Parental Tolerance Scale (PTS)

Abstract

The Parental Tolerance Scale (PTS), initially developed by Butler, Brewin, and Forsythe in 1986, is a brief, specialized psychological scale designed to quantify the attitudes and emotional responses of parents toward their child’s nocturnal enuresis (bedwetting). The instrument measures the degree to which a parent expresses empathy, understanding, and acceptance (tolerance) versus frustration, disappointment, and punitive actions (intolerance) regarding the child’s wetting episodes. The PTS is valuable in clinical settings for assessing the psychosocial impact of enuresis and identifying parental attitudes that may interfere with effective treatment.

Keywords

Parental Tolerance Scale, PTS, Nocturnal Enuresis, Bedwetting, Maternal Attitudes, Parental Attributions, Child Psychology, Clinical Assessment.

Authors

R. J. Butler, C. R. Brewin, W. I. Forsythe.

Purpose

The primary purpose of the Parental Tolerance Scale is to provide a standardized, quantifiable measure of parental attitudes toward a child experiencing nocturnal enuresis. This assessment is crucial because parental reactions—whether supportive or punitive—significantly influence the child’s self-esteem, psychological distress, and overall response to treatment for bedwetting.

The scale aids clinicians and researchers in mapping the psychosocial environment surrounding the child’s condition. By identifying patterns of low tolerance or high punitive behavior, the PTS helps pinpoint areas where parental education or counseling may be necessary to maximize the potential for successful treatment outcomes and minimize the emotional sequelae of enuresis on the child.

Construct

The PTS measures the construct of Parental Tolerance, which encompasses both cognitive attributions and affective responses related to enuresis. High tolerance is characterized by the attribution of bedwetting to uncontrollable factors (e.g., medical or developmental immaturity) and associated feelings of empathy and support. Low tolerance, conversely, is characterized by the attribution of bedwetting to controllable factors (e.g., laziness or deliberate defiance) and associated feelings of frustration, disappointment, and the use of punitive measures.

The scale effectively distinguishes two core dimensions of parental response: an empathic, tolerant dimension focused on support, and a punitive, intolerant dimension focused on blame and punishment. This dual structure allows for a nuanced assessment of parental attributions regarding the etiology and controllability of the child’s wetting.

Validity

The construct validity of the PTS has been supported through its consistent factor structure and its ability to correlate logically with related psychological measures. Studies, such as those published in the journal Behaviour Research and Therapy, have shown that the PTS successfully discriminates between parents who adopt supportive coping strategies and those who resort to blame or punishment.

Further validation evidence comes from the scale’s ability to predict clinical outcomes. Parental intolerance, as measured by the PTS, has been shown to correlate negatively with treatment compliance and positively with psychological distress reported by the child. This predictive power highlights its utility as a clinical screening tool.

Reliability

The reliability of the Parental Tolerance Scale, particularly its internal consistency, has been established in multiple research contexts. Measures of internal reliability (such as Cronbach’s alpha) typically demonstrate acceptable to good coefficients, confirming that the items within the scale consistently measure the underlying construct of tolerance or intolerance.

While the overall scale demonstrates good consistency, the reliability may be more robust when the scale is scored using its empirically derived subscales (Tolerance and Intolerance factors), ensuring that specific dimensions of parental reaction are measured accurately. The stability of the scale over time (test-retest reliability) is generally assumed to be reasonable, reflecting the stability of core parental attitudes during the treatment phase.

Factor Analysis

Empirical analyses of the PTS generally support a two-factor model, reflecting the bipolar nature of the construct being measured. These factors are:

1. Tolerance/Empathy Factor: This factor groups items reflecting understanding, pity, acceptance, and a belief that the child cannot control the wetting. High scores on this factor indicate a supportive parental environment.
2. Intolerance/Punitive Factor: This factor groups items reflecting frustration, disappointment, attributing the wetting to a lack of effort or maturity, and the use of punishment. High scores on this factor indicate a potentially stressful or punitive home environment related to the enuresis.

This distinct factor structure allows researchers to measure specific aspects of parental response rather than just a global score, offering a deeper insight into the psychological mechanisms at play.

Instrument

Test Type: Parent Self-Report Inventory

Format: 16 Dichotomous items (Yes/No response format)

Language Available: English (Original)

Population Group: Parents, primarily Mothers, of children diagnosed with nocturnal enuresis.

Age Group: Parents of children typically aged 5 years and older who experience persistent bedwetting.

Population Details: The scale was initially validated using samples of mothers whose children were attending specialist enuresis clinics. It focuses on the primary caregiver who manages the domestic and emotional consequences of the child’s condition.

Test Methodology: The parent responds to 16 statements by indicating either “Yes” or “No.” Scoring involves assigning points to tolerant responses and reverse-scoring intolerant responses to calculate overall tolerance scores or separate factor scores.

Keywords

Attitude measurement, Parent-Child Interaction, Enuresis treatment, Construct Validity, Psychological assessment, Clinical Psychology.

Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Not specified in source material.

Permissions & Fee and Test Year

Test Year: 1986 (First publication).

Permissions and Fees: The scale is published in major clinical sourcebooks (e.g., Fischer & Corcoran, 2007). Academic and non-commercial research use generally requires citing the original source (Butler et al., 1986) and may require direct permission from the primary author, R. J. Butler, or the publisher of the original journal, Behaviour Research and Therapy.

Reference’s

• Butler, R. J., Brewin, C. R., and Forsythe, W. I. (1986). Maternal attributions and tolerance for nocturnal enuresis. Behaviour Research and Therapy, 24(3), 307-312.
• Butler, Richard J., Redfern, Edwin J., Fopsythe, Ian. (1993). The maternal tolerance scale and nocturnal enuresis. Behaviour Research and Therapy, 31(4), 433-436.
• Butler, Richard J. (2001). Impact of Nocturnal Enuresis on Children and Young People. Scandinavian Journal of Urology and Nephrology, 35(3), 169-176.
• Butler, R.J. (1986). Parental Tolerance Scale (PTS). In Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page(s): 398-399.
• Fischer, Joel., Corcoran, Kevin J. (2007). Measures for Clinical Practice and research: A sourcebook. (4th ed.). NY. Oxford University Pr. Vol. 1, Page(s): 398-399.

Items of the Parental Tolerance Scale (PTS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. I feel sorry for any child who wets the bed.
2. I try to help him/her not to be upset.
3. It’s a pity the bedwetting stops him/her doing so many things.
4. It’s embarrassing to be a bed wetter.
5. I don’t mind the washing because he/she can’t help it.
6. I tell him/her it does not matter.
7. Bed wetting usually clears up on its own.
8. I find It difficult to get used to wet beds.
9. Alter a wet bed I show him/her I am disappointed.
10. I try to make him/her realize the unpleasantness the bedwetting causes for others.
11. The bedwetting is a nuisance to the rest of us
12. I don’t see why my child can’t be dry when other children can.
13. Children could stop bedwetting if they tried hard enough.
14. If he/she would grow up a bit we wouldn’t have all the trouble with wet beds.
15. I punish my child for bedwetting.
16. A smack following bedwetting never did any harm.

Response format: Yes, No