Caregiving burden of families looking after persons with intellectual disability and behavioural or psychiatric problems

Validation of the Subjective and Objective Family Burden Interview (SOFBI/ECFOS) in primary caregivers to adults with intellectual disabilities living in the community

BACKGROUND

There is little information on the psychometric properties of instruments for assessing family care burden in adults with intellectual disabilities (ID). The aim of this study is therefore to analyse the usefulness of the 'Subjective and Objective Family Burden Interview' (SOFBI) in the assessment of principal caregivers in Spain.

METHODS

The SOFBI was administered to 166 principal caregivers of adults with ID in a vocational centre. The psychometric analysis included: internal consistency, inter-rater and test-retest reliability, construct validity, convergent validity with the World Health Organization's Disability Assessment Schedule II, and feasibility.

RESULTS

The Cronbach's alpha was 0.88 for the overall interview and always above 0.7 in the quantitative subdomains. The Kappa coefficients for test-retest were between 0.5 and 0.8, whereas inter-rater agreement was nearly perfect. Maximum-likelihood factor analysis showed four well-defined factors, which fitted the previously designed domains. Feasibility was also good.

CONCLUSIONS

The SOFBI is a multi-domain, modular instrument which is feasible, reliable and valid for measuring the burden of family caregivers to adults with ID living in the community.

Subjective burden in mothers of speech-impaired children

OBJECTIVE

Evaluation of perceived subjective burden in mothers of speech-impaired children against the presence or absence of an emotional disorder.

METHODS

89 mothers (age 33.3 +/- 5.5 years, range: 19.6-43.8 years) of 89 preschool children (23 girls, 66 boys, age: 3.9 +/- 1.5 years, range: 1.6- 7.1 years) with specific speech impairment were investigated. German versions of the Hospital Anxiety and Depression Scale (HADS) and the Burden Scale for Family Caregivers (BSFC) were applied.

RESULTS

11% of the mothers met criteria for a depressive disorder (normal controls: 2.5%; p = 0.008). Twenty-eight percent of the mothers met criteria for anxiety disorders (normal controls: 9.6%; p = 0.000). The HADS depression subscore and the BSFC correlate with r = 0.75. The HADS anxiety subscore and the BSFC correlate with r = 0.59.

CONCLUSIONS

Results suggest the need for routine clinical assessment of mothers' well-being when their children are affected by speech impairment.

[Critical factors for subjective burden of mothers of children with developmental language disorders]

BACKGROUND

In earlier studies, it was found that mothers of children with developmental language disorders had a higher incidence of anxiety and depression in comparison to the normal population. This study concentrated on the following questions: is the perceived stress, anxiety and depression of mothers with children with developmental language disorders higher than in the normal population, even for those mothers who are not exposed to any further stressors? and what environmental factors play an important role in the mental health of the mothers?

MATERIALS AND METHODS

A total of 90 mothers (aged 32.9+/-4.7 years) of preschoolers diagnosed with a developmental language disorder, but with otherwise normal development, participated in the study. The mental health of the mothers was assessed using the Perceived Stress Scale (PSS) and the German version of the Hospital Anxiety and Depression Scale (HASD-D). Environmental factors were captured by a structured anamnestic procedure. Predictors of mental health were determined using multivariate regression analysis.

RESULTS

The entire sample demonstrated significant levels of stress, anxiety and depression. In comparison to the standardized values, those mothers of children with developmental language disorders who were not exposed to any further stressors, were also shown to have significantly higher rates of stress and depression on the scales used, although not significantly higher levels of anxiety. A significant predictor of positive overall mental health of the mothers was the extent of adequate support in child rearing.

CONCLUSIONS

Health professionals dealing with children with developmental language disorders must reckon with a considerable number of mothers whose mental health is negatively affected. When treating a child with a developmental language disorder, measures to improve the mother's state of well-being should be considered, including counseling and self-help groups.

[Somatic complaints in mothers of children with developmental language disorders]

BACKGROUND

In preliminary studies of mothers of children with developmental language disorders it was found that the mothers' quality of life was diminished and that they suffered from increased emotional disorders. Studies have shown that women with emotional problems also experience increased somatic afflictions. This phenomenon has not yet been confirmed in the context of mothers of children with developmental language disorders.

MATERIALS AND METHODS

Ninety mothers (aged 21-48 years) of 90 preschoolers diagnosed with a developmental language disorder, but otherwise of normal development, were questioned using the Giessen Complaint Questionnaire (Giessener Beschwerdebogen, GBB), to assess their level of somatic complaints. The multivariate statistical method used was the regression analysis.

RESULTS

In comparison to women of the same age in the normal population, the mothers in this study had significantly more somatic symptoms. This was shown to be true even for those mothers who, though specifically asked, could not name any particular illness. In mothers of children being treated for developmental language disorders, psychosomatic complaints occurred more frequently. The same result can be observed in mothers who perceived a lack of adequate support in caring for their children as opposed to those who perceived support to be adequate.

CONCLUSIONS

Physicians and health workers treating children with developmental language disorders must reckon with a considerable number of mothers with somatic complaints. As these complaints often occur without any specific illness, they must be considered psychosomatic in nature. These findings are in accordance with earlier studies looking at the relationship between specific emotional disorders and diminished quality of life of those affected. Specific channels of help include utilization of self-help groups or mothers' groups, educational enhancement programs and speech therapists.

Supporting parents of youths with intellectual disabilities and psychopathology

BACKGROUND

Parents of children and adolescents with both intellectual disabilities (ID) and psychopathology often experience high levels of parenting stress. To support these parents, information is required regarding the types of support they need and whether their needs are met.

METHOD

In a sample of 745 youths (aged 10-24 years) with moderate to borderline ID, 289 parents perceived emotional and/or behavioural problems in their child. They were asked about their needs for support and whether these needs were met. Logistic regression analysis revealed the variables associated with both needing and receiving specific types of support. In addition, we asked those parents who had refrained from seeking support about their reasons.

RESULTS

Most parents (88.2%) needed some supports, especially a friendly ear, respite care, child mental health care and information. Parents who perceived both emotional and behavioural problems in their child needed support the most. In addition, parents whose child had any of these problems before the past year, who worried most about their child and suffered from psychopathology themselves, more often needed support. Parents of children with moderate ID or physical problems especially needed 'relief care', that is, respite care, activities for the child and practical/material help. The need for a friendly ear was met most often (75.3%), whereas the need for parental counselling was met least often (35.5%). Not receiving support despite having a need for it was primarily related to the level of need. Parents who indicated to have a stronger need for support received support more often than parents who had a relatively low need for support. The parents' main reasons for not seeking support concerned their evaluation of their child's problems (not so serious or temporary), not knowing where to find support or wanting to solve the problems themselves first.

CONCLUSIONS

Most parents had various support needs that were frequently unmet. Service providers should especially aim at providing information, activities, child mental health care and parental counselling. Furthermore, parents need to be informed about where and how they can obtain what kind of support. A case manager can be of help in this.

Syndrome specificity and behavioural disorders in young adults with intellectual disability: cultural differences in family impact

BACKGROUND

This study examined whether behaviour problems and adaptive behaviour of low functioning young adults, and well-being of their families, varied by diagnostic syndrome [intellectual disability (ID) only, cerebral palsy, Down syndrome, autism], as well as by cultural group.

METHODS

Behaviour disorders in young adults with moderate to severe ID were assessed from information provided by 282 caregivers during in-home interviews. The sample consisted of 150 Anglo participants, and 132 Latino, primarily Spanish-speaking, participants drawn from Southern California.

RESULTS

Behaviour disorders and maternal well-being showed the same pattern across disability syndromes. Autism was associated with the highest scores in multiple behaviour problem areas as well as maternal reports of lower well-being. Down syndrome was associated with the lowest behaviour problem scores and the highest maternal well-being. When behaviour problems were controlled for, diagnostic groups accounted for no additional variance in maternal stress or depression. The pattern of behaviour problems and well-being did not differ by sample (Anglo vs. Latino), although level on well-being measures did. Latina mothers reported significantly higher depression symptoms and lower morale, but also higher positive impact from their child than did Anglo mothers.

CONCLUSIONS

Caregivers of young adults with autism report more maladaptive behaviour problems and lower personal well-being, or stress, relative to other diagnostic groups, regardless of cultural group. However, cultural differences exist in caregiver reports of depression, morale, and positive perceptions. Implications for service provision aimed at families of children with challenging behaviour problems are discussed in the context of culture.

Empowerment in parents of school-aged children with and without developmental disabilities

BACKGROUND

Despite the widespread use of the term 'empowerment' in clinical literature to describe both a desirable process and the outcome of service delivery, the term remains more of a theoretical than practical construct. This study examined the factors that contribute to empowerment in parents of school-aged children with and without developmental disabilities (DD) using the Double ABCX model of family adaptation contrasted with the linear ACBX model.

METHODS

Parents of children with (n = 100, 97% mothers) and without (n = 100, 98% mothers) DD completed questionnaires relating to child behaviour problems, parent stress and well-being, and formal and informal support. Structural equation modelling was used

RESULTS

Parents of children with DD reported more child behaviour problems, more stress, less well-being and more social support than parents of children without DD. Structural equation modelling supported the ACBX model for both groups. A linear relationship was found in which parent well-being and resources mediated the relationship between the stressor (child behaviour problems) and the outcome (empowerment).

CONCLUSIONS

The results of the current study support Hastings and Taunt's assertion in 2002, in that empowerment was adequately explained using a traditional model of family functioning. The significant prediction offered by the parent's resources points to the need to deliver services in a manner that is more family-centred. In the education system, this means providing parents with clear messages regarding the schools goals, clarifying the parent's rights and responsibilities, including the parent in planning and decision making, respecting their knowledge as caregivers and supporting their hopes for their child.

Preschool children with intellectual disability: syndrome specificity, behaviour problems, and maternal well-being

BACKGROUND

Children with intellectual disability (ID) are at heightened risk for behaviour problems and diagnosed mental disorder. Likewise, mothers of children with ID are more stressed than mothers of typically developing children. Research on behavioural phenotypes suggests that different syndromes of ID may be associated with distinct child behavioural risks and maternal well-being risks. In the present study, maternal reports of child behaviour problems and maternal well-being were examined for syndrome-specific differences.

METHODS

The present authors studied the early manifestation and continuity of syndrome-specific behaviour problems in 215 preschool children belonging to 5 groups (typically developing, undifferentiated developmental delays, Down syndrome, autism, cerebral palsy) as well as the relation of syndrome group to maternal well-being.

RESULTS

At age 3, children with autism and cerebral palsy showed the highest levels of behaviour problems, and children with Down syndrome and typically developing children showed the lowest levels. Mothers of children with autism reported more parenting stress than all other groups. These syndrome-specific patterns of behaviour and maternal stress were stable across ages 3, 4 and 5 years, except for relative increases in behaviour problems and maternal stress in the Down syndrome and cerebral palsy groups. Child syndrome contributed to maternal stress even after accounting for differences in behaviour problems and cognitive level.

CONCLUSIONS

These results, although based on small syndrome groups, suggest that phenotypic expressions of behaviour problems are manifested as early as age 3. These behavioural differences were paralleled by differences in maternal stress, such that mothers of children with autism are at elevated risk for high stress. In addition, there appear to be other unexamined characteristics of these syndromes, beyond behaviour problems, which also contribute to maternal stress.

[Subjective aspects in mothers of speech impaired children]

OBJECTIVE

The purpose of this study was to evaluate the subjective burden in mothers of speech impaired children against the presence or absence of emotional disorders such as anxiety and depression.

METHODS

A total of 89 mothers (age 33.3+/-5.5 years, range: 19.6-43.8 years) of 89 speech impaired preschool children (23 girls, 66 boys, age: 3.9+/-1.5 years, range: 1.6-7.1 years) were examined. Screening for a depressive or anxiety disorder was performed using the German version of the Hospital Anxiety and Depression Scale HADS-D. The "Short Questionnaire on Current Burden" (Kurzfragebogen zur Aktuellen Belastung, KAB) was used to measure the level of perceived subjective burden at the time of the investigation.

RESULTS

A higher score in the KAB test occurred significantly more often in mothers with a positive HADS depression/anxiety subscale result than in those with a negative one.

CONCLUSIONS

There is a need for specific assessment of wellbeing in mothers of speech impaired children. In clinical practice, one may restrict oneself to the use of a screening test for anxiety and depression.