Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child's difficulties

1000 Families Study, a UK multiwave cohort investigating the well-being of families of children with intellectual disabilities: cohort profile

PURPOSE

The 1000 Families Study is a large, UK-based, cohort of families of children with intellectual disability (ID). The main use of the cohort data will be to describe and explore correlates of the well-being of families of children with ID, including parents and siblings, using cross-sectional and (eventually) longitudinal analyses. The present cohort profile intends to describe the achieved cohort.

PARTICIPANTS

Over 1000 families of UK children with ID aged between 4 and 15 years 11 months (total n=1184) have been recruited. The mean age of the cohort was 9.01 years old. The cohort includes more boys (61.8%) than girls (27.0%; missing 11.1%). Parents reported that 45.5% (n=539) of the children have autism. Most respondents were a female primary caregiver (84.9%), and 78.0% were the biological mother of the cohort child with ID. The largest ethnic group for primary caregivers was White British (78.5%), over half were married and living with their partner (53.3%) and 39.3% were educated to degree level.

FINDINGS TO DATE

Data were collected on family, parental and child well-being, as well as demographic information. Wave 1 data collection took place between November 2015 and January 2017, primarily through online questionnaires. Telephone interviews were also completed by 644 primary caregivers.

FUTURE PLANS

Wave 2 data collection is ongoing and the research team will continue following up these families in subsequent waves, subject to funding availability. Results will be used to inform policy and practice on family and child well-being in families of children with ID. As this cohort profile aims to describe the cohort, future publications will explore relevant research questions and report key findings related to family well-being.

Chinese fathers of children with intellectual disabilities: their perceptions of the child, family functioning, and their own needs for emotional support

As more and more evidence accrues in support of family-centered approaches to disability services, parents' experiences raising children with disabilities is receiving increasing attention internationally. The literature on parents of children with disabilities, however-whether intellectual disability (ID) or other chronic health conditions (OCHC)-tends to focus on mothers as the primary research subject. To address the paucity of research focused on fathers' experiences of raising a child with disabilities, I surveyed over 4500 fathers of children with disabilities in Mainland China. The surveys focused on fathers' perceptions of their children, their perceptions of family functioning, and their perceptions of their own needs for emotional support. Results derived from statistical analyses of the data suggest that fathers tend to believe their children with ID are harder to raise than other children, and that they more often do things that irritate them and make them feel angry. Fathers of children with ID also tend to perceive their family functioning as somewhat problematic. Generally, these fathers are disinclined to seek emotional support from outside their families, although fathers from the majority Han population and fathers who have greater than high school education are more likely to seek support than are fathers from minority ethnic groups and fathers with lower educational background. Comparisons are made with fathers of children with OCHC. Implications of the findings are identified and lines of further research suggested.

Health-related quality of life amongst primary caregivers of children with intellectual disability

BACKGROUND

Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health-related quality of life (HRQoL) across co-morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population.

METHODS

Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ-5D-5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties.

RESULTS

Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ-5D-5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ-5D-5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age-equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co-morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL.

CONCLUSIONS

This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost-effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers.

Caregiving of offspring with intellectual developmental disabilities in Israeli Jewish and Arab households: Financial and psychosocial differences

BACKGROUND

This research responds to the lack of evidence-based knowledge regarding the psychosocial and financial gaps among caregivers of children with intellectual disabilities living in Jewish and Arab households. It examines the financial gaps and explores whether caregivers' social economic status and households' affiliation (Jewish vs. Arab) can explain the psychosocial variables such as levels of stress, social participation types and rates, and use of public services.

METHOD

One hundred and twenty-five Jewish and Arab caregivers completed an income and expenditure survey, including out-of-pocket expenditures, a services use survey, a questionnaire regarding resources and stress levels, and a social participation scale.

RESULTS

Arab households are more likely to have a low socioeconomic status (SES) than Jewish ones, characterized by lower per capita income, less spending, fewer out-of-pocket expenditures, and less ability to deal with an unexpected expense. In respect to psychosocial measures, Arab caregivers report lower use of public services than Jewish caregivers and lean more toward contact with relatives and religious participation than do Jewish caregivers. Caregivers' social economic status and households' affiliation do not have any interaction effect on psychosocial variables.

CONCLUSIONS

Findings are discussed regarding research and practice.

Healthy Parent Carers peer-led group-based health promotion intervention for parent carers of disabled children: protocol for a feasibility study using a parallel group randomised controlled trial design

Background

Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme's effectiveness and cost-effectiveness.

Methods

We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants' and facilitators' feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups.

Discussion

This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme.

Trial registration

ISRCTN, ISRCTN151144652, registered on 25 October 2018; ClinicalTrials.gov, NCT03705221, registered on 15 October 2018.

Mental health and well-being of fathers of children with intellectual disabilities: systematic review and meta-analysis

BACKGROUND

Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers.

AIMS

The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population.

METHOD

A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria.

RESULTS

Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10).

CONCLUSIONS

There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.

Developmental trajectories of behaviour problems and prosocial behaviours of children with intellectual disabilities in a population-based cohort

BACKGROUND

The study examined developmental trajectories of prosocial behaviours, internalising and externalising behaviour problems in children with intellectual disabilities (ID) between pre-school and middle childhood.

METHOD

Growth models examined the best-fitting trajectories for internalising and externalising behaviour problems, as well as prosocial behaviours, in 555 children with ID between the ages of three and 11 years from the UK Millennium Cohort Study. Models were also fitted to examine the association of child outcomes with time-varying maternal psychological distress and life satisfaction. Finally, models were extended to compare trajectories with typically developing children.

RESULTS

Externalising behaviour problems and prosocial behaviours generally improved, whereas internalising problems did not change systematically over time. A cubic trend indicated a slowing down of improvement between ages 5 and 7 for prosocial behaviours and externalising problems. Maternal psychological distress positively co-varied with internalising and externalising behaviour problems over time. Life satisfaction was not related to changes in child behaviours over time. Compared to behavioural trajectories in typical development, intercepts were worse and trajectories also differed in the ID group.

CONCLUSIONS

Over an 8-year period, externalising behaviour problems and prosocial behaviours of children with ID tended to improve. These behavioural improvements slowed between five and seven years, possibly coinciding with school-related environmental changes. Children with ID significantly differ from children with typical development in both the initial level of difficulties (exhibiting higher externalising and internalising behaviours, and lower prosocial behaviours) and subsequent development as they age, showing comparatively lower decreases in both externalising and internalising behaviours, and lower increases in prosocial behaviours. Findings also highlight the significant role of maternal mental health problems in the trajectory of child behaviour problems.

Assessing the quality, efficiency and usefulness of the Western Australian population-based Intellectual Disability Exploring Answers (IDEA) surveillance system: a surveillance system evaluation

OBJECTIVES

Our overall aim was to evaluate the Western Australian Intellectual Disability Exploring Answers (IDEA) surveillance system. The primary objective was to evaluate the attributes of the system. The secondary objective was to provide recommendations to data custodians and stakeholders to strengthen the system.

METHOD

The IDEA system was evaluated using process observation, interviews and secondary data analysis of system attributes: usefulness, simplicity, data quality, acceptability, representativeness, timeliness and stability. 2001 US Centers for Disease Control and Prevention guidelines were used.

RESULTS

We found that the IDEA system was useful, simple, flexible, acceptable, representative, timely and stable. We compared individuals from the IDEA system (n=10 593) with those with cerebral palsy and intellectual disability (ID) (n=582) from another surveillance system. Of the 582 with cerebral palsy and ID, 501 (86.1%) were in the IDEA system and 81 (13.9%) were not. In total, 0.7% of cases (81/10674) with ID were not identified in the IDEA system. There were little differences in cases that were not identified in the IDEA system between Indigenous status, sex and place of residence.

CONCLUSIONS

The strengths of the IDEA system include having a high data quality resource contributing to national and international data on ID, strong government support and a dedicated management team. Output from studies linking to IDEA data have had major contributions to the international literature about ID. However, limited resources have prevented it from realising its full potential in relation to translational activities. The IDEA system is a valuable resource to address the needs of people living with ID.

Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis

Being a family carer can be rewarding but can also lead to mental and physical exhaustion as well as feelings of social exclusion and isolation. Research has shown that the use of the Internet and online forums can provide an immediate place to find information and reassurance and that forum use can be an empathetic place to share experiences and seek emotional support. This article details a systematic literature search of research on carers of people with intellectual disabilities and/or autism using the Internet. A thematic synthesis of the resulting papers identified that online forums give carers a sense of agency by providing a place to go for informational support that may not be elsewhere. Carers also enjoyed the safe community of solidarity and emotional support that online forums provide. An important finding is the lack of published papers in this area with the inclusion of just eight papers.

Caregiver burden in children with intellectual disability: Does special school education help?

BACKGROUND

Caregivers are playing a vital role in mentally ill patients in India. Families of children with intellectual disability encounter a high degree of stress such as physical, emotional, and financial.

AIM

The aim of this study was to compare and evaluate the caregiver burden and depression between the special school-going children and nonschool-going children with intellectual disability.

MATERIALS AND METHODS

The present study was conducted on caregivers of patients with intellectual disability at Radianz Health Care and Research Private Limited, Ahana Hospitals, Akash Special School, and M. S. Chellamuthu Trust and Research Foundation, Madurai. The Zarit Burden Interview scale was utilized to assess the level of burden experienced by the caregivers. The Major Depression Inventory scale was utilized to assess the severity of depression experienced by the caregivers. The Binet Kamat Test of Intelligence was administered by a psychologist to assess the IQ level of the children.

RESULTS

Totally 80 caregivers were participated in the study. The mothers of children with intellectual disability suffered from burden and depression when compared to the fathers (P < 0.0001). The parents of nonschool-going children had a higher level of burden and depression as compared to the parents of special school-going children (P < 0.0001).

CONCLUSION

Special school is playing a vital role for children with intellectual disability. It can be reasonably concluded from the study that both the groups face burden and depression. However, the severity of burden and depression is comparatively higher among parents of nonschool-going children.

Psychologic Distress and Anxiety in Mothers of Children With Gastroesophageal Reflux Undergoing Antireflux Surgery

OBJECTIVES

Parents of children with a chronic illness are at risk for impaired psychosocial functioning. Gastroesophageal reflux disease (GERD) is such a disease, and no studies have investigated effects of antireflux surgery on parental psychological distress. The aims of this study were to assess psychological distress and state and trait anxiety in mothers of children with GERD, and to explore possible changes after antireflux surgery.

METHODS

Mothers of children referred for antireflux surgery were included in this prospective study. Standardized questionnaires were used to evaluate psychological distress and state and trait anxiety before and 12 months after antireflux surgery.

RESULTS

Of 87 eligible mothers of children with GERD, 62 (71%) agreed to participate. All children had objectively verified GERD by 24-hour pH-monitoring and/or upper gastrointestinal contrast study and unsatisfactory symptom relief of pharmacological treatment. Thirty-one (50%) mothers returned questionnaires postoperatively. Preoperatively, mothers of children undergoing antireflux surgery reported high levels of psychological distress and state anxiety, and 54% had scores indicating clinically significant psychological distress. None of the preoperative child characteristics were found to significantly influence maternal psychological distress or state anxiety. Twelve months postoperatively, both psychological distress and state anxiety were reduced.

CONCLUSIONS

Mothers of children undergoing antireflux surgery reported reduced levels of psychological distress and state anxiety 12 months after the operation.

Having another child without intellectual disabilities: Comparing mothers of a single child with disability and mothers of multiple children with and without disability

To investigate how having a child without a disability is related to maternal mental health and its predictors, we compared mothers of a single child with intellectual disabilities (single-child group, n = 117) and mothers of children with and without intellectual disabilities (multiple-children group, n = 457), in Japan. Compared to the multiple-children group, the single-child group had lower hope and social capital and poorer mental health; furthermore, 42.5% of them had decided not to have another child, despite desiring one. Hope was the strongest predictor of mental health in both groups but was more positively related to mental health in the multiple-children group. The fear of the possibility of the next child having a disability and receiving inadequate support were the obstacles for mothers who had decided not to have another child. Thus, greater support and more opportunities for obtaining adequate information about the implications of having another child may be needed.

The Effect of Disability on the Diagnosis and Treatment of Multiple Myeloma in Korea: A National Cohort Study

PURPOSE

This study aimed to determine whether the diagnosis, treatment approach, and prognosis of multiple myeloma (MM) vary according to the presence and type of disability.

Materials and Methods

Demographic, socioeconomic, and medical data were obtained from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database. An age- and sex-matched cohort was established using a 1:3 ratio constituted with 2,776,450 people with disabilities and 8,329,350 people without disabilities. Adult patients diagnosed with MM were subsequently selected from this cohort. Disabilities were categorized as physical, communication, intellectual or psychological, and affecting the major internal organs.

RESULTS

The cohort included 4,090 patients with MM, with a significantly lower rate per 100,000 persons among people with disabilities than among people without disabilities (29.1 vs. 39.4, p < 0.001). People with disabilities were more likely to undergo dialysis treatment at the time of diagnosis (16.3% vs. 10.0%, p < 0.001), but were less likely to undergo autologous stem cell transplantation (37.5% vs. 43.7%, p=0.072). This trend was more evident among patients with intellectual or psychological disabilities. The median overall survival among patients with disabilities was significantly shorter than that among patients without disabilities (36.8 months vs. 51.2 months, p < 0.001).

CONCLUSION

In Korea, people with disabilities generally have a lower rate of MM diagnosis, receive less intensive treatment, and have a lower survival rate than people without disabilities.

Healthcare practitioners' views and experiences of barriers and facilitators to weight management interventions for adults with intellectual disabilities

BACKGROUND

Obesity is common in adults with intellectual disabilities, yet little is known about how weight management interventions are provided for this population.

METHODS

Semi-structured interviews were held with 14 healthcare practitioners involved in weight management interventions in an English county. A study topic guide was developed to elicit practitioners' views and experiences of barriers and facilitators to weight management for adults with intellectual disabilities. Responses were analysed using thematic analysis.

RESULTS

Several barriers are involved in weight management for people with intellectual disabilities including communication challenges, general practitioners' lack of knowledge and awareness of weight management services, inconsistencies in caring support, resource constraints, wider external circumstances surrounding the individuals and motivational issues. Facilitators include reasonable adjustments to existing weight management services. However, there is a need for specialist weight management provision for people with intellectual disabilities.

CONCLUSIONS

This study provides suggestions for future research, policy and practice consideration.

Sensory processing in children with autism spectrum disorder and the mental health of primary caregivers

BACKGROUND

Sensory processing difficulties, which commonly occur in autism spectrum disorder (ASD), are expected to have negative effects on the primary caregiver's mental health. The aim of this study was to examine the association between sensory processing difficulties in children with ASD and the mental health of primary caregivers.

METHODS

A total of 707 primary caregivers (mothers in the present study) and their children with ASD (4-18 years of age) participated in this study. Sensory processing difficulties were indexed using the Short Sensory Profile (SSP). The mental health of primary caregivers was indexed using the General Health Questionnaire (GHQ12).

RESULTS

Higher scores on Auditory Filtering as measured with the SSP were associated with poorer mental health of primary caregivers, even after an adjustment for ASD symptom severity. Analyses of two age sub-groups, a young (4-10 years) and an old age group (11-18 years), revealed that higher scores on Tactile Sensitivity and Auditory Filtering were associated with poorer mental health of primary caregivers in younger children, whereas only higher scores on Auditory Filtering were associated with poorer mental health of primary caregivers in older children.

CONCLUSIONS

Our findings suggest that practitioners who support primary caregivers of children with ASD need to focus not only on the social and communication-related symptoms of the child but also on their specific sensory processing difficulties.

Impact of severe polyhandicap on parents' quality of life: A large French cross-sectional study

Background

Polyhandicap (PLH) is a condition of severe and complex disabilities and is defined by a combination of profound intellectual impairment and serious motor deficits. Parents of PLH individuals are chronically confronted with stressful situations. The aims of this study are i) to assess and compare the quality of life (QoL) of a large panel of parents of PLH individuals with age- and gender-matched controls and ii) to identify potential determinants of parents’ QoL.

Method

We conducted a cross-sectional study. Parents were recruited from 4 specialized rehabilitation centres, 9 residential facilities, and a specialized paediatric/neurological department. The selection criteria were age above 18 years and being the mother/father of a PLH individual. The data collected from the parents included sociodemographic, health status, and psycho-behavioural data (including QoL); additionally, the health status of the PLH individuals was collected.

Results

The QoL scores of all dimensions were significantly lower for parents than for controls. The main factors modulating parents’ QoL were financial issues, health status, and coping strategies. The PLH individuals’ health status was not associated with parents’ QoL.

Conclusions

Some QoL determinants might be amenable. These findings should help health care workers and health decision makers to implement specific and appropriate interventions.

Barriers to accessing mental health treatment for parents of children with intellectual disabilities: a preliminary study

Purpose: Parents of children with intellectual disability often experience heightened levels of psychological distress compared to parents of typically developing children due to increased parenting demands. Given these demands, parents may also have difficulty accessing mental health treatment for themselves. This research investigated whether parents of children with intellectual disability experience barriers in accessing mental health treatment for themselves related to the increased parenting demands of having a child with an intellectual disability.Materials and methods: 80 parents of children with intellectual disability were surveyed about barriers to accessing mental health treatment for themselves and interest in an e-treatment.Results: Parents who experienced mental health difficulties were more likely to experience barriers in accessing treatment. For parents who had experienced mental health difficulties, cost, arranging childcare, and availability of providers were significant barriers to accessing treatment. Older participants were less likely to report cost as a barrier. Participants with higher incomes were less likely to report work scheduling as a barrier. Participants reported interest in an e-treatment, with younger participants more likely to express interest.Conclusions: These preliminary findings suggest that parents of children with intellectual disability experience barriers to accessing treatment. Research directions include developing e-treatments for these carers.Implications for rehabilitationHaving a child with an intellectual disability is associated with increased parenting demands, and significant stress for parentsThe results of this survey suggest that for parents who are experiencing mental health difficulties, cost, arranging childcare and availability of providers may act as barriers to accessing treatment for their own mental health concernsRehabilitation professionals can assist parents in addressing these barriers and encourage parents to seek treatment for themselves by offering flexibility in appointment times, reduced cost services and options for childcareAccessible and affordable treatment options, such as e-treatments may further assist these parents in accessing care for themselves.

Hysterectomy for the Management of Menstrual Hygiene in Women With Intellectual Disability. A Systematic Review Focusing on Standards and Ethical Considerations for Developing Countries

Background: Menstruation poses particular challenges for women with intellectual disability (ID). In low-and middle-income countries, where these women do not have access to facilities and resources for adequate menstrual care, hysterectomy could be considered as an ethically acceptable procedure. We conducted the first systematic review to identify what constitutes best practice for menstrual hygiene in women with ID and explored the perspectives of actors involved in the hysterectomy decision.

Methods: Theory-informed mixed-method thematic systematic review with theory development.

Results: Eleven ethical guidelines and 17 studies were included. Respect for autonomy and the patient's best interest were the criteria to determine what constitutes best practice. The actors' values and attitudes expressed some dimensions of existing inequities. In low-and middle-income countries, the main concern of parents was the difficulty to train their daughters about menstrual hygiene. Parents (mothers in particular) also expressed the feeling of being excessively burdened, and complained about the limitations of their support networks. Doctors perceived hysterectomy as a safe procedure and a solution for women with ID, whose menstrual hygiene is problematic. In general, the more severe or profound the level of ID, the more likely the interested parties advocated for a hysterectomy. The women with ID perceived their menstruation as a negative experience. Hence, the three parties supported hysterectomy for menstrual hygiene. Parents and doctors considered informed consent or assent (from the women with ID) as necessary and achievable.

Conclusion: The international ethical guidelines suggest that non-therapeutic hysterectomy in women with ID should not and ought not to be recommended as routine and appropriate method to cope with menstrual hygiene even if it is technically safe. Although hysterectomy to cope with menstrual hygiene is still a live issue in high-, middle-, and low-income countries, in high income countries it is performed with authorization from the Court; whilst in low-and middle-income countries there is not an active involvement of the State, or financial or training support for women with ID and their carers. Hence, in low-and middle-income countries there is an urgent need to develop and enact policies and statutes in this area of public health and clinical practice.

The effect of neonatal hypothyroidism and low family income on intellectual disability: A population-based cohort study

BACKGROUND

To investigate relationships among neonatal hypothyroidism, family income, and intellectual disability, as well as the combined effects of neonatal hypothyroidism and low family income on intellectual disability.

METHODS

Data were extracted from the National Health Insurance Service-National Sample Cohort from 2002 to 2011. This retrospective study included 91,247 infants. The presence of intellectual disability was based on the disability evaluation system in Korea. Newborn hypothyroidism was identified from diagnosis and prescription codes. Family income was determined from average monthly insurance premiums. Cox proportional hazards models were used to calculate adjusted hazard ratios.

RESULTS

Of the 91,247 infants, 208 were considered to have intellectual disability (29.18 cases per 100,000 person-year). The risk of intellectual disability was higher in infants with hypothyroidism than in those without hypothyroidism (hazard ratio = 5.28, P: < .0001). The risk of intellectual disability was higher in infants with low family income than in those with high family income (hazard ratio = 2.32, P: < .0001). The risk of intellectual disability was higher in infants with hypothyroidism and low family income than in those without hypothyroidism and with high family income (hazard ratio = 36.05, P: < .0001).

CONCLUSIONS

Neonatal hypothyroidism and low family income were associated with the risk of intellectual disability in Korea. Additionally, neonatal hypothyroidism and low family income significantly increased the risk of intellectual disability. Public health policymakers should consider providing additional resources for alleviating neonatal hypothyroidism among low-income families.

Maternal Stress and the Functions of Positivity in Mothers of Children with Intellectual Disability

Although mothers raising children with Intellectual Disability (ID) report poorer mental health than parents raising typically developing children, they also report feelings of positivity; both generally and specific to their child. To date little is known about the function of maternal positivity thus, we explored the putative compensatory and protective functions of maternal positivity, within both a cross-sectional and one-year longitudinal framework that examined the relationship between children's behaviour and mental health problems with maternal mental health problems. Participants included 135 mothers of children with severe ID who were between 3 and 18 years of age. Multiple linear regression models investigated the potential function of maternal positivity. At a cross-sectional level, maternal positivity was found to be a significant independent predictor of maternal stress and moderated the impact of child behaviour problems on maternal parenting stress. Longitudinally, maternal positivity did not have a direct effect on later parenting stress nor function as a moderator. Findings from our cross-sectional analysis are consistent with the view that positivity serves a compensatory function. Further exploration is needed to understand the longitudinal function of maternal positivity.

Working and caring for a child with chronic illness: A review of current literature

BACKGROUND

Advances in medical knowledge have contributed to the increase in the number of children living with some form of long-term chronic illness or condition. As a consequence of these advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of parent work, the challenges experienced, and the flow-on consequences to well-being.

METHODS

Employing a narrative, meta-synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness.

RESULTS

The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of "doing it all." And third, the above challenges lead to additional impacts on parental quality of life.

CONCLUSIONS

This review summarizes what is currently known about work patterns, challenges, and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched, other challenges (eg, personal and family) and impacts on their well-being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings.

Individual and Contextual Correlates of Frequently Involved Special Olympics Athletes

It is important to understand factors associated with sport participation for youth with intellectual and developmental disabilities (IDD). With a sample of 414 Special Olympics (SO) athletes, this study examined how frequently involved athletes differ from other youth who are less involved in SO. Results showed that frequently involved athletes are older, have more sport-specific parental support, stronger athlete-coach relationships, and more positive SO experiences than other athletes. These factors were predictive of SO involvement, even after controlling for athlete characteristics, including behavior problems and adaptive behavior. Athletes with IDD have the potential to be highly involved in sports when external supports (i.e., coaches and parents) are strong.

Healthy Parent Carers programme: development and feasibility of a novel group-based health-promotion intervention

Background

Parent carers of disabled children report poor physical health and mental wellbeing. They experience high levels of stress and barriers to engagement in health-related behaviours and with ‘standard’ preventive programmes (e.g. weight loss programmes). Interventions promoting strategies to improve health and wellbeing of parent carers are needed, tailored to their specific needs and circumstances.

Methods

We developed a group-based health promotion intervention for parent carers by following six steps of the established Intervention Mapping approach. Parent carers co-created the intervention programme and were involved in all stages of the development and testing. We conducted a study of the intervention with a group of parent carers to examine the feasibility and acceptability. Standardised questionnaires were used to assess health and wellbeing pre and post-intervention and at 2 month follow up. Participants provided feedback after each session and took part in a focus group after the end of the programme.

Results

The group-based Healthy Parent Carers programme was developed to improve health and wellbeing through engagement with eight achievable behaviours (CLANGERS – Connect, Learn, be Active, take Notice, Give, Eat well, Relax, Sleep), and by promoting empowerment and resilience. The manualised intervention was delivered by two peer facilitators to a group of seven parent carers. Feedback from participants and facilitators was strongly positive. The study was not powered or designed to test effectiveness but changes in measures of participants’ wellbeing and depression were in a positive direction both at the end of the intervention and 2 months later which suggest that there may be a potential to achieve benefit.

Conclusions

The Healthy Parent Carers programme appears feasible and acceptable. It was valued by, and was perceived to have benefited participants. The results will underpin future refinement of the intervention and plans for evaluation.

Lived Experience of the Mother&apos;s Caring of Adult Children with Persistent Vegetative State

PURPOSE

The purpose of this study was to deepen understanding the nature of the care experience by the mothers with adult children in persistent vegetative state.

METHODS

Participants were 7 mothers caring for their adult children in persistent vegetative state. Data were collected individually through in-depth interviews on their lived experiences. Also texts were included as data from literary works, novels, movies, essays, and arts containing on patients with persistent vegetative state and their mothers. Data were analyzed by van Manen's phenomenological methodology.

RESULTS

The essential themes of caring experiences of the mothers were as follows. The theme in relation to lived time has shown as back to the past and caring experience related lived body has emerged as locked the body in children. The theme related lived space was getting into the swamp and the theme in lived others was derived as lonely struggle into.

CONCLUSION

The nature of mothers' caring experiences for adult children in persistent vegetative state is summarized as 'Do not off hand of hope in a locked state'. This study suggests long-term supports are necessary for mothers to care persistent vegetative state children.

The psychological and physical health of fathers of children with Autism Spectrum Disorder compared to fathers of children with long-term disabilities and fathers of children without disabilities

BACKGROUND

The psychological and physical health of fathers of children with Autism Spectrum Disorder (ASD) is under-researched. Due to the unique parenting demands, fathers of children with ASD may be at increased risk of experiencing psychological and physical health difficulties compared to fathers of children without disabilities (W/OD) and fathers of children with other long-term disabilities (LTD). What little research there is on fathers of children with ASD is often conducted on small clinical samples, or embeds the experiences of fathers within other groups.

AIM

The current study aimed to explore the extent to which fathers of children with ASD experience psychological distress and physical health issues (e.g., general health, smoking, chronic pain) compared to fathers of children W/OD and fathers of children with a LTD.

METHOD

From a large, nationally representative sample of children, 159 fathers of children with ASD were identified, along with 45 fathers of children with a LTD and 6578 fathers of children W/OD.

RESULTS

The majority of fathers were experiencing good psychological and physical health. Approximately 1 in 6 fathers of children with ASD were experiencing elevated levels of psychological distress and poor global health, and were at significantly greater risk than fathers of children W/OD; although these differences were not found compared to fathers of children with a LTD.

CONCLUSIONS

Some fathers of children with ASD may require additional support which not only focuses on their psychological wellbeing but also fathers' physical health. The current findings encourage health services to check-in with, or reach-out to fathers as they too may require additional support.

Longitudinal Correlates of Maternal Depression Among Mothers of Children With or Without Intellectual Disability

This study identified trajectories of depressive symptoms among mothers of children with or without intellectual disability longitudinally across eight time points. Results of fitting a linear growth model to the data from child ages 3-9 indicated that child behavior problems, negative financial impact, and low dispositional optimism all significantly related to initial maternal depressive symptoms. Child behavior problems were significantly associated with changes in depressive symptoms over time, relating above and beyond child disability status. When looking from late childhood into early adolescence, hierarchical linear regression analysis revealed that maternal depressive symptoms at child age 9 and perceived financial impact significantly related to maternal depressive symptoms at child age 13. Implications for practice and future research directions are discussed.

Stress in caregivers of individuals with intellectual or developmental disabilities: A systematic review of mindfulness-based interventions

BACKGROUND

The efficacy of mindfulness-based interventions (MBIs) for stress and psychological distress in professional caregivers supporting individuals with intellectual or developmental disabilities (IDDs) is reviewed.

METHODS

Eight studies met inclusion criteria and were systematically reviewed, including RCTs and single-group designs.

RESULTS

As per Reichow, Volkmar, and Cicchetti (Journal of Autism and Developmental Disorders, 38, 2008), three studies were classified as "adequate quality" and five were classified as "weak." There were inconsistent findings in relation to stress, with significant reductions or increases reported by caregivers following MBIs. MBIs consistently improved caregivers' ratings of distress. Process outcomes suggested increased mindful awareness, increased cognitive defusion and reduced thought suppression. Treatment effects were maintained or continued to grow at follow-up.

CONCLUSIONS

Caregivers of individuals with IDDs face multiple challenges on a daily basis. This review supports, at least, short-term benefits for MBIs in the management of stress and distress in caregivers of individuals with IDDs.

The relation between social anxiety and biased interpretations in adolescents with mild intellectual disabilities

BACKGROUND

Cognitive theories of anxiety emphasize the importance of cognitive processes in the onset and maintenance of anxiety disorders. However, little is known about these processes in children and adolescents with Mild Intellectual Disabilities (MID).

AIMS

The aim of this study was to investigate interpretation bias and its content-specificity in adolescents with MID who varied in their levels of social anxiety.

METHOD AND PROCEDURES

In total, 631 adolescents from seven special secondary schools for MID filled in questionnaires to measure their levels of social anxiety. They also completed the Interpretation Recognition Task to measure how they interpret ambiguous situations.

OUTCOMES AND RESULTS

Adolescents with higher self-reported levels of social anxiety interpreted ambiguous scenarios as more negative than adolescents with lower self-reported social anxiety. Furthermore, this negative interpretation was specific for social situations; social anxiety was only associated with ambiguous social anxiety-related scenarios, but not with other anxiety-related scenarios.

CONCLUSIONS AND IMPLICATIONS

These findings support the hypothesis that socially anxious adolescents with MID display an interpretation bias that is specific for stimuli that are relevant for their own anxiety. This insight is useful for improving treatments for anxious adolescents with MID by targeting content-specific interpretation biases.

Impact of caring for patients with severe and complex disabilities on health care workers' quality of life: determinants and specificities

AIM

Individuals with severe and complex disabilities, defined by a combination of profound intellectual impairment and serious motor deficit resulting in extreme dependence, often remain in hospital or at residential facilities. The aim of this study was to identify the determinants of quality of life (QoL) of 238 health care workers (HCWs) caring for individuals with severe and complex disabilities.

METHOD

We conducted a cross-sectional study. The recruitment of the HCWs was performed in five French centres specializing in patients with severe and complex disabilities. The selection criteria were age above 18 years, being an institutional referent HCW (a resource person coordinating various issues for or about the patient), and agreeing to participate. Sociodemographic, health, professional variables, and psycho-behavioural (QoL, burn-out, and coping strategies) data were collected.

RESULTS

Of the 362 eligible HCWs, 65.7% returned the questionnaires. The scores of the physical and social dimensions of QoL were significantly lower, and the score of the psychological dimension significantly higher, than those of a comparison group. The main factors modulating QoL were age, financial difficulties, nature of coping strategy, and burn-out.

INTERPRETATION

This research provides preliminary evidence that caring for patients with severe and complex disabilities affects the QoL of HCWs. These results support the need for optimization of the work environments for HCWs.

The impact of child and family stressors on the self-rated health of mothers of children with autism spectrum disorder: Associations with depressed mood over a 12-year period

Employing a cohort sequential design and multilevel modeling, the effects of child and family stressors and maternal depressed mood on the self-rated health of 110 mothers of children with autism spectrum disorder were assessed over a 12-year period when children in the study were 7–19 years old. Findings indicate a significant decline in self-rated health over time. In addition, child and family stressors, as well as maternal depressed mood, exerted significant between-persons effects on self-rated health such that mothers who reported more stressors and depressed mood across the study period were less likely to rate themselves in better health across that period. In addition, a significant within-person relationship between maternal depressed mood and self-rated health was found, indicating that at times when mothers reported higher levels of depressed mood than usual (their personal average across the study), they were significantly less likely to report better self-rated health. Finally, maternal depressed mood partially mediated the between-persons effects of child and family stressors on self-rated health such that increased stressors led to increased maternal depressed mood which, in turn, led to poorer maternal self-rated health. Findings suggest that chronic stressors erode maternal health over time and that depression may be an important mechanism linking stressors to decreased maternal health.

Social support, coping, and positive perceptions as potential protective factors for the well-being of mothers of children with intellectual and developmental disabilities

Objectives: Behavioral and emotional problems exhibited by children with intellectual and developmental disabilities (IDD) have been identified as significant stressors for family members in both cross-sectional and longitudinal research. However, there is variability in the extent to which family members are affected by behavioral and emotional problems. In the present study, we explored whether perceived social support, positive perceptions, or coping style explain some of this variability and specifically whether these three variables function as protective factors. Methods: One hundred and thirty-eight mothers of children aged between four and 18 years old with IDD participated in a cross-sectional survey. Results: Using moderated multiple regression models, we found consistent evidence that perceived social support functioned as a protective factor - affecting the relationship between child behavioral and emotional problems and maternal depression, life satisfaction, and positive affect. There was no evidence that coping and positive perceptions acted as a protective factors. Conclusion: Building social support through parental interventions, especially in families of children with behavioral and emotional problems, may result in improved well-being for mothers of children with IDD.

Family adaptation to cerebral palsy in adolescents: A European multicenter study

BACKGROUND AND AIM

Factors promoting family adaptation to child's disability are poorly studied together. The aim of the study was to describe the family adaptation to disability and to identify determinants associated with using a global theoretical model.

MATERIALS AND METHODS

286 families of teenagers [13-17 years] with cerebral palsy (CP) from 4 European disability registers were included and visited at home. Face to face interviews were performed in order to measure parental distress, perceived impact in various dimensions of family life, family resources and stressors. Relationships were modelled with structural equations.

RESULTS

31.8% of parents living with an adolescent with CP showed clinically significant high stress requiring professional assistance. The main stressors were the level of motor impairment and behavioural disorders in adolescent. A good family functioning was the best protective factor. Respite in care and a parents' positive attitude were significantly related to less parental distress. Material support, socioeconomical level, marital status or parental qualifications did not appear to be significant protector factors.

CONCLUSIONS

Particular attention must be paid not only on physical condition but also on adolescent psychological problems to improve family adaptation. Families at risk of experiencing severe distress should be targeted early and proactive caregiver interventions on the whole family should be performed.

WHAT THIS PAPER ADDS

Family is a dynamic system: facing disability, it tries to recover its balance with available resources and its perception of the situation. Literature highlights potential stressors and protecting factors that could affect the disabled child's family adaptation but few papers study a global model including most of these factors. This study validated a global theoretical model of family adaptation to disability at adolescence. It identified behaviour disorders and motor impairment level as main stressors, family functioning as the largest protecting factors, and equipment and financial support as non significant protective factors.

Cognitive Behavioural Therapy and Mindfulness for Health-Related Quality of Life: Comparing Treatments for Parents of Children with Chronic Conditions - A Pilot Feasibility Study

Background:

Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders.

Objective:

The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions.

Method:

The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months.

Results:

The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner.

Conclusion:

The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.

The Impact of Self-Narratives of Motherhood for Mothers of Children with Autism

The main goal of this study was to identify the impact of a narrative construction of a life challenge - discovering to have a child with autism - on the meaning of life and on resources for coping depending on the challenge’s novelty, i.e., the number of years from the diagnosis. Three hundred and sixty four mothers of children with autism participated in a long-term 3 × 2 experiment. Half of the mothers had children with autism at the age of 9–12 years. For the remaining half, having children with autism was a new and stressful life situation. Their children were 2–3 years old and just diagnosed by a medical center as having autism spectrum disorder. The mothers were assigned to one of three study conditions: they were either asked to write stories of their motherhood or to describe their children’s behavior on a questionnaire or they did not participate in any tasks. One month and then 4 months after this task the participants completed measures of meaning of life and several well-being scales. The results indicated that following the narrative writing the participants had the highest scores on the meaning of life and well-being scales. This affect was sustained over 4 months and was significant only for mothers with older children. The mediation analysis showed that the effects of the experimental conditions on different well-being scales were mediated by the changes in perceived meaning of life. The results suggest that construction of self-narratives of difficult ongoing challenges facilitates meaning making and subsequently strengthens resources for coping. However, it seems that a meaning-making construction of such self-story may be blocked by the uncertainty and stress caused by novelty of the challenging situation.

The Longitudinal Effects of Network Characteristics on the Mental Health of Mothers of Children with ASD: The Mediating Role of Parent Cognitions

Employing a cohort sequential design, the effects of network characteristics on maternal cognitions (perceived social support and parenting self-efficacy) and mental health (depression and well-being) were assessed over 7 years when children with ASD of mothers in the study were age 7-14. Findings indicated that network size, network emotional support, and network instrumental support were positively related to perceived support, while network availability and emotional support were positively linked to self-efficacy. In addition, network support exerted direct and indirect effects on maternal depression and well-being, with cognitive resources mediating the social network-mental health relationship. Finally, consistent with the support-efficacy model, parenting efficacy partially mediated the effects of perceived support on maternal mental health outcomes. Study findings and implications are discussed.

Mental health and positive change among Japanese mothers of children with intellectual disabilities: Roles of sense of coherence and social capital

We investigated predictors of mental health and positive change among mothers of children with intellectual disabilities in Japan based on the concept of the Double ABCX model. We used variables of having a child with autism spectrum disorder (ASD) and dissatisfaction with systems as stressors, availability of social support and social capital (SC) as existing resources, sense of coherence (SOC) as appraisal of the stressor, and mental health and positive change as adaptation. A self-administered questionnaire was distributed to 10 intellectual disability-oriented special needs schools in Tokyo, and obtained 613 responses from mothers of children under age 20 attending these schools. The results showed that our Double ABCX model explained 46.0% of the variance in mothers' mental health and 38.9% of the variance in positive change. The most powerful predictor of this model was SOC, and SC may be directly and indirectly related to maternal mental health and positive change through mothers' SOC. Increasing opportunity for interaction between neighbors and family of children with disabilities may be one effective way to enhance SOC through SC. Since maternal SOC, SC, mental health, and positive change were significantly correlated with each other, synergy among these elements could be expected.

Behavioral disorder in people with an intellectual disability and epilepsy: A report of the Intellectual Disability Task Force of the Neuropsychiatric Commission of ILAE

The management and needs of people with intellectual disability (ID) and epilepsy are well evidenced; less so, the comorbidity of behavioral disorder in this population. "Behavioral disorder" is defined as behaviors that are difficult or disruptive, including stereotypes, difficult or disruptive behavior, aggressive behavior toward other people, behaviors that lead to injury to self or others, and destruction of property. These have an important link to emotional disturbance. This report, produced by the Intellectual Disability Task Force of the Neuropsychiatric Commission of the ILAE, aims to provide a brief review of some key areas of concern regarding behavioral disorder among this population and proposes a range of research and clinical practice recommendations generated by task force members. The areas covered in this report were identified by experts in the field as being of specific relevance to the broad epilepsy community when considering behavioral disorder in persons with epilepsy and ID; they are not intended to be exhaustive. The practice recommendations are based on the authors' review of the limited research in this field combined with their experience supporting this population. These points are not graded but can be seen as expert opinion guiding future research and clinical practice.

Parental quality of life in complex paediatric neurologic disorders of unknown aetiology

Complex paediatric neurology (CPN) patients generally present with non-specific symptoms, such as developmental delay, impaired movement and epilepsy. The diagnostic trajectory in these disorders is usually complicated and long-lasting, and may be burdensome to the patients and their parents. Additionally, as caring for a chronically ill child can be stressful and demanding, parents of these patients may experience impaired health-related quality of life (HRQoL). This study aims to assess parental HRQoL and factors related to it in CPN. Physical and mental HRQoL of 120 parents was measured and compared to the general population using the SF-12 questionnaire. Parents also completed this questionnaire for the measurement of patient HRQoL. Additional questionnaires were used to measure parental uncertainty (Visual Analogue Scale) and worry phenomena (Penn State Worry Questionnaire), and to obtain socio-demographic data. A linear mixed model with random effect was used to investigate which of these variables were associated with parental HRQoL. As compared to the general population, HRQoL of these parents appeared diminished. Fathers showed both lowered physical (51.76, p < 0.05) and mental (49.41, p < 0.01) HRQoL, whereas mothers only showed diminished mental (46.46, p < 0.01) HRQoL. Patient HRQoL and parental worry phenomena were significantly correlated with overall and mental parental HRQoL. The reduction in parental mental HRQoL is alarming, also because children strongly rely on their parents and parental mental health is known to influence children's health. Awareness of these problems among clinicians, and supportive care if needed are important to prevent exacerbation of the problems.

Parental coping with adolescent developmental disabilities in terms of stress, sense of coherence and hope within the Druze community of Israel

BACKGROUND

Many studies have examined the coping resources of parents of children with disabilities but most have involved Western families and only a few refer to unique and traditional cultures.

AIM

This study sought to compare Druze parents of adolescents with and without developmental disabilities (DD) in the context of Druze traditions and beliefs and whether they may lead to better coping by parents of a child with DD. The study used the measures of stress; sense of coherence (SOC) - an orientation towards the world which reflects an ongoing confidence that things fall into place in a logical and meaningful way; and hope.

METHODS AND PROCEDURES

The sample group consisted of 99 Druze parents of adolescents with and without DD enrolled in regular and special schools in Israel. The parents were asked to complete four questionnaires on demography, stress, SOC (Sense of coherence) and hope.

OUTCOMES AND RESULTS

The research findings indicate a higher sense of parental stress and a lower overall SOC, particularly meaningfulness, and hope among parents of adolescents with DD. There was no difference between the two groups of parents with respect to marital, economic and overall stress or in the other two components of SOC.

CONCLUSIONS AND IMPLICATIONS

The results of the study partly contradict the assumption in the limited literature about Druze that they may cope better with life stressors as a result of their traditions and beliefs. The results also indicate the need for further research and culturally-based intervention programs.

Self-reported health and sickness benefits among parents of children with a disability

This article investigates the possible consequences in self-reported health and receipt of sickness benefits when parenting a child with a disability This study uses data from the population health study, The Nord-Trøndelag Health Study (HUNT 2), and the historical event database, FD-Trygd, which contains Social Security and national insurance data for the Norwegian population. In the analysis, we compare 1587 parents of a child with a disability to other parents. Results indicate that parenting a disabled child impacts on self-reported health, particularly among mothers; however, being a parent to a disabled child has a much stronger effect in explaining the variance in received sickness benefits, and also length of time and frequency of having received sickness benefits. Parents with disabled children report just slightly lower self-reported health but are on sickness benefits more often than other parents which may be attributed to their extended care responsibilities.

Mothers supporting children with autistic spectrum disorders

Parents of children with autistic spectrum disorders (ASDs) are more likely to experience serious psychological distress than parents of children with other developmental disabilities. To examine the impact of a range of factors on psychological wellbeing, interviews were undertaken with 68 mothers of children with ASDs to explore aspects of social support, mental health status and satisfaction with services. Findings indicated that over half of mothers screened positive for significant psychological distress and that this was associated with low levels of family support and with bringing up a child with higher levels of challenging behaviour. Mothers were more likely to report lower levels of support if they were a lone parent, were living in poor housing, or were the mother of a boy with ASD. The study also investigated areas of useful support and areas of unmet need, the latter including care breaks and advice needs.

The impact of caring for an adult with intellectual disability and psychiatric comorbidity on carer stress and psychological distress

BACKGROUND

Given that carers of individuals with intellectual disability (ID) and carers of individuals with psychiatric disorders experience elevated levels of stress and psychological distress, carers of individuals with both ID and a comorbid psychiatric disorder are potentially at even greater risk for psychological difficulties. The aim of the present study was to investigate the psychological well-being of carers of adults with a dual diagnosis compared with carers of adults with intellectual disability alone.

METHOD

Four-hundred and forty-two questionnaires were sent to four community services and seventy-five family carers of adults with intellectual disability responded. Psychological well-being of carers was assessed using the Questionnaire on Resources and Stress - Friedrich edition (QRS-F) and the General Health Questionnaire (GHQ). Comorbid psychopathology for their family member with ID was assessed using the Reiss Screen for Maladaptive Behaviour (RSMB).

RESULTS

Twenty-four percent of the individuals with ID were reported to have comorbid psychopathology. Between-group analyses compared carers of people with ID and comorbid psychopathology to carers of people with ID alone. Regression analyses examined the relationship between psychopathology and other care-related variables to carer stress and psychological distress. Carers of people with ID and comorbid psychopathology were found to have significantly higher levels of stress and psychological distress than carers of people with ID alone. Autism was found to be the only significant predictor of both stress and psychological distress among measures of psychopathology.

CONCLUSIONS

Additional comorbid psychopathology in individuals with intellectual disability has a significant impact on their carers' psychological well-being.

Psychosocial correlates of psychiatric diagnoses and maladaptive behaviour in youth with severe developmental disability

BACKGROUND

We know little about the correlates of mental health problems in youth with severe and profound intellectual disability (ID), as most research includes these youth within larger samples that include greater proportions of mild and moderate disability. The purpose of the current study was to identify the child, family and psychosocial characteristics that were associated with the presence of psychiatric diagnoses and maladaptive behaviour in youth with severe ID.

METHODS

Participants were 141 parents of youth with severe or profound levels of ID, 4 to 18 years of age. The mean age of children was 11.04 years (SD = 3.38), with 68% male and 39% with autism spectrum disorder (ASD). Parents completed a primarily online survey of child and family characteristics, negative life events, family quality of life and their own mental health.

RESULTS

Logistic regression analyses revealed that youth with a psychiatric diagnosis had higher levels of adaptive behaviour and experienced more negative life events than youth without psychiatric diagnosis, while the presence of clinically significant maladaptive behaviour was related to higher levels of adaptive behaviour, parents' mental health problems and lower family quality of life. Child age, gender, ASD status and financial hardship were not related to either outcome variable.

CONCLUSIONS

Youth with severe and profound ID who experience psychosocial stressors are more likely reported to have mental health problems than youth without such stressors. It is likely that a combination of child and family based interventions, along with with policies that address larger systemic issues of social adversity, are needed to promote mental health and treat psychopathology when it arises.

Pathways from Early Childhood Adversity to Later Adult Drug Use and Psychological Distress: A Prospective Study of a Cohort of African Americans

Drawing on the life course perspective, this research addresses the direct and indirect pathways between childhood adversity and midlife psychological distress and drug use across a majority of the life span in an African American cohort (N = 1,242) followed from age 6 to 42 (1966 to 2002). Results from structural equation models highlight the impact of low childhood socioeconomic status (SES), poor maternal mental health, and the role of first-grade maladaptation in launching a trajectory of social maladaptation from age 6 to 42. Specifically, for men, we found a direct pathway from early low SES to drug use in mid adulthood and an indirect pathway to psychological distress through first-grade maladaptation and adolescent poor mental health. For females, early SES affected first-grade maladaptation and low school bonds, which then predicted later drug use.