centred’ , where the children’s lives provide the
focus and the parents rem ain critical, interfering and
unable to give up the parenting role.
T hese variations in parent adult± child relation-
ships can be attributed to a variety of factors. Firstly,
the parent’s resources (i.e. physical, emotional and
® nancial) determ ine the am ount of support expected
or needed and m ay som etimes in¯ uence the child’s
satisfaction with the relationship. Parents w ho receive
and expect high levels of ® lial support are m ore likely
to be single, of low incom e and in poor health with
low m orale (Seelbach & Saur, 1977). Well-educated,
resou rcefu l, healthy elderly requ ire on ly rou tine
interactions with their children, do not expect direct
assistance except in the m ost extrem e circum stances
and are m ore concerned with remaining close without
interfering (Blieszner & M ancini, 1987). M oreover,
active and self-su fficient parents are m ore likely to
receive positive appraisals from their adult children

Correspondence to: Professor Henry Brodaty, Academic Department of Psychogeriatrics, Prince Henry Hospital, Little Bay,
Sydney 2036, Australia. Tel: 61 2 9382 5007. Fax: 61 2 9382 5016. E-mail: research.adpg@ unsw.edu.au
Received for publication 28th November 1997. Accepted 13th August 1998.
1360-786 3/99/010028-1 1 $9.00 ½ Carfax Publishing Limited
 The parent adult± child relationship questionnaire (PACQ)
(Robinson & T hurner, 1979), whilst poor health in a
m other is associated w ith lower rapport with her
daughter (Baruch & Barnett, 1983).
Secondly, the previous child± parent relationship or
the perception of this m ay determ ine the child’ s
preparedness to assu m e the caregiver role and any
asso ciated burden. Adult children w ho recalled early
parental rejection tend to be less concerned about
staying in close touch w ith their parents, m onitoring
their wellbeing or providing support (W hitbeck et al.,
1994); although som e children rem ain com m itted to
their parents despite a lack of affection (H orowitz &
Schindelm an, 1983) or n egative feelin gs such as
im patience, frustration and irritation (Cicerelli, 1983).
Such commitment m ay be driven by obligation, which
su bsu m es factors such as gu ilt, culturally d riven
expectations and m orality, as well as gre ed and
subjugation. Conversely, feelings of closeness, love
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an d com p atibility increase attach m ent (visitin g ,
telephoning) and helping (e.g. personal care) behavi-
ours (C icerelli, 1983). M any adult children welcom e
the opportunity to reciprocate a nurturant childhood
and, accordingly, affe ction, gratitude and `equity’ drive
the ® lial relationship (Horl, 1989). Im portantly, close-
ness does not always equate with a positive relation-
ship (O ’ C on nor, 1990). W hile care given in the
context of positive affe ct is perceived as less stressful
(H orowitz & Schindelman, 1983), the `closer’ the
em otional bond between child and parent the m ore
stressful the caregiver role (Cantor, 1983).
A third determ inant of the nature of the relation-
ship is the personality and gender of the child. W hen
an elderly parent becomes sick and frail, the child on
w ho m responsibility for care fa lls is u su ally the
daughter (Brody, 1981). Wom en caregivers (Brodaty
& H adzi-Pavlovic, 1990; F itting et al., 1986; Hin-
r ichsen , 1991; M or ris et al., 1991), par ticu larly
daughters (Scho® eld et al., 1995; Tudor et al., 1995),
have higher rates of psychological m orbidity and
burden than their m ale counterpar ts, possibly because
of an emotionally involved, hands-on provider approach
rather than an instrumental and managerial approach
to caregiving. Gender differences in non-caregiving
parent adult± child relationships are mainly speculative,
anecdotal rather than empirical and largely focused on
exploring speci® c aspects of m other± daughter relation-
ships (Chodorow, 1978; Freud, 1961; Friday, 1981;
Phillips, 1991; Rich, 1977).
In sum m ary, the parent adult± child relationship is
com plex and m ay depend on past aspects of the
relationship, the parent’s wellbeing, gender of the
parent and the child, as well as other factors. Comm it-
m ent to care and `closeness’ m ay be independent of
positive or negative feelings about the parent. K ey,
quanti® able constructs rem ain largely theoretical and
untested em pirically, perhaps in part because there is
no instru m ent which m easures the parent adult±
child relationship. Currently available instrum ents can
be broadly classi® ed into ® ve types which m easure:
29
(1) the early child± parent relationship such as the
Children’s Reports of Parental Behaviour Inven-
tor y (Schaefer, 1965); the Parental B ond ing
Instrument (Parker, 1983); the Parent Child Rela-
tions Q uestionnaire (Siegelman & Rod, 1979);
and the O wn M em ories of Childhood Rearing
Experiences (Perris et al., 1980).
(2) the relationship in adolescence or young adult-
hood, w hen issues of individuation and separa-
tion predominate over issues of ® lial reciprocity
and responsibility. E xam ples include the Parental
Attachm ent Q u estion naire (K enny, 1987),
designed for ® rst-year college students, which
assesse s dim ensions which are likely to be life
cycle speci® c, i.e. Parents as a Source of Support,
Parents as Facilitators of Ind epen dence, and
Affective Q uality of the Parental Relationship,
and does not distinguish between m aternal and
paternal attachm ent; the C ontinued Attachm ent
Scale-Parent version (Berm an et al., 1994), which
m easures cognitive and emotional responses to
the perceived separation from parents in college
students; and the Inventory of Parent and Peer
A ttachm en t (A rm sden & G reenb erg , 1987),
which was developed to assess Trust, Availab ility
and Security in parental and peer relationships
during early to m iddle adolescence.
(3) non-speci® c adult or fam ily relationships, assu m -
ing a com m o nality in all ad ult attachm en ts,
regardless of the attachm ent ® gure. For exam ple,
the Attachm ent Style Inventory (Sperling et al.,
1992) asks subjects to identify their relationships
with parents, friends and intimates from a number
of descriptors derived from attachment and object
relations theory, depicting D ependent, Avoidant,
H ostile and Resistant/Am bivalen t attachm ent
styles. The Adult Attachm ent Scale (West et al.,
1987) is also a non-spe ci® c scale which m easures
dim ensional aspects of attachm ent such as Feared
Loss and Secure Base, and adult styles of attach-
ment such as Com pulsive Caregiving, Com pulsive
Careseeking, C ompulsive Self-reliance and Angry
W ithdrawal. Sim ilarly, Hazan and Shaver (1987)
developed an instrument used to classify rom antic
love as either S ecu re, Avo id an t or A n xiou s/
Am bivalent.
(4) caregiving asp ects of relationships w here parents
are sick or impaired. M any instrum ents m easure
fam ily burden in severe m ental illness (Schene et
al., 1994) and several focus on the im paired
elderly (usually w ith dementia) (C airl et al., 1985;
Vitaliano et al., 1976; W hittick, 1989; Zarit et al.,
1980), though none is speci® c for child caregivers.
Moreover, they m easure aspects such as economic
costs, social networks, grief reactions, attitudes
and em otional and physical burden rather than
the relationship itself.
(5) interactions between non-speci® c fam ily m embers
such as the Cam berwell Fam ily Interview (Leff
 30 C. Peisah et al.
& Vaughn, 1985; Vaughn & Leff, 1976), w hich
derives Expressed E m otion scores with ratings of
Criticism , H ostility, Warm th, Positive com ments
and O ver-involvem ent; the M cM aster Fam ily
Assessm ent D evice (E pstein et al., 1983), w hich
m easu re s P ro blem solvin g , C om m u n ication ,
Roles, Affective responsiveness, Affe ctive involve-
m ent, Behaviour control and general functioning;
and the Fam ily Environm ent Scale (M oos &
M oos, 1981), w hich m easures C ohesion, Expres-
siveness and Con¯ ict.
In this study we aimed to identify constructs central
to the ® lial relationship and to develop an instrum ent
to m easure the parent adult± child relationship w hich
was sim ple to adm inister and score.
M ethods
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Derivation of items
Item s depicting the gam ut of constructs asso ciated
with the parent adult± child relationships including
® lial obligation, reciprocity, gratitude, anger, financial
gain and concern for the physical and psychological
wellbeing of the parent were generated from the
published literature, pilot interviews with both clinical
and non-clinical subjects, and surveys of psychiatrists
who were asked to generate or m odify items. C linical
subjects were those w ho presented with non-sp eci® c
difficulties in their relationship w ith their parents,
and children of depressed parents. Psychiatrists were
senior general psychiatrists, psychotherapists, child
and adolescent psych iatrists and psychogeriatricians.
Derivation of the samples and testing
An earlier and lengthier version of the ® nal question-
naire was administered to two sam ples. We used two
samples to strengthen our ® ndings and to counter any
response bias associated with the ordering of items in
such a lengthy questionnaire (the item order being rand-
om ized for Sam ple 2). Sam ple 1 com prised 302
subjects: 200 prim ary care patients recruited from ten
general practices and a convenience sample of 102
from the community. Sample 2 comprised a community
convenience sample of 100 subjects. The prim ary care
patients were consecutive routine attenders of general
practices across the Sydney metropolitan area, who
were aged 18 or over, with at least one living parent and
a reasonable command of English. Both community
convenience sam ples were volunteers recruited by the
® rst author and colleagues. Subjects were asked to
provid e d em ograp hic in for m ation an d rate their
responses to 97 items on a four-point Likert-type scale
ranging from 0 (`very true’ ) to 3 (`not true at all’ ). Two
identical versions of the 97-item scale were administered
to each subject, one which referred to `mother’ and the
other to `father’ . Consenting subjects completed the
questionnaires alone and anonymously and placed them
in collection boxes.
Statistical analyses
All analyses were carried out using SPSS software
(Norusis & SPSS Inc, 1993). The ® nal questionnaire
was derived by subjecting a reduced pool of items to
fa ctor an alysis u sing the Principal C om p on en ts
m ethod of extraction. Because of possible gender
differences, solutions were also generated separately
for sons and daughters. Spearm an’s correlation coef-
® cients (r s) were used to exam ine the asso ciation
between age and factor scores because age was not
norm ally distributed. Two aspects of reliability were
assessed: internal consistency using Cronbach’s alpha
and test-retest reliability using Spearm an’s correla-
tion coefficient (r s) for dim ensional variables which
were not norm ally distributed. Spearm an’ s correla-
tion coefficient was also used to com pare instrum ent
and interview scores to determine concurrent validity.
N in ety-® ve p er cen t co n ® d en c e in ter vals w ere
calculated for all correlations. N orm ality of variable
distribution was assesse d using skewness values (S)
(Tabachnick & Fidell, 1989). All tests were two-tailed.
W ithin each sam ple, ® gures for m other and father
differed if subjects had only one living parent.
Reliability and validity studies
Statistical analyses generated a re® ned instrum ent
called the Parent Adult± Child Questionnaire or PACQ
(Appendix 1), w ith fewer items (see below) and from
which factors of regard, responsibility and control were
differentially derived from m others and fathers (see
below). Test-retest reliability was tested using a third
sam ple (Sample 3) of 26 non-clinical volunteers from
the com m unity w ith the sam e inclusion criteria used
for Sam ples 1 and 2. The re® ned instrum ent was
adm inistered to Sam ple 3 and then readm inistered to
the sam e sam ple three to six weeks later. We assessed
the validity of the instrum ent, as a m easure of the
relationship perceived by the child, by interview ing a
fourth sam ple (Sam ple 4) of another 26 non-clinical
volunteers from the com m unity using the sam e inclu-
sion criteria as previously. The interview com prised
six open questions (e.g. `Tell m e how you feel about
your m other’ ) designed to elicit qualitative data, and
closed questions to assess speci® cally the factors of
regard (e.g. `H ow close are you to your m other?’ ) and
responsibility (e.g. `How reliant on you is your mother?’ )
for m other, and the three dim ensio ns of regard,
responsibility and control for father. Each of the closed
questions, of which there were six for regard, eight for
responsibility and four for control, was rated on a four-
point ordinal scale. A global rating of each of the
three factors was also rated on a four-po int ordinal
scale. T he interview score for each factor was thus a
com posite of the sum med ordinal ratings plus the
global rating; the m axim al interview factor scores
thus being different from the m axim al PACQ factor
scores. After the interview, the subjects were asked to
 The parent adult± child relationship questionnaire (PACQ)
com plete the PACQ and resultant scores were inter-
correlated with the interview scores. All the interview s
were conducted, au diotaped and rated by C P, a
psychiatrist and fam ily therapist (`A’ ). Audiotaped
interviews were rated by a second psych iatrist or a
psychologist (HB or G L) (`B’ ).
Results
D emog raphics
Sam ple 1 com prised 219 fem ales (73% ), 82 m ales
(27% ) and one subject whose gender was not speci-
® ed. T he m ean subject age was 32 years (SD = 9.4,
range 18± 59 years) and the m ean parent age was 64
(SD = 12.8, range 39± 93 years). Subjects were profes-
sional or m anagerial workers (37% ), trades, clerical,
sales or process workers (30%), students (13%), home
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w orkers (4% ), pension ers (1% ) o r em ploye d in
another occupation (11%). O ccupational data were
m issing in 4% of cases. Eighty-four per cent were
from Australian or other English-speaking back-
grounds, while 3% were from European, 4% from
Asian and 7% from other backgrounds (e.g. African,
M iddle Eastern, South Am erican). Country of birth
was not speci® ed in 2% of cases.
Sample 2 com prised 67 fem ales and 33 m ales,
w ith a m ean age of 31 years (SD = 10.5, range 18± 60
years) and a m ean parent age of 59 years (SD = 10.2,
range 40± 83 years). Fifty-o ne percent were profes-
sional or m anagerial workers, while 18% were trades,
clerical, sales or process workers, 4% did home duties,
18% were students, 6% were pensioners and 1%
worked in other m iscellaneous occupations. O ccu-
pational data were m issing in 2% of cases. Seventy-
® ve per cent were from Australian or other English-
speaking backgrounds, while 7% were from European,
4% from Asian and 12% from other backgrounds
(e.g. African , M idd le E astern , So uth A m erican).
C ountry of birth was not speci® ed in 2% of cases.
Sample 3 (reliability testing) was sim ilar dem o-
graphically to that of Sam ples 1 and 2, i.e. 17 fem ales
(65% ), six m ales (23% ) and three (12% ) gender
unknown; m ean subject age 33 years (SD = 8.8, range
19± 53 years). Parent age was not obtained for this
sam ple. Sam ple 4 (validity testing) was also similar
dem ographically, i.e. 20 fem ales (77% ) and six m ales
(23% ), with a m ean subject age of 33 (SD = 8.7,
range 19± 60 years) and a m ean parent age of 63
(SD = 8.4, range 49± 87 years).
D erivation of the re® ned questionnaire
T he initial, exploratory factor analysis was perform ed
using data collected from Sam ple 1 (N = 302). Items
were deleted which were found to be am biguous (e.g.
`I no longer feel that I have to be the right person for
my m other/father’ ); to be contam inated by realities
31
of parental divorce and separation (`I know that my
m other/father will be taken care of by my other parent
if I don’ t’ ); or to re¯ ect a general personality response
set (`I hate it when my m other/father tells people how
strong I am and how well I cope because I feel that I
don’ t’ ). T he residual item s were further reduced by
rem oving items which were highly intercorrelated (>
0.7) with the rest of the item pool or w hich did not
provide a sufficiently wide range of responses (item s
which had over 90% of responses on either the `agree’
or `disagree’ end of the scale). The rem aining item s
(74 for the m other solution and 32 for the father
solution) were subjected to a factor analysis and both
or thogon al and obliquely rotated solu tion s were
exam ined, as well as unforced and forced rotations of
two, three, four, ® ve and six factors, using paired and
unpaired items. The solutions chosen (i.e. two-factor
for m other and three-factor for father) were those
w hich provided the m ost co n cep tually co heren t
factors while maxim izing percentage of the varian ce
explained and internal consistency. A factor loading
threshold of 0.6 determ ined the ® nal items. Scree
plots con® rm ed the num ber of factors chosen were
app ropriate, with a substantial drop in eigenvalues
between the second and third factors for the m other
solution and the third and fourth factors for the father
solution.
M other. For the m aternal relationship, an orthogonal
two-factor solution appeared to be the m ost interpret-
able. The ® nal solution com prised two factors which
were labelled regard and responsibility. After exam ining
factor loadings and deleting item s w hich showed
m ajor differences between sons and daughters (i.e.
item s which loaded on different factors for sons and
daughters), the regard factor was lim ited to ® ve item s
and the responsibility factor to eight items. The regard
factor accounted for 29.3% (eigenvalue 3.81) and
the responsibility factor for 26.7% of the varian ce
(eigenvalue 3.47). T he factor loadings for the item s
contributing to these factors for sons and daughters
com bined, as well as the factor loadings derived
separately for sons and daughters, are provided in
rank order in Table 1.
Father. For the paternal relationship, an orthogonal
three-factor solution was m ost interpretable. These
three factors consisted of regard and responsibility,
conceptually sim ilar but w ith different item s to those
derived for m other, plus an additional factor term ed
control. After exam ining factor loadings and removing
overtly sex-spe ci® c item s, the ® nal solution for father
generated four items on the regard factor, four on the
responsibility factor and ® ve on the control fa ctor
(Table 2). The regard factor accounted for 18.9%
(eigenvalue 2.46), the responsibility factor for 10.6%
(eigenvalue 1.37) and the control factor for 37.2% of
the variance (eigenvalue 4.84).
The control factor, w hich accounted for a relatively
 32 C. Peisah et al.

TAB LE 1. Factor loadings for items contributing to the ® nal m easureÐ PAC Q (mother)

Item Factor loading

All Sons Daughters

Fac tor 1Ð R egard

I look forward to seeing my m other 0.86 0.85 0.86
I am glad to be able to repay my m other for all the love and care she 0.81 0.72 0.83
gave me as a child
I respect my mother’s opinion 0.80 0.70 0.83
M y m other is my best friend 0.79 0.66 0.82
M y m other shows her appreciation of me 0.78 0.79 0.79

Fac tor 2Ð R espon sibility

I feel like I parent my m other 0.76 0.76 0.75
M y m other relies on m e too much 0.75 0.80 0.71
I feel that I have to protect my mother 0.70 0.57 0.73
M y m other thinks I’ m good in a crisis so she calls on me all the time 0.67 0.68 0.67
I am the only one my mother can rely on 0.66 0.76 0.63
M y m other’s difficulty m aking decisions has been a burden on m e 0.61 0.68 0.59
I feel that I should take care of my m other because she has suffered so 0.61 0.48 0.66
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much in her life

I feel responsible for my m other’s happiness 0.60 0.54 0.61

TAB LE 2. Factor loadings for items contributing to the ® nal measureÐ PACQ (father)

Item Factor loading

All Sons Daughters

Fac tor 1Ð R egard

I respect my father’s opinion 0.84 0.85 0.84
I look forward to seeing my father 0.83 0.74 0.85
I know I can rely on my father to help me if I need him 0.78 0.72 0.79
I don’ t mind putting myself out for my father 0.78 0.80 0.77

Fac tor 2Ð R espon sibility

Something will happen to my father if I don’ t take care of him 0.86 0.92 0.82
I feel responsible for my father’s happiness 0.81 0.80 0.80
If I don’ t see my father for a week I feel guilty 0.72 0.87 0.70
M y father thinks I’ m good in a crisis so he calls on m e all the time 0.60 0.74 0.54

Fac tor 3Ð C ontro l

If I don’ t do things my father’ s way he will nag me 0.85 0.83 0.86
I feel that my father tries to m anipulate me 0.80 0.81 0.81
M y father tries to dominate me 0.77 0.72 0.76
I feel that my father m akes too many demands on me 0.76 0.70 0.76
I don’ t discuss m uch with my father because I’ m afraid of being criticized 0.71 0.69 0.70

large percentage of the varian ce for fathers, did not
appear in the m ultifactorial m other solutions. W hen
the control items derived from the father sam ple were
exam ined as a possible third (i.e. forced) factor in the
m other sam ple, they emerged as a separate factor for
daughters only and even then accounted for less than
3% of the varian ce. T hus, the control factor was
retained only for fathers.
T he factor analysis was con® rm ed in Sam ple 2
(N = 100). T he m other solution was identical except
that regard counted for slightly less of the varian ce
(24.0% , eigenvalue 3.12) and responsibility for slightly
m ore (27.9% , eigenvalue 3.62). T he father solution
was also reproduced in the second sam ple except for
the dropping of one item from the responsibility factor
(eigenvalue 1.26, 9.7% of variance; control: eigen-
value 5.33, 41% of variance, regard: eigenvalue 2.41,
18.5% of variance).
Factor scores and age
Factor scores were then calculated for each of Sample
1 and Sam ple 2. After exam ining correlations between
subject age and factor score in the two sam ples we
found no signi® cant associations (r s ranged from -0.17
to 0.10).
Reliability
Internal con sistency as m easured by C ro nbach’ s
alphas were for the m other solution, 0.87 for the
regard factor and 0.82 for the respon sibility factor. T he
father solution yielded a Cronbach’s alpha of 0.86 for
the regard factor, 0.74 for the responsibility factor and
0.87 for the control factor.
T he reliability of the derived factors is re¯ ected
 The parent adult± child relationship questionnaire (PACQ)
further in the sim ilarity in the m ean scores across the
two occasions (Table 3) and the size of the correla-
tion coefficients which were r s = 0.9 2 [C I (95%
C on® dence Interval) = 0.82± 0.96; n = 24] for the
m other rega rd factor; r s = 0.9 3 (C I = 0.8 4± 0.9 7;
n = 24) for the m other responsibility factor; r s = 0.89
(C I = 0.75± 0.95; n = 21) for the father regard factor;
r s = 0.77 (CI = 0.50± 0.90; n = 21) for the father
respon sibility factor; and r s = 0.84 (C I = 0.63± 0.93;
n = 21) for the father control factor. All correlations
were highly signi® cant at p < 0.001 level.
Validity
Interrater reliability coefficients (rater `A’ and rater
`B’ scores intercorrelated) are outlined in Table 4. All
correlations were highly signi® cant at p < 0.001 level.
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All PAC Q factor scores correlated highly (p < 0.001)
w ith both judges’ ratings of the three dim ensions of
regard, responsibility and control. N inety-® ve per cent
con® dence intervals for both sets of correlations are
outlined in Table 4.
M ean scores and distribution of the data
M ean scores of the ® ve factors derived from the reli-
ability and validity studies are outlined in Table 3.
M ost of the data were skewed to som e extent (i.e.
skewness < 2.2), but only father control and, to a
lesser ex ten t, m oth er re sponsibility were skew ed
signi® cantly (both positively).
D iscussion
T he Parent Adult± Child Questionnaire (PACQ ) was
designed to m easure the relationship between adults
and their parents as perceived by the adult child.
C onsiderably shorter than other measures of relation-
ship s which range from 25 to 50 item s, the instru-
m ent is sim ple to com plete, efficient and app licable
to both sexes. Its psych om etric properties suggest
TABLE 3. Norm ative data obtained in reliability and validity studies
Test
Time 1
PACQ scale (total score) N Mean
a
PACQ M
Regard (15) 24 7.5
Responsibility (24) 24 4.7
PACQ F b
Regard (12) 21 8.1
Responsibility (12) 21 1.1
Control (15) 21 2.3
a
PACQM refers to PACQ for mother. b PACQ F refers to PAC Q for father.
33
that it is reliable and valid. The high correlations
between factor scores returned on our measure and
assessm ents of the dimensions by two independent
raters support the concurrent validity of the m easure.
Internal consistency as re¯ ected by Cronbach’ s alpha
was high, and m ean test scores for each factor were
stable over tim e and test-retest correlation coef-
® cients were high, supporting reliability.
The sim ilarity between the dim ensions of regard,
responsibility and control identi® ed in this study and
constructs of care/affe ction, protection and control
previously identi® ed in studies of early child± parent
relationships (Arrindell et al., 1986; Bow lby, 1979;
1980; M urphy et al., 1997; Parker, 1983; Schaefer,
1965) su ggest that these them es per vade child±
parent relations throughout the life cycle, regardless
of the descriptive or conceptual m odel used. Sim ilar
constructs have been identi® ed in studies of intimate
relationships, leading to the untested hypo thesis that
individuals have a general tendency to care, protect
and control in all relationships (Hinde, 1979; W ilhelm
& Parker, 1988). These tendencies m ay be shap ed by
the stage of the life cycle and the speci® c nature of
the relationship.
The regard factor corresponds closely to sim ilar
concepts of attachm ent or care, and encom passe s
® lial gratitude or reciprocity and perceived closeness
or com patibility (C icerelli, 1983; Eisdorfer, 1991;
H orl, 1989). In addition, item s such as I respect my
mother’s/father’s opinion or I know I can rely on my
father to help me if I need him suggest that Kenny’s
(1987) Paren tal S u ppo r t d im en sio n, w h ich w as
developed for students, extends beyond the early
child± parent relationship. The need to be appreciated
probably encom passes the continuing need for posi-
tive appraisal by parents as well as the need to feel
that caretaking efforts have been acknowledged. This
is co n sisten t w ith C icerelli’ s (1983) co n cept of
reciprocity. W hile the balance of care m ay gradually
favo ur the parents, m utuality is im portant and adult
children still turn to their parents for suppor t and
validation.
The responsibility factor includes parental behaviours
as well as the adult child’s feelings of guilt, burden
Retest Validity study
Tim e 2
SD Mean SD N M ean SD
3.7 7.5 4.0 25 11.7 3.2
4.8 4.6 4.9 25 5.6 5.7
3.1 8.1 2.9 21 8.9 3.6
1.6 1.3 1.4 21 2.1 2.4
3.2 2.1 2.9 21 3.1 4.7
 34 C. Peisah et al.
TAB LE 4. Concurrent validityÐ correlation coefficients
Rater A interview score
versus
Rater B interview score
d
PACQ scale N r sc CI
a
PACQM
Regard 25 0.93 0.84± 0.97
Responsibility 24 0.93 0.85± 0.97
PACQF b
Regard 21 0.94 0.85± 0.98
Responsibility 21 0.95 0.88± 0.98
C ontrol 21 0.89 0.75± 0.96
a b
PACQ M refers to PACQ for m other. PACQF refers to PACQ for father. r s = Spearman’s correlation coefficient. CI =
95% con® dence interval.
and protectiveness, and has elements of parenti® ca-
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tion and the desire to com pensate for the parent’s
past suffer ing (Boszorm enyi-N agy & Spark, 1984;
W hittick, 1989). Responsibility m ay vary according
to the parent’s m ental state (Coyne, 1976; C oyne et
al., 1988; 1990), but whether feeling responsible for
happiness is a norm ative concept in all ® lial relation-
ships or differentially applies to children of depressed
parents is uncertain. Responsibility as a construct
also is predicated upon culturally speci® c patterns of
kin relations and contact, the relevance of which will
be lim ited by circum stances. For exam ple, feeling
guilty about not seeing parents for a week will be
relevant only for fam ilies living in reasonable proxim ity
but not cohabiting. M oreover, the rapidly changing
nature of fam ily structure, kin relationships and provi-
sion for the aged w ill alter m any of these concepts,
especially in western industrialized societies where
fam ily m em bers are becom ing increasingly inde-
pendent (Kornhab er & Woodward, 1981). Changes
are taking place also throughout East Asia and inter-
generational relations are approxim ating those of
western cultures, i.e. they are m ore affection based,
convenience orientated and freer from intense ® lial
piety (Sung, 1998). Interestingly, constructs such as
responsibility, affe ction and repaym ent identi® ed by
Sung (1998) as prim ary and shared between cultures
as diverse as Korean and Am erican, were sim ilar to
those identi® ed in this study. However, Sung (1998)
notes there is greater em phasis on respect, fam ily
harm ony an d sacri® ce in K orean cu lture. T hus,
although the PACQ was tested on a som ewhat cultur-
ally homogeneous sam ple (its diversity lim ited by the
criterion of having adequate English to participate),
the factors identi® ed rem ain relevant to other cultures
and the PACQ will provide fur ther scope to com pare
® lial relationships across cultures.
T he control factor (relevant for fathers only) is akin
to that identi® ed in analyses of earlier relationships
(Parker, 1983; Siegelm an & Roe, 1979) but without
the protection element. T his, together with the more
positive skew of the factor, suggests the possibility of
a pathological entity, which m ay re¯ ect the naturalistic
Rater A interview score Rater B interview score
versus versus
PACQ score PAC Q score
N rs CI N rs CI
25 0.75 0.50± 0.88 25 0.77 0.53± 0.89
25 0.90 0.79± 0.96 24 0.88 0.73± 0.95
21 0.83 0.63± 0.93 21 0.85 0.67± 0.94
21 0.79 0.55± 0.91 21 0.81 0.59± 0.92
21 0.78 0.53± 0.91 21 0.71 0.41± 0.88
c d
evolution of parental power over the life cycle. Clearly
an im portant factor in childhood (M inuchin, 1974;
M urphy et al., 1997), parental power dim inishes over
time (Benbow et al., 1990; C arter & M cGoldrick,
1980) as m ost parents gradually view their children
m o re as fr ien d s than su bo rd in ates (B lieszn er &
Mancini, 1987).Thus, the control factor m ay be m ore
useful in clinical populations than large com m unity
screens, while the m ore norm al distribution of the
other factors su ggests that they m ay have w ider
ap plicatio n . T h ese issu es m ig ht be clar i® ed b y
adm inistering the instrum ent to a larger com m unity
sam ple.
We concede som e lim itations to the developm ent
of the PAC Q. Firstly, the entire sam ple m ay have not
been sufficiently heterogenous due to the use of
convenience samples rather than probability sam ples
of a known population. However, the fact that sim ilar
results were obtained in two different convenience
sam ples and the sim ilarity between the dim ensions
identi® ed here and those identi® ed in other studies of
interpersonal relationships suggests the ® ndings are
ro bust. S econ d ly, th ere w as a con cer n th at the
`double-barrelled’ nature of som e of the items (e.g. I
feel that I should take care of my mother because she has
suffered so much in her life) introduced am biguity, but
this did not occur in practice. Thirdly, a difficulty
with the principal com ponents approach towards
qu estionn aire design is that discrim inatory item s
which are m ore unusual tend to em erge in the factor
analysis, while m ore comm only held `everyday’ beliefs
about parents may be lost in the analysis. For exam ple,
M y mother is my best friend loaded highly on the regard
scale, yet intuitively the item I treat my mother as a
friend m ay be m ore generally app licable. Such ques-
tions are also potentially affe cted by response bias, a
problem w ith any m easure of individuals’ percep-
tions of their relationship with their parents (W ilhelm
& Parker, 1988). Feelings of disloyalty and guilt may
in¯ uence responses to questions about parents as
`best friends’ or respecting their opinion.
Fourthly, the effects of child gender, parent gender
and their interaction are problem atic. A m easure
 The parent adult± child relationship questionnaire (PACQ)
applicable to sons and daughters m ay lose gender
speci® c item s and blur sex differences, but it allows
direct com pariso ns, de® nes central constructs better
and has m ore utility in applied research. In this study,
differences between sons and daughters were m inor
and could be ignored, while the differences between
m others and fathers were m ajor. C ontrol emerged as a
separate factor for fathers only and several item s were
speci® c to m others, such as the parenti® cation or the
appreciation questions, or to fathers such as can rely on
to help if needed. O ur ® ndings that the concepts of
regard an d responsibility are applied d ifferently to
m others and fathers and that parental differences
outweigh child gender differences accords with reports
by others (D e Vaus, 1994; M ain et al., 1985). Finally,
the PACQ ’s applicability across a wide range of the
life cycle is supported by the failure to ® nd correla-
tions between age and factor scores. Potential differ-
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ences between relationships w ith older and younger
parents were not borne out, suggesting that the PACQ
is not `life-stage dependent’ .
Future work will be directed at providing further
validation of the instrum ent as well as testing its
application in various populations. We will extend
validity testing by com paring scores with objective
observer assessm ents of the adult± child relationship.
A com pariso n with the parent’s perception of the
relationship m ight be interesting but would not be a
useful assessm ent of validity because of the question-
able `objectivity’ of fam ily m embers as raters (W ilhelm
& Parker, 1988). C oncurrent validity could be tested
by com paring with instrum ents such as the Cam ber-
well Fam ily Interview (Leff & Vaughn, 1985; Vaughn
& L eff; 1976), the Adult Attachm ent Scale (West et
al., 1987) and the Attachment Style Inventory (Sper-
ling et al., 1992). Continuity and evolution of relation-
ship s m ight be explored by com paring results on the
PAC Q w ith m easures of the early relationship such
as the Parental Bonding Instrum ent (Parker, 1983).
A body of research regarding the in¯ uence of primary
fam ily relationships on the mental health of elderly
people is emerging. Vulnerability in caregivers and
aspects of fam ily relationships are associated with
dysfunctional behaviour in patients with Alzheim er’s
disease (Vitaliano et al., 1993), elder abuse (Sadler et
al., 1995) and poor recovery, relapse (Hinrichsen &
Hernandez, 1993) and suicidality (Zweig & Hinrichsen,
1993) in depressed elderly subjects. Caregivers have
been exam ined largely as a heterogenous group of
spo uses an d children , and in terperson al facto rs
m easured in a general way. As a speci® c, well-derived
m easure for assessing the parent± child relationship,
the PACQ perm its exam ination of the interaction
between variables related to the parent adult± child
relationship and m ental health variables of the parent.
For exam ple, it has been found that elderly husbands
were less depressed when their wives were emotion-
ally in d ep en d en t, w hile eld erly w ive s were less
depressed when they felt em otionally im por tant to
35
their husbands (Tower & K asl, 1996). The PACQ
will facilitate extension of such studies exam ining the
in teraction between ® lial variables, gen d er, an d
depressive or other sym ptoms in elderly people.
Potential research applications include exam ining
correlations and interactions with other m easures of
psych ological function, such as m easures of per-
sonality, interpersonal sensitivity or locus of control
to exam ine the determ inants of relationships. O ther
research applications include the assessm ent of parent
adult± child relations in speci® c clinical populations,
such as adult children of parents w ith psychiatric
illness or children of survivors of traum a.
The PACQ m ay also prove a useful clinical instru-
m ent. It is widely acknowledged that assessm ent of
the aging patient m ust include assessm ent of the
fam ily. The PACQ will provide an efficient estim ation
of the nature of the ® lial relationship during the assess-
m ent phase, guiding the clinician to future strengths
or weaknesses in the patient’s support system . In a
m ore form al sense, in either individual or fam ily
psych otherapy it m ight be used as an assessm ent
in str u m en t to u n d er sta n d fa m ily relatio n sh ip s.
Problem areas of relationships such as issues of control
or responsibility m ight be identi® ed and used to plan
treatm ent goals, develop intervention strategies or
explore the outcom e of therapy. O ther general uses
m ight be to identify or predict psychological m orbidity
or potential elder abuse in adult children forced into
the role of caregivers. For exam ple, a pattern of low
regard and high responsibility (som etimes m issed or
denied on the ® rst interview ) m ight rapidly identify a
child caregiver in need of respite or future m onitoring.
Furtherm ore, such patterns m ight confer particular
vulnerability to depression, anxiety or pathological
grief when the parent dies.
In conclusion, the PACQ (Appendix 1) is a useful
addition to the literature in providing a sim ple and
effective m eans of m easuring constructs central to
the parent adult± child relationship with potential
app lication in both clinical and non-clinical popula-
tions.
Acknowledgem ents
M rs Sue Sproule entered the data and M s Jenny
Grice assisted with the preparation of the m anuscript.
Professo rs G ordo n Parker, Wayne H all an d K ay
W ilhelm assisted with the m ethodology. D rs John
Brennan, C aroline Q uadrio and Brian D raper prof-
fered suggested item s. D rs M ichael D avis, An na
G ranger, D avid L im , M ichael Lowy, Alan Pollack,
D ick Q uan , A ndrew Sm all, D avid Tan usdisastro,
Stephanie Way and Shane Woods allowed access to
their patients for collection of data. T he volunteers in
the validity study gave their time to be interviewed,
often about distressing issues. D r Peisah was sup-
ported by an Eli Lilly Fellowship in the ® rst year of
the project. All are thanked w ith gratitude.
 36 C. Peisah et al.
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A ppendix 1
The Parent Adult± C hild R elationship Q uestionnaire

This form contains a number of statements about relationships between adults and their parents. Please read each statement
carefully, and decide how well it describes your relationship with your mother and your father as it has been over the last year.
Please circle the m ost appropriate response of the four possible responses.

Ver y true
Tick if you feel that the statement describes your relationship with your parent accurately.

M oderately tru e
Tick if you feel that the statement describes your relationship with your parent for the m ost part.

S om ew hat true
Tick if you feel that the statement describes your relationship with your parent to a small extent.

N ot true at all
Tick if you feel that the statement does not describe your relationship with your parent at all.

R elationsh ip with M other (PAC Q M ) Very true M oderately So m ewhat N ot true at

tru e true all

1. I look forward to seeing my mother (3) (2) (1) (0)

2. I feel responsible for my mother’s happiness. (III) (II) (I) (0)
3. I feel that I should take care of my mother because she (III) (II) (I) (0)
has suffered so much in her life.
4. My mother is my best friend. (3) (2) (1) (0)
5. My mother’s difficulty in making decisions has been a (III) (II) (I) (0)
burden on me.
6. My mother shows her appreciation of me. (3) (2) (I) (0)
 38 C. Peisah et al.

7. I am the only one my mother can rely on. (III) (II) (I) (0)
8. M y m other thinks I am good in a crisis so she calls on (III) (II) (I) (0)
m e all the time.
9. I respect my mother’s opinion. (3) (2) (1) (0)
10. I feel that I have to protect my m other. (III) (II) (I) (0)
11. M y m other relies on m e too much. (III) (II) (I) (0)
12. I am glad to be able to repay my m other for all the love (3) (2) (1) (0)
and care she gave me as a child.
13. I feel like I parent my m other. (III) (II) (I) (0)

Scoring: Rega rd Scale Arabic numerals

Responsibility Scale Roman numerals

R elation ship w ith Fath er (PAC Q F) Very true M oderately S om ew hat N ot tru e at
true tru e all

1. If I don’ t do things my father’s way he will nag me. (3) (2 ) (1) (0 )

2. I respect my father’s opinion. (3) (2) (1) (0)
3. Something will happen to my father if I don’ t take care (III) (II) (I) (0)
of him.
4. I feel that my father tries to m anipulate me. (3) (2 ) (1) (0 )
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5. I look forward to seeing my father. (3) (2) (1) (0)

6. I feel responsible for my father’s happiness. (III) (II) (I) (0)
7. M y father tries to dominate me. (3) (2 ) (1) (0 )
8. I feel that my father makes too many demands on m e. (3) (2 ) (1) (0 )
9. I know I can rely on my father to help me if I need (3) (2) (1) (0)
him.
10. If I don’ t see my father for a week I feel guilty. (III) (II) (I) (0)
11. I don’ t discuss m uch with my father because I’ m afraid (3) (2 ) (1) (0 )
of being criticized.
12. I don’ t mind putting myself out for my father. (3) (2) (1) (0)
13. M y father thinks I’ m good in a crisis so he calls on m e (III) (II) (I) (0)
all the time.

Scoring: Rega rd Scale Arabic numerals

Responsibility Scale Roman numerals
Control scale Italic Arabic numerals