The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

A total of 661 manuscripts were identified from searches of databases, Google Scholar, and reference lists, of which 218 were duplicates, leaving 443 that were screened for eligibility. Of these, 295 were removed at the title and abstract screening stages, leaving 148 for eligibility screening of full-text articles. After removal of 51 articles due to ineligibility, and inclusion of an additional 6 and 8 articles from the two updated searches in November 2017 and September 2018, respectively, 111 manuscripts (representing 112 studies) were considered eligible and included in the review (Fig. 1).

Studies were excluded for a number of reasons: (1) household chaos was included within a composite measure of family functioning or household environment, (2) no child, parent, or family outcomes were reported, (3) only predictors of household chaos were assessed, (4) the construct of household chaos was not adequately measured (i.e. a different construct was measured), (5) household chaos was only included as a covariate in the analysis and not reported in the results, (6) the paper reported simulation data, and (7) the paper was retracted.

A summary of characteristics of the included studies can be found in Table 3. Overall there was generally an even mix of cross-sectional and longitudinal study designs (n = 57 vs n = 52), in addition to two experimental/laboratory studies and one case-control study. With respect to the longitudinal studies, samples were primarily drawn from large, nationally representative, longitudinal cohorts, which was reflected in the relatively large number of analyses conducted in sample sizes of greater than 1000 participants (24/104; 23%).

There has been an increasing trend in recent years in the number of manuscripts investigating the relationship between household chaos and child/parent/family outcomes (Fig. 2), with the majority of publications from research conducted in the USA (n = 74) and the UK (n = 21) (Fig. 3).

The aim of this scoping review was to provide a general summary of the extant research investigating household chaos in children and their families, with respect to (1) measurement tools used, (2) study details, and (3) outcomes assessed. The review found that research to date predominantly relied on either the short- or long-form version of the CHAOS scale, was conducted in either the U.S or U.K, and utilised primarily cross-sectional or longitudinal study designs. Almost a quarter of the research was undertaken in large, nationally representative samples of over 1000 study participants, and mostly focussed on young, healthy children. Both direct and indirect relationships between household chaos and outcomes were investigated, with the majority of studies assessing the relationship between household chaos and socio-emotional and behavioural outcomes. While an in-depth analysis of findings and assessment of bias was beyond the scope of this review, a preliminary summation of the research showed consistency in the evidence for significant relationships between household chaos and adverse effects across seven categories of outcomes in diverse populations with respect to age, disease status, and SES. To the best of our knowledge, this scoping review is the first review to map the literature within this field.

The review demonstrated that household chaos appears to influence a range of child, parent, and family outcomes. The breadth of these findings are not surprising given the diverse ways household chaos potentially interferes with processes in the home environment known to support healthy child development [125]. For example, evidence suggests that parenting behaviours and parent-child interactions are compromised within chaotic home environments [12, 39, 89, 126]. Parents in chaotic homes have been shown to be less responsive, less stimulating, more likely to interfere with children’s attempts at exploration, less likely to provide scaffolding, and more likely to engage in harsher discipline [2]. Not surprisingly, parenting was found to mediate the relationship between household chaos and a number of outcomes, including sibling relationship quality [91], child behaviours [64], receptive and expressive language [85], and children’s representation of family dysfunction [100]. Yet, it was also shown that even in the presence of positive parenting, such as maternal monitoring, the adverse effects of household chaos remain, suggesting that the negative effects of living in a chaotic home environment may not always be overcome by positive parenting practices [71].

It has also been suggested that the mechanism through which chaos impacts on parents is through increasing levels of stress and distraction, resulting in reduced regulatory functioning of the prefrontal lobe, and thus rendering even parents with normal to high emotional regulation and cognitive control compromised in their ability to parent effectively [127]. For example, household chaos has been shown to moderate the relationship between parenting behaviours and child outcomes, whereby chaos exacerbates the effects of negative parenting behaviours and undermines the effects of positive parenting behaviours [4, 24, 26, 58, 73, 92, 97].

Household chaos has also consistently been found to impact on measures of stress physiology in young children, and thus may represent a form of toxic, albeit low-level, stress [106, 128]. Toxic stress in childhood has been linked with increased risk of negative health outcomes in later life [129], and one potential pathway connecting toxic stress in childhood and adult health is through an altered stress response [130]. Exposure to household chaos during the preschool years was shown to be associated with a blunted diurnal cortisol slope in middle childhood [112], and further, household chaos was found to partially mediate the relationship between low SES and cortisol levels [107]. These findings are concerning as a blunted diurnal cortisol slope, which is considered maladaptive, has been identified as a precursor to a number of diseases and disorders in adulthood [131]. As such, household chaos may signify an aspect of toxic stress in childhood that should be considered by public health researchers.

It may also be that household chaos impedes child development directly through effects on attention allocation and information-processing skills [1]. In the context of a home environment with high frequency or high levels of distractions and background noise, the child develops adaptive techniques for filtering out stimulation; however, these techniques may not be selective, meaning that stimulation that facilitates development is also inadvertently filtered out [132]. Importantly, technological advances in the last 10 years may have created greater opportunities for children to be exposed to background media stimulation. For emphasis, it is possible that newer media devices, such as Smartphones, have increased the level of background media distraction that children are exposed to in the modern home environment. These newer devices not only interfere with child attention processes, but can also reduce responsive parenting behaviours. A recent review found that increased mobile connectivity distracts parents from parent-child interactions, and that distracted parents are more likely to be less responsive and sensitive to the needs of their children [133]. Further, a 2018 cross-sectional study in preschool-aged children (n = 385) found that greater levels of household chaos were associated with increased total screen use in pre-schoolers and screen-use behaviours related to disrupted nighttime sleep [134]. Future research will need to determine whether screen use mediates the relationship between household chaos and outcomes, or alternatively, whether new media devices contribute to the household chaos construct itself.

We also identified a number of studies demonstrating the mediating role of household chaos between risk factors and adverse child outcomes. Of particular interest was the potential role household chaos plays in explaining, at least in part, the relationship between SES and chid outcomes. For example, household chaos was found to mediate the relationship between low SES and daily cortisol output [107], socioemotional adjustment [14], academic achievement (via the disorganisation pathway rather than the instability pathway) [26], and emotional problems [70], but not conduct problems in children with ADHD [47]. More generally, household chaos was also shown to mediate relationships between child sleep and anxiety [52], child behavioural problems and sleep resistance [13], and maternal self-regulation and infant distress to limitations [39].

Finally, household chaos was also shown to moderate the relationship between risk/protective factors and outcomes. For example, children in high chaos homes were shown to be more vulnerable to risk factors, such as hostile parenting [82], and less likely to benefit from positive parenting practices, such as parental control [59]. Alternatively, children in lower chaos homes appeared more likely to benefit from protective factors, such as parental monitoring [81]. A systematic review of these studies is required to document the evidence supporting the mediating and moderating roles of household chaos between risk/protective factors and child outcomes.

This review had a number of strengths and limitations. The scoping review methodology allowed us to map a heterogeneous research area, providing an overview of research within a field that has previously escaped comprehensive review [19]. It also enabled us to summarise research using a variety of study designs and methodologies, and assess a large number of outcomes across several categories. As a result, this scoping review provides a comprehensive overview of published evidence investigating the construct of household chaos, with no limitations on study design, outcomes of interest, context, or age groups. Further, the review appears timely, given the potential for an increasing level of chaos in the daily lives of families [115], in addition to the increasing number of studies published in the field in recent years.

However, scoping reviews are not without their limitations. While we provided a general narrative overview of findings, more work is required to further analyse and synthesise the findings reported in the included studies. Additionally, we did not conduct an assessment of study quality, in line with scoping review guidelines [15], and therefore it is not possible to comment on the quality of the research reported herein, and further, while we followed recommended guidelines for conducting scoping reviews, we did not undertake the optional consultation process. The considerable heterogeneity across studies, with respect to study designs, methodologies, and outcomes of interest, may also be considered a weakness, as it did not allow in-depth synthesis of the findings, and therefore difficulty in identifying nuances in the research, such as critical windows of exposure. Finally, our reliance on published data only subjected the review to publication bias; however, the decision was made to exclude the grey literature, given the large number of published studies identified by the original search.

Our findings highlighted that the majority of research in the area has been conducted in U.S and U.K populations, and as such, studies from other countries may be needed to better understand how chaotic home environments affect families within different cultural contexts. Research is also needed to assess whether household chaos has been increasing in recent years, and if so, if this increase is across the population or only within specific sub-groups. Drivers of this potential change should also be investigated. For example, widespread social changes may have reduced a family’s ability to engage in routines, an important pathway by which household chaos may negatively affect children [6]. Families today are more likely to have two parents who work [135], and children who are cared for outside the family home [136]. These activities may increase family disorganisation and environmental confusion, through increasing logistical demands, feelings of hurriedness, and increasing perceptions of time scarcity, which in turn may result in decreased engagement in important family routines and rituals [137]. Finally, while high levels of household chaos negatively influence children and families, it is unknown whether there is an ideal lower limit of household chaos, below which adverse effects of an ‘overly structured household’ may occur.

Identifying, targeting, and effectively reducing household chaos may offer a unique course of action for (1) improving child, parent, and family outcomes, (2) tackling social, behavioural, cognitive, and health problems linked with low SES in childhood [107], and (3) increasing the impact of family-based programmes designed to improve child outcomes. Yet we do not believe it is possible to make recommendations for practice as our scoping review did not assess the methodological quality of the included research [15]. Before recommendations can be made, we suggest the need for systematic reviews that focus on specific outcomes of interest, pathways linking chaos and outcomes, and the mediating and moderating role of household chaos between risk and protective factors and child outcomes. These reviews would allow for an assessment of study quality and would enable recommendations to be made about how findings could inform practice. Studies are also needed to assess whether it is possible to reduce household chaos. To the best of our knowledge, no interventions have been undertaken with the primary aim of targeting household chaos and as such no tools are currently available that have demonstrable effectiveness in reducing chaos in the family home. Further, it remains to be seen whether a reduction in household chaos actually translates into positive outcomes for children, parents, and families.

Our review identified a diverse body of literature investigating the construct of household chaos. We found that chaotic home environments appear to correlate with a broad spectrum of adverse child, parent, and family outcomes, potentially describe, at least to some extent, the relationship between low SES and adverse outcomes, undermine positive parenting behaviours, and exacerbate negative parenting behaviours. Future research is needed to investigate whether household chaos has been increasing in recent years, what factors may have driven the hypothesised increase in household chaos, whether newer mobile media devices create greater opportunity for the experience of household chaos, and, if so, how to capture this in a new or updated measurement tool. The effects of the construct on outcomes also need to be investigated in other cultural contexts, and programmes developed to not only investigate how household chaos can effectively be reduced, but also assess whether a reduction in household chaos translates into improved outcomes. Before recommendations to inform practice can be made, we propose the undertaking of systematic reviews looking at specific outcomes of interest and the pathways through which household chaos impacts on child, parent, and family outcomes.