In the United States, approximately 5.4 million youth under the age of 18 are caregiving for family members experiencing age-related declines in health and functioning, chronic illness, or disability (AARP & National Alliance for Caregiving, 2020; Armstrong-Carter et al., 2019). In the last 15 years, the number of youth caregivers is estimated to have tripled (Armstrong-Carter et al., 2021). One group of caregiving youth of particular interest are children and adolescents being raised by grandparents, who may be providing care without the assistance of other adults. According to U.S. Census data, there are approximately 2.5 million children and adolescents being raised by grandparents and other relatives in a home with no parents present (Annie E. Casey Foundation Kids Count Data Center, 2022), in what are known as custodial grandfamilies. Given evidence that custodial grandparents may experience health problems (Musil et al., 2010; Whitley et al., 2015), it is likely that custodial grandchildren are engaged in varying degrees of caregiving. To date, however, few studies have examined the nature of grandchildren’s caregiving and its impact on their lives and well-being. Understanding how caregiving shapes grandchildren’s well-being is particularly important given evidence that custodial grandchildren may be at increased risk for a variety of negative psychosocial outcomes (Smith & Palmieri, 2007; Ziol-Guest & Dunifon, 2014) due to the challenging circumstances (e.g., parental abuse/neglect, substance misuse) that contributed to their care arrangement (Hayslip et al., 2017).

Reviews of the research on young caregivers reveal that caregivers experience positive and negative outcomes (Hendricks et al., 2021; Kavanaugh et al., 2016), and that the provision and experience of care is complex and shaped by a variety of developmental and contextual factors (Armstrong-Carter et al., 2022; National Alliance for Caregiving, 2005; Siskowski, 2009). Additionally, while the challenges of caregiving impact all youth, some youth are more likely to provide care and may be more vulnerable to negative outcomes (Armstrong-Carter et al., 2021; National Alliance for Caregiving, 2005; Siskowski, 2009). This study extends previous research by examining different types of caregiving and how they are associated with psychosocial well-being among a uniquely vulnerable youth population. That is, informed by the stress process model (Pearlin et al., 1990), we utilized a sample of adolescents being raised by custodial grandmothers to examine the nature of grandchildren’s caregiving, sociodemographic variations in the provision of care, and the relationship of providing care to grandchildren’s perceived caregiving interference and internalizing and externalizing behavior problems.

Caregiving Youth

It is normative for youth to provide adult family members with regular assistance with household chores (e.g., cooking, cleaning) and some degree of emotional support (Kavanaugh et al., 2016). However, caregiving youth provide more intensive care to family members with a medical condition or functional declines, often assisting with instrumental activities of daily living (IADLs) and activities of daily living (ADLs) (Armstrong-Carter et al., 2019; Armstrong-Carter et al., 2021; East, 2010; Hendricks et al., 2021; Kallander et al., 2018; Kavanaugh et al., 2016; Siskowski, 2009). ADLs are skills related to managing basic physical needs and include transferring, feeding, dressing, bathing, and toileting (Katz, 1983). IADLs are more complex skills required to live independently and include using transportation, shopping, managing finances, housekeeping, preparing food, using the telephone, and handling medications (Katz, 1983). For caregiving youth, assisting with ADLs has been associated with more negative outcomes, due to the intimate, off-time, and demanding nature of these tasks (Kallander et al., 2018; Kavanaugh et al., 2016). Collectively, research emphasizes that youth caregiving is a heterogenous and highly individual experience that varies in terms of the type and intensity of the care, the time spent caregiving, and the amount of assistance received from others.

Not all youth are equally likely to provide care. Youth living in families experiencing financial distress, or headed by single caregivers, provide more care, often because the family lacks the resources needed to access services and supports (Armstrong-Carter et al., 2021; National Alliance for Caregiving, 2005; Siskowski, 2009). Racial and ethnic minority youth also engage in more caregiving, which may reflect cultural values of familial care as well as structural marginalization that unequally impacts access to resources and supports (Armstrong-Carter et al., 2022; East, 2010; National Alliance for Caregiving, 2005; Siskowski, 2009). In accordance with gendered constructions of care (Bozalek & Hooyman, 2012), it is thought that female youth are more likely to be selected into providing care and provide more actual care (East, 2010; East & Weisner, 2009); yet, some research finds that male and female youth largely provide equivalent care (National Alliance for Caregiving, 2005) or that male youth provide significantly more frequent care (Armstrong-Carter et al., 2022). Finally, there are also mixed findings related to the age of caregiving youth. While some research has found that caregiving is more common among older youth (i.e., adolescents; National Alliance for Caregiving, 2005), Armstrong-Carter et al. (2022) found that younger youth (i.e., middle childhood) were providing more care. The authors suggest that this may be due to older youth having more commitments (e.g., paid work, schoolwork, extracurricular activities) outside of the home.

Young caregivers consistently report both positive and negative experiences and outcomes associated with providing care. Benefits of caregiving include a range of positive outcomes such as greater sense of purpose, self-understanding, empathy, closeness to the care recipient, caregiving self-efficacy, a sense of maturity, and life skills development (Cohen et al., 2012; Fruhauf et al., 2006; Fruhauf & Orel, 2008; Gough & Gulliford, 2020; Kallander et al., 2018; Shifren & Chong, 2012). Despite these benefits, the challenges related to caregiving and associated negative outcomes are significant. Physically, in a study of over 10,000 youth caregivers, Armstrong-Carter et al., (2022) found evidence of poor dietary quality and lack of sleep, while other studies found that youth caregivers report poor self-rated health (Doran et al., 2003) and higher somatization (Pakenham et al., 2006). Psychologically, evidence suggests that young caregivers experience emotional difficulties (e.g., hopelessness and suicidal ideation), feelings of stress and burden, and psychological distress (i.e., depression and anxiety) (Armstrong-Carter et al., 2022; Cohen et al., 2012; Early et al., 2007; East et al., 2010; Kallander et al., 2018; National Alliance for Caregiving, 2005; Shifren & Chong, 2012). Youth caregivers may also experience peer difficulties, in the form of peer conflict and victimization (Armstrong-Carter et al., 2022; National Alliance for Caregiving, 2005). Academically, caregiving has consistently been shown to interfere with youths’ school attendance, disciplinary problems, participation in extracurricular activities, and academic performance (e.g., grades) (Armstrong-Carter et al., 2022; Diaz et al., 2007; East et al., 2010; East & Weisner, 2009; National Alliance for Caregiving, 2005; Siskowski, 2006).

Although some youth may view caregiving as their responsibility or an obligation (Hendricks et al., 2021), caregiving is often a stressful and time-consuming undertaking for youth that alters their routines and requires them to make sacrifices in their daily lives (Hendricks et al. 2021, Kallander et al., 2018). Additionally, if the caregiving is occurring during adolescence, youth are simultaneously navigating a developmental period focused on identity development, autonomy, and a desire for independence (Siskowski, 2009). This may create tensions for some young caregivers, particularly if they perceive their caregiving responsibilities as interfering with their academic, social, and leisure goals and preferences.

Custodial Grandchildren as Caregivers

Within grandfamilies, there are several factors that may uniquely shape caregiving by custodial grandchildren. First, custodial grandparents are likely to experience chronic health conditions and age-related functional declines that require care, due to their more advanced age and other social determinants of health (Hayslip et al., 2017; Musil et al., 2010; Whitley et al., 2015). When grandparents’ increased care needs are combined with the fact that grandfamilies are frequently “skipped generation” (i.e., absence of the grandchild’s biological parent(s)) and headed by single grandmothers (Hayslip et al., 2017), grandchildren may become their grandparents’ major or only source of care. Additionally, as grandfamilies are overrepresented among racial and ethnic minorities and often experience financial distress (Hayslip et al., 2017), this may further contribute to the likelihood of grandchildren engaging in caregiving and create challenges that increase grandchildren’s risk of negative outcomes.

While few studies have examined caregiving among custodial grandchildren, the traumatic and challenging circumstances contributing to their care arrangement (e.g., parental abuse/neglect, substance misuse), may also amplify grandchildren’s risk for negative outcomes. Specifically, custodial grandchildren have consistently been shown to experience higher rates of internalizing and externalizing behavior problems than normative peers and youth living in other family constellations (Smith & Palmieri, 2007; Ziol-Guest & Dunifon, 2014). Custodial grandchildren are also at increased risk for negative academic outcomes and elevated rates of limiting conditions and poor physical health (Pilkauskas & Dunifon, 2016; Ziol-Guest & Dunifon, 2014). These pre-existing risk factors, combined with the demands of caregiving, highlight the critical need to understand the experiences of these unique young caregivers.

The Present Study

The goal of the present study was to examine the nature of adolescent grandchildren’s caregiving to their custodial grandmothers and the relationship of providing this care to grandchildren’s perceived caregiving interference and personal well-being. This goal was informed by the stress process model (Pearlin et al., 1990), which is widely used in caregiving research and postulates that the primary stressors of caregiving (e.g., grandchildren providing IADL and ADL care) result in secondary stressors of role strain and intrapsychic strain (e.g., perceived caregiving interference with grandchildren’s social and academic roles) which, in turn, impacts various indicators of well-being. We addressed our study goal via the following aims: (1) What types of IADL and ADL care, and how much care, do grandchildren provide for their custodial grandmothers? (2) What sociodemographic characteristics are associated with grandchildren’s provision of IADL and ADL care? (3) Does the provision of IADL and ADL care predict grandchildren’s perceived caregiving interference and, in turn, indicators of grandchild well-being (e.g., internalizing and externalizing behavior problems)?

For Aim 1, we hypothesized that grandchildren would be involved in providing both IADL and ADL care, but more IADL caregiving. For Aim 2, based on previous research, we hypothesized that younger, female, racial/ethnic minority grandchildren, as well as those living in grandfamilies with limited resources and headed by a single grandmother, would be more likely to engage in IADL and ADL care. For Aim 3, we hypothesized that greater grandchild involvement in IADL and ADL care would predict a greater sense of caregiving interference, and this would be associated with more internalizing and externalizing behavior problems.

Method

Sample

Study participants consisted of 81 dyads, including adolescent (ages 12 to 18 years) grandchildren and their custodial grandmothers. Participants were recruited from the 17 states in the Southern United States (U. S. Census Bureau, 2020) through over 50 community-based programs serving grandfamilies. To participate in the study, grandmothers had to be primarily responsible for the care of an adolescent (ages 12 to 18 years) grandchild. Grandchildren were required to live in the grandmothers’ home full-time, in the absence of any biological parents.

On average, grandchildren were 14 years old (SD = 1.88; Range: 12-18) and approximately half identified as female (50.6%). Most grandchildren identified as White (56.8%) or African American (32.1%). On average, grandchildren had been living with their grandmothers for 10 years (SD = 5.01; Range: 0-18) in a home with an average of 2 (SD = 1.43; Range: 1-10) custodial grandchildren. The majority (84.0%) of grandchildren were in the legal custody or guardianship of their grandmothers, and most were being raised by the grandmothers primarily due to parental abuse/neglect (44.4%) and/or substance misuse (54.3%). Grandmothers, on average, were 61 years old (SD = 6.46; Range: 47-80). Additional demographic information about the grandmothers and grandchildren is presented in Table 1.

Table 1 Demographic characteristics of grandchildren and custodial grandmothers (N = 81)
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Procedures

After receiving IRB approval, interested participants were screened for eligibility and eligible dyads were scheduled for a data collection session over the telephone (83%) or in-person (17%), depending on the grandmother’s location and preference. There were no significant differences in any study variables based on the data collection modality. Prior to data collection, grandmother consent and grandchild assent were obtained. Grandmothers also consented for their grandchild to participate in the study. Grandmothers and grandchildren completed survey questionnaires independently, with the assistance of a trained interviewer. As compensation, each participant received a $20 store gift certificate.

Measures

Sociodemographic characteristics

To measure sociodemographic characteristics that may be related to grandchildren’s caregiving, several measures were utilized. First, via a demographic questionnaire, grandchildren self-reported their age, gender, race, grade, and employment status (i.e., employed full- or part-time vs. not employed) in the past 6 months. Grandmothers provided their age, race, annual household income, education level, employment status, and relationship status.

The Family Resource Scale (FRS; Dunst & Lee, 1987), which was completed by grandmothers, was used to measure whether the family had adequate physical and nonphysical resources necessary to meet their needs. This 30-item scale assesses the adequacy of resources such as money, transportation, food, social support, and time. Each resource was rated on a Likert scale ranging from 1 = Not at All Adequate to 5 = Almost Always Adequate. An average score was created (M = 3.72; SD = 0.70), with higher scores indicating more adequate resources. The FRS has established validity and reliability (Dunst & Lee, 1987), and the reliability for the current study was excellent at α = 0.95.

Grandmothers’ physical health was measured using a single item drawn from the Medical Outcomes Study Short Form-36 (SF-36; Ware & Sherbourne, 1992). Grandmothers rated the item, “In general, would you say that your health is…” on a Likert scale ranging from 1 = Poor to 5 = Excellent (M = 2.87; SD = 1.27). Single item health measures are considered appropriate for obtaining a global assessment of health in exploratory studies (Bowling, 2005) and have evidence of strong reliability and validity (DeSalvo et al., 2006).

IADL and ADL caregiving

To measure their involvement in IADL and ADL caregiving for their grandmothers, grandchildren indicated whether (1 = Yes; 0 = No) they had engaged in a particular care task. IADLs were measured with 11 items including doing light housework, doing heavy housework, fixing things around the house, going grocery shopping, working outside the house, cooking meals, doing laundry, driving the grandmother somewhere, and helping the grandmother take medication, use the telephone, and pay bills (Lawton & Brody, 1969). The seven ADLs assessed included assisting the grandmother with transferring from bed or a chair, using stairs, walking, dressing, eating, bathing, and toileting (Katz et al., 1963). Total IADL and ADL caregiving was calculated by summing the number of endorsed IADL and ADL items, respectively. Higher scores reflect greater grandchild engagement in providing IADL and ADL care.

Perceived caregiving interference

To measure grandchildren’s perceptions of interference associated with caregiving, four items were created for the purpose of the study. Items focused on social and academic domains and included, “Because of helping my grandparent(s), I have not been able to do some fun things I want to do like participating in sports or clubs or hanging out with friends,” “Compared to my friends, I spend more time helping with chores,” “Helping my grandparent(s) makes it difficult for me to go to school,” and “Helping my grandparent(s) makes it difficult for me to finish my homework.” Grandchildren rated each item on Likert scale ranging from 1 = Strongly Disagree to 4 = Strongly Agree. Higher scores indicated greater grandchild perceptions of caregiving interference. Cronbach’s alpha for the average scale score was adequate at 0.67.

Grandchild behavior problems

Grandchild behavior problems were measured with the Youth Self-Report/11-18 (YSR) and the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001). Grandchildren completed the YSR and grandmothers completed the CBCL, to provide a more comprehensive understanding of the grandchild’s behavior problems. Both measures assess the extent to which 120 behaviors were true of the grandchild within the previous 6 months. Items were rated as 0 = Not True, 1 = Somewhat or Sometimes True, or 2 = Very True or Often True. The CBCL and YSR yield nine clinical syndrome scales, which can be grouped into total internalizing and externalizing behavior problem scores. The total internalizing scale includes items from the anxious/depressed, withdrawn/depressed, and somatic complaints syndrome scales. The total externalizing scale is drawn from items on the aggressive and rule-breaking behavior syndrome scales. Raw scale scores were constructed in accordance with YSR and CBCL guidelines (Achenbach & Rescorla, 2001). Both measures have well-documented evidence of their reliability and validity (Achenbach & Rescorla, 2001), and higher scores reflect more severe levels of internalizing and externalizing behavior problems. The internalizing and externalizing scales of the CBCL demonstrated high reliability, with α = 0.90 and α = 0.92, respectively. For the YSR, these scales showed Cronbach’s alpha values of 0.87 and 0.88.

Data Analysis

To examine our first aim, we calculated descriptive statistics for grandchildren’s involvement with IADL and ADL caregiving, and bivariate correlations between grandchildren’s total IADL and ADL caregiving and the perceived caregiving interference items. For the second aim, we examined the associations between sociodemographic characteristics (i.e., grandchild age, gender, and race (white vs. other); grandmother age, race, relationship status (partnered vs. single), physical health, and family resources), the perceived interference items, and grandchildren’s total IADL and ADL caregiving using bivariate correlations or t-tests.

Regarding the final aim, we utilized a path analysis framework to examine the sequential association between grandchildren’s involvement with IADL and ADL caregiving, their perceptions of caregiving interference, and subsequent impacts on their well-being, as indicated by grandchild- and grandmother-reported internalizing and externalizing behavior problems. This approach allowed for the examination of direct and indirect effects. The model was assessed using various fit indices to determine its overall adequacy. Standardized coefficients (β) were utilized to quantify the strength of the direct and indirect relationships within the model. Additionally, to ensure the robustness of our findings and provide precise estimation of the uncertainty in model parameters, bootstrapped standard errors (BSE) are reported.

Results

Aim 1: IADL and ADL Caregiving

As indicated in Table 2, grandchildren reported assisting their grandmothers with a variety of IADL and ADL caregiving tasks. On average, grandchildren endorsed assisting with 5 (SD = 1.99; Range: 1-10) IADL and 1 (SD = 1.78; Range: 0-7) ADL activities. When IADL and ADL activities were combined, grandchildren reported assisting with an average of 6 caregiving tasks (SD = 3.01; Range: 2-15). There was a significant, positive association between grandchildren’s engagement in IADL and ADL caregiving (r = 0.27; p = 0.01).

Table 2 Grandchild IADL and ADL caregiving (N = 81)
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The most frequently endorsed IADLs were light housework (93.8%), heavy housework (85.2%), and fixing things around the house (69.1%). The least frequently endorsed IADLs were driving the grandmother (9.9%) and helping the grandmother pay bills (3.7%). For ADLs, the most frequently endorsed tasks were helping the grandmother with getting in and out of bed or a chair (34.6%), walking (28.4%), and going up and down stairs (28.4%). The ADLs that grandchildren assisted with the least frequently were helping the grandmother with showering or bathing (8.6%), eating (8.6%), and toileting (6.2%).

Table 3 provides the correlations between grandchildren’s IADL and ADL caregiving and the perceived caregiving interference items. Greater IADL assistance was significantly associated with greater grandchild endorsement of not being able to do fun things like participating in sports or clubs or spending time with friends (r = 0.26, p = 0.02). Greater assistance with ADLs was also significantly correlated with greater endorsement of not being able to do fun things like participating in sports or clubs or spending time with friends (r = 0.31, p = 0.005). Among the caregiving interference items, not being able to do fun things was significantly associated with greater difficulty going to school (r = 0.38, p < 0.001) and finishing homework (r = 0.41, p < 0.001). Greater difficulty finishing homework, due to helping the grandmother, was also associated with greater difficulty going to school (r = 0.74, p < 0.001) and spending more time, compared to friends, helping with chores (r = 0.30, p = 0.007).

Table 3 Descriptive statistics & correlations for grandchild caregiving (N = 81)
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Aim 2: Sociodemographic Associations with Caregiving

Analyses revealed no significant associations between grandchild and grandmother sociodemographic characteristics and grandchildren’s IADL caregiving. For ADLs, younger grandchildren reported significantly greater involvement with ADLs (r = −0.27, p = 0.01). Grandchildren who identified as White reported being engaged in significantly more ADL caregiving tasks than grandchildren of other races (MW = 1.61, SDW = 2.00; MO = 0.86, SDO = 1.33; t (79) = 2.02, p = 0.05). A post-hoc analysis suggests that this may be because White grandmothers were significantly older than grandmother of other races (MW = 62.37, SDW = 6.41; MO = 0.57.97, SDO = 5.61; t (79) = 3.12, p = 0.002), though there were no group differences in terms of the grandmothers’ physical health. Expectedly, grandchildren also reported significantly more ADL involvement when grandmothers reported poorer physical health (r = −0.22, p = 0.05).

Examination of the associations among grandchild and grandmother sociodemographic characteristics and the perceptions of caregiving interference items revealed that being a younger grandchild was significantly correlated with agreeing that helping their grandparent(s) made it difficult for them to go to school (r = −0.24, p = 0.03). Compared to female grandchildren, male grandchildren more strongly agreed that helping their grandparent(s) made it difficult for them to finish their homework (MM = 1.67, SDM = .66; MF = 1.35, SDF = 0.58; t (79) = 2.26, p = 0.03), while difficulty going to school was a trend (p = 0.06) for male grandchildren. No other sociodemographic characteristics were associated with grandchildren’s perceptions of caregiving interference.

Aim 3: Caregiving and Grandchild Well-Being

Table 3 also summarizes the correlations among grandchildren’s IADL and ADL caregiving, the perceptions of caregiving interference items, and indicators of grandchild well-being (i.e., internalizing and externalizing behavior problems). Greater involvement in ADL caregiving was significantly related to higher grandmother reports of grandchild internalizing problems (r = 0.23, p = 04). There were no significant correlations among IADL caregiving and any indicators of grandchild well-being. In terms of the indicators of caregiving interference, not being able to do fun things like participating in sports or clubs or spending time with friends was positively and significantly correlated with both grandchild (r = 0.22, p = 0.05) and grandmother (r = 0.30, p = 0.007) reports of externalizing behavior problems.

The path analysis model, as illustrated in Fig. 1, adequately captured the complexity and relationships within the data, indicating an excellent fit (χ2(9) = 7.51, p = 0.58, RMSEA = 0.00, CFI = 1.00, TLI = 1.00, SRMR = 0.06). The analysis revealed significant direct effects of grandchildren’s assistance with ADLs (but not IADLs) on their perception of caregiving interference (β = 0.21, p < 0.05), suggesting this as a key area impacting how grandchildren perceive their caregiving responsibilities. Additionally, the effects of perceived caregiving interference on grandchildren’s well-being, namely regarding externalizing behavior problems as reported by grandmothers, were significant (β = 0.34, p < 0.05). The indirect pathways from grandchildren’s assistance with ADLs to their well-being, mediated by their perceptions of caregiving interference, approached statistical significance (β = 0.07, BSE = 0.01, p = 0.053), indicating a trend that warrants further investigation.

Fig. 1
figure 1

Path analysis of grandchild caregiving, perceived caregiving interference, and well-being. Note. Standardized coefficient along with bootstrapped standard errors (in parentheses) are presented. Bolded paths are statistically significant. The dashed line depicts an indirect effect that approached significance (†p < 0.10). Asterisks denote levels of statistical significance (*p < 0.05, **p < 0.01). Correlated variances between externalizing and internalizing behaviors, as assessed by the Youth Self-Report (YSR) and Child Behavior Checklist (CBCL), are not displayed for simplicity.

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Discussion

The purpose of this study was to examine the nature of adolescent grandchildren’s caregiving to their custodial grandmothers and the relationship of providing this care to grandchildren’s perceived caregiving interference and personal well-being. Understanding grandchild caregiving in grandfamilies is critical, given that custodial grandparents may experience health conditions that result in them requiring care (Musil et al., 2010; Whitley et al., 2015) and there may be no other adults available in the home to assist the grandchildren (Hayslip et al., 2017). The potential impacts of grandchild caregiving may be further amplified by existing vulnerabilities within the grandfamily, including a lack of financial resources and grandchildren’s increased risk for internalizing and externalizing behavior problems (Hayslip et al., 2017; Smith & Palmieri, 2007; Ziol-Guest & Dunifon, 2014).

For our first aim, as hypothesized, grandchildren endorsed being heavily engaged in providing IADL care. This finding confirms previous research suggesting that it is normative in many families for adolescents to provide regular assistance with household chores (Kavanaugh et al., 2016). It may also reflect grandmothers’ cultural or generational expectations related to children’s involvement with housework and chores (Hayslip et al., 2017). While fewer grandchildren were engaged in ADL care, more than a quarter reported assisting their grandmothers with getting in and out of a bed or chair, going up or down stairs, or walking. Providing this type of intensive and personal care has been associated with more negative outcomes among young caregivers (Kallander et al., 2018; Kavanaugh et al., 2016), suggesting that ADL care may be particularly impactful for custodial grandchild caregivers, especially if no other adults are living in the home and able to assist, or the family lacks the resources necessary to obtain needed supports. In these cases, the demands of care would fall to the grandchild.

For our second aim, we examined sociodemographic variations in grandchildren’s provision of IADL and ADL care and perceived caregiving interference. We found no associations between any sociodemographic characteristics and grandchildren’s IADL caregiving, likely reflecting grandchildren’s overall heavy involvement in IADL activities. For ADL tasks, younger grandchildren reported significantly higher involvement, as did grandchildren who identified as White and those with grandmothers in poorer physical health. The association between ADL care and grandmothers’ physical health is predictable and suggests that grandchildren’s involvement with caregiving is likely to be more intensive when their grandmothers are experiencing chronic health conditions or age-related functional declines. The findings related to grandchild age support previous research findings that younger youth may provide more care and be more impacted by that care, perhaps due to greater availability (Armstrong-Carter et al. 2022). The finding that grandchildren who identified as White reported more ADL caregiving contradicts previous work suggesting that racial and ethnic minority youth engage in more caregiving (Armstrong-Carter et al., 2022; East, 2010; National Alliance for Caregiving, 2005; Siskowski, 2009), though our analyses would suggest that other sociodemographic factors (i.e., grandmother age) may partially explain this association. Finally, like some previous research (National Alliance for Caregiving, 2005), we also found few gender differences in caregiving, other than male grandchildren reporting greater academic interference. Collectively, these sociodemographic findings point to the value of utilizing an intersectional perspective when studying caregiving experiences and outcomes among custodial grandchildren, as there are likely multiple, intersecting social identities at work (Dolbin-MacNab & Few-Demo, 2018).

Our final aim explored whether the provision of IADL and ADL care predicted grandchildren’s perceived caregiving interference and, in turn, indicators of grandchild well-being (e.g., internalizing and externalizing behavior problems). Our hypothesis was only partially supported, with grandchildren’s assistance with ADLs being associated with greater perceptions of caregiving interference in social and academic arenas, which were associated with increased externalizing behavior problems. The lack of associations with IADL care may be attributed to societal perceptions that these activities are routine daily chores typically assigned to grandchildren. Echoing previous research (Kallander et al., 2018; Kavanaugh et al., 2016), our findings suggest that ADL caregiving may be particularly challenging for custodial grandchildren, as engaging in these tasks may obstruct normative academic responsibilities and social relationships during adolescence, as well as developmental milestones related to gaining autonomy and establishing their social identities (Siskowski, 2009). The findings related to externalizing behavior problems further advance the understanding of grandchild caregivers by revealing that the impacts of ADL care on well-being may manifest in different ways beyond the typical focus on depression and anxiety – some form of acting out may be how some grandchildren express the challenges and difficult feelings associated with caregiving.

Finally, as suggested by the stress process model (Pearlin et al., 1990), our findings advance the idea that secondary stressors related to role strain and perceptions of caregiving interference may be critical factors in explaining the association between actual caregiving responsibilities and indicators of grandchild well-being. Like other research on young caregivers (e.g., Armstrong-Carter et al., 2022; Diaz et al., 2007; East et al., 2010; East & Weisner, 2009; National Alliance for Caregiving, 2005; Siskowski, 2006), grandchildren in this study perceived their ADL care as interfering with their ability to attend school and complete homework, as well as limiting their opportunities for social and leisure activities. In turn, this perceived interference was associated with compromised grandchild well-being. Given grandchildren’s existing risk for poor academic outcomes and behavior problems (Pilkauskas & Dunifon, 2016; Smith & Palmieri, 2007; Ziol-Guest & Dunifon, 2014), our results suggest that ADL caregiving may exacerbate grandchildren’s risk for a variety of negative outcomes.

Limitations

Despite the contributions of this study, it is not without limitations. First, while the measure of caregiving did include both IADL and ADL caregiving, it did not assess the frequency or intensity of this caregiving, nor was there a formal measure of caregiving burden or interference. There were also no measures of positive appraisals or outcomes associated with caregiving. Future research would benefit from more comprehensive measures of caregiving, including measures that capture both positive and negative aspects of caregiving as well as measures that distinguish between typical family assistance and caregiving. Relatedly, the study utilized only grandchild reports of caregiving. With self-reported data, it is possible that grandchildren over- or underreported their caregiving due to any number of factors including social desirability or a desire to downplay the extent of their grandmothers’ caregiving needs. Obtaining information about caregiving from grandparents would be useful, though they may hesitate to disclose this information for fear of losing custody of their grandchildren should they be deemed unable to provide adequate care (Peterson, 2018). Also, while the sample demographics compared favorably to the larger population of grandfamilies (U.S. Census Bureau, 2021), it was still a relatively small sample and various sources of bias may have been present; for future studies, the use of a larger sample could minimize potential biases and would allow for more complex analyses.

Future Directions & Implications

Beyond the methodological recommendations already delineated, the study findings have additional implications for future research. One key area of investigation is exploring the distinctions between normative adolescent involvement in household chores and caregiving responsibilities that may result in compromised well-being. Specifically, it would be useful to examine the extent to which the type, nature, and volume of caregiving tasks are relevant to grandchild well-being. Longitudinal and daily diary explorations of the short- and long-term impacts of caregiving on grandchildren’s well-being would further advance the literature in this area, as would studies testing process models that delineate individual, family, and contextual factors predictive of involvement in caregiving, perceptions of caregiving, and grandchild well-being. In these studies, grandchild well-being should be conceptualized broadly to include peer relationships, academic performance, physical health, and diverse indicators of psychological health. Due to the complex nature of caregiving, potential positive outcomes (e.g., prosocial behavior, resilience, etc.) for grandchildren should be considered as well. Finally, conducting in-depth, qualitative interviews may be a productive avenue for obtaining additional information about the complexities and experiences of caregiving within custodial grandfamilies.

The study findings also have implications for practice. Practitioners who work with grandfamilies should regularly assess for grandparents’ caregiving needs and grandchildren’s involvement in providing that care. As care needs are identified, practitioners can work with grandfamilies to develop meaningful strategies for meeting the grandparents’ needs (e.g., home modifications, enlisting the assistance of friends and family) and connect the grandfamily to appropriate services. Given the linkages found in this study between caregiving, perceived caregiving interference, and grandchild well-being, practitioners should also assess for the impact of caregiving on grandchildren’s academic performance, social relationships, and psychological health. To promote grandchild resilience and attenuate any negative impacts of caregiving, practitioners should consider services tailored to grandchild caregivers. These services could address the benefits and costs of caregiving via modalities such as support groups, psychoeducational interventions, skills training, individual and family therapy, and respite assistance. Ultimately, the goal would be to provide supports and services that address the needs of both grandparents and their caregiving grandchildren.

Conclusion

Due to the unique nature of their caregiving arrangement, grandchildren in custodial grandfamilies are likely to be key sources of care for their aging grandparents. The results of this study demonstrate that grandchildren are providing substantial IADL and ADL care for their custodial grandmothers. Our findings also revealed that the provision of ADL care may pose challenges for grandchildren in academic and social arenas, and that these challenges may contribute to compromised grandchild well-being. Understanding the nature and impact of caregiving in custodial grandfamilies is essential, in terms of promoting resilience, preventing negative outcomes, and providing these unique families with needed resources and support.