Age and gender differences in the well-being of midlife and aging parents with children with mental health or developmental problems: report of a national study

Reconceptualizing Family Adaptation to Developmental Delay

This study explores accurate conceptualization of the adaptation construct in families of children with developmental delay aged 3 to 8 years. Parents' self-reported measures of adaptation and observed dyadic relationship variables were examined. Confirmatory factor analysis and longitudinal growth modeling were used to evaluate the nature of adaptational processes. Results indicate that adaptational processes vary across adaptation index, child developmental level, and parent gender. Adaptation indices did not load onto a single construct at any time point. Several adaptational processes remained stable across time, although others showed linear or quadratic change. The findings of the current study indicate that it is time for a change in how adaptation is conceived for families of children with developmental delay.

Health-related quality of life--from the perspective of mothers and fathers of adult children suffering from long-term mental disorders

There is a lack of studies on mothers' and fathers' experiences of Health-Related Quality of Life (HRQOL) associated with caregiving of adult children suffering from mental disorder. A cross-sectional study was therefore carried out with 108 mothers and 43 fathers. Data were collected by means of the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Family Involvement and Alienation Questionnaire (FIAQ) and the Burden Assessment Scale (BAS). Mothers' HRQOL was affected more than fathers' and lower compared to Swedish age related norms. HRQOL was predominantly related to ratings on HADS and BAS.

Still stressed but feeling better: Well-being in autism spectrum disorder families as children become adults

The transition to adulthood and adulthood itself have been identified as times of stress for parents of individuals with autism spectrum disorder. Longitudinal studies, however, show improvements in the well-being of mothers of adolescents and young adults with autism spectrum disorder. This article presents a cross-sectional study of 102 Spanish parents (51 mothers and 51 fathers) of 102 individuals with autism spectrum disorder. The aim was to examine parental well-being (evaluated based on stress, anxiety, depression and psychological well-being) in three groups of parents of adults, adolescents and young children with autism spectrum disorder. In addition, the relationships between parental well-being and the characteristics of their children, social support, parental age and sense of coherence were analysed. The results showed that although parental stress and psychological well-being levels were similar across the groups, depression and anxiety were lower in parents of adolescents or adults compared with parents of young children. Different factors predicted different measures of parental well-being, but sense of coherence emerged as the main predictive factor for all parental well-being measures. These findings are discussed in relation to parental adaptation over the lifespan and the implications for interventions in autism spectrum disorder families.

Young Adults' Provision of Support to Middle-Aged Parents

OBJECTIVES

Middle-aged adults often provide support to aging parents, but researchers know little about support that young adults provide middle-aged parents. This study examined support that young adults provide parents and explanations for that support from both offspring's and parents' perspectives.

METHOD

Young adults (n = 515, mean age = 22.34) and their parents (n = 364, mean age = 50.09) from the Family Exchanges Study reported support that offspring provide parents. Participants also reported parental personal problems, parental disability status, relationship quality, and support that parents provide offspring.

RESULTS

Offspring provided parents with emotional support and listening more often than other forms of support. Offspring reported providing more frequent support than parents reported receiving. We examined factors associated with support using multilevel models. Both offspring and parents reported more frequent support provided to parents when they had higher quality relationships and when parents gave more frequent support to offspring. Offspring (but not parents) reported providing more frequent support to parents when parents were disabled.

DISCUSSION

Findings are consistent with solidarity theory, which suggests that high-quality relationships may explain support. The concept of self-enhancement and generativity in middle-aged parents may explain the intergenerational differences in the association between parental disability and support.

The challenges for primary caregivers of adolescents with disruptive behavior disorders

Adolescents with disruptive behavior disorders (DBD), including oppositional defiant disorder and conduct disorder, present unique challenges for their families. Although, most empirically supported treatments for DBD are family-based, the emphasis is typically on the behavior of the child rather than on the life challenges and resultant distress experienced by the family members. Fifteen families of adolescents with DBD were recruited from a large publicly funded Community Mental Health Center. For this report, data from in-depth interviews with the adolescents' primary caregivers were analyzed by standard content analytic procedures to describe the challenges they experienced living with and caring for the adolescents. The primary caregivers reported that the challenges were overwhelming, demanding, and unrelenting. The two most salient challenges were (a) managing the adolescents' aggressive, defiant, and deceitful behaviors, and (b) interacting frequently with a number of child-serving agencies. A number of clinical implications are drawn from these findings.

Health and well-being in midlife parents of children with special health needs

The objectives of this study were to delineate variation in mental and physical health outcomes over a 10-year period among parents with a child with special health needs as compared to parents of a typically developing child; and evaluate the possible protective effects of parental perceived control and social support. The sample consisted of 646 parents from the longitudinal Midlife Development in the United States (MIDUS) study. Nearly one-quarter of the sample (n = 128; 22.3%) reported having a child with a special health care need. Cross-sectional analyses indicated that parents of a child with special care needs reported poorer self-rated mental health, greater depressive symptoms, and more restrictions in instrumental activities of daily living (IADL). Parents of a child with special health care needs had greater increases in depressive symptoms over time and greater declines in instrumental activities of daily living than parents of typically developing children. Perceived control was a robust predictor of all health outcomes over time. The added stressors of parenting a child with special health needs may undermine the long-term health of parents. Behavioral interventions and clinical practices that facilitate parental perceived control may enable resilience and better health.

Interventions for family members of adolescents with disruptive behavior disorders

PROBLEM

The family members of adolescents diagnosed with disruptive behavior disorders (DBDs) experience profound stress and burden. Despite the need for empirically supported interventions that address the challenges faced by these family members, few such interventions are available.

METHODS

In this qualitative descriptive study, we conducted in-depth interviews with 15 families of adolescents diagnosed with DBD. We asked the family members to identify what types of mental health services they needed and to describe the "ideal" program that would best address their concerns.

FINDINGS

Family members identified several intervention modalities that would fit their needs, including multifamily groups, family therapy, individual therapy, and community-based hotlines. They indicated that programs should address the following topics: family communication, conflict resolution, education about DBD, and strategies to improve interactions with child service agencies.

CONCLUSIONS

Clinicians should recognize that all family members may need support to manage the stressors associated with caring for or living with adolescents with DBD. When working with families, clinicians should provide information about the etiology and management of DBD, help navigate interactions with child service agencies, and employ strategies to improve family communication and functioning.

Parent and family impact of raising a child with perinatal stroke

Background

Perinatal stroke is a leading cause of early brain injury, cerebral palsy, and lifelong neurological morbidity. No study to date has examined the impact of raising a child with perinatal stroke on parents and families. However, a large breadth of research suggests that parents, especially mothers, may be at increased risk for psychological concerns. The primary aim of this study was to examine the impact of raising a child with perinatal stroke on mothers’ wellbeing. A secondary aim was to examine how caring for a child with perinatal stroke differentially affects mothers and fathers.

Methods

In Study I, a matched case-control design was used to compare the wellbeing of mothers of children with perinatal stroke and mothers of children with typical development. In Study II, a matched case-control design was used to compare mother-father dyads. Participants completed validated measures of anxiety and depression, stress, quality of life and family functioning, marital satisfaction, and marital distress. Parents of children with perinatal stroke also completed a recently validated measure of the psychosocial impact of perinatal stroke including guilt and blame outcomes. Disease severity was categorized by parents, validated by the Pediatric Stroke Outcome Measure (PSOM), and compared across the above outcomes in Study I.

Results

A total of 112 mothers participated in Study I (n = 56 per group; mean child age = 7.42 years), and 56 parents participated in Study II (n = 28 per group; mean child age = 8.25 years). In Study I, parent assessment of disease severity was correlated with PSOM scores (γ = 0.75, p < .001) and associated with parent outcomes. Mothers of children with mild conditions were indistinguishable from controls on the outcome measures. However, mothers of children with moderate/severe conditions had poorer outcomes on measures of depression, marital satisfaction, quality of life, and family functioning. In Study II, mothers and fathers had similar outcomes except mothers demonstrated a greater burden of guilt and higher levels of anxiety.

Conclusions

Although most mothers of children with perinatal stroke adapt well, mothers of children with moderate/severe conditions appear to be at higher risk for psychological concerns.

Relationship status and depressive symptoms among older co-resident caregivers

OBJECTIVES

Informal caregiving has been found to be burdensome and is associated with depression among older caregivers. These outcomes are often accentuated when caregivers and care recipients co-reside. The current study aims to examine whether the status of the relationship between caregiver and care recipient lessens the negative outcomes commonly associated with informal caregiving.

METHODS

The study focused on the subsample of co-resident caregivers (N = 3280) in the fourth wave of the Survey of Health Ageing and Retirement in Europe, of persons aged 50 or above, collected in 2011. A logged count of depressive symptoms, measured on the EURO-D scale, was hierarchically regressed on relationship status, measured as relationship type and closeness (confidant) controlling for sociodemographic background, health and country.

RESULTS

Co-resident caregivers of spouse and children experienced more depressive symptoms than other relationship co-resident caregiving dyads. However, those who cared for a confidant experienced fewer depressive symptoms, independent of the relationship type.

CONCLUSIONS

The provision of informal care is stressful and results in a heightened experience of depressive symptoms. Nonetheless, the type and closeness of the relationship between the caregiver and the care recipient can lessen caregiver depression. When informal caregivers care for a confidant, the emotional bond may reduce the depressive symptoms.

Parenting stress among mothers of children with different physical, mental, and psychological problems

BACKGROUND

Parents of children with developmental problems are always bearing a load of stress. The aim of this study is to compare the stress in mothers of children with different disabilities to each other, considering their demographic background.

MATERIALS AND METHODS

This was a cross-sectional study conducted in Isfahan, Iran during 2012 on 285 mothers of 6-12 years old children with chronic physical disease, psychological disorder, and sensory-motor and mental problems. Abedin's parenting stress questionnaire was used and obtained data were analyzed using multivariate analysis of variance or covariance as appropriate.

RESULTS

Mothers of children with sensory-motor mental and chronic physical problems experience more stress than mothers of children with psychological disorders (P < 0.05). The stress score of mothers of children with psychological disorders was lower than the other two groups. Also there was a significant difference between the score of mothers of children with chronic physical problems and mothers of children with psychological disorders regarding parent-child dysfunctional interaction (P < 0.01). A significant difference was observed in terms of stress among mothers of children with sensory-motor mental problems with different number of children (P < 0.05); also mothers of children with chronic physical problems in different levels of education have experienced different levels of parenting stress (P < 0.05).

CONCLUSION

Due to high level of parenting stress among our studied samples, special education and early intervention are needed for parents in our study population in order to deepening their diagnostic knowledge and professional consultation on stress management.

Transition-age children with mental illness: hearing the voices of mothers

Members of a local NAMI organization were surveyed in order to explore the perspectives of mothers of transitional age (18-25) children diagnosed with mental illness. Social workers in a diversity of mental health care settings can use this information to improve competence with this population. Results indicate a dynamic shift in the mothering role during this time period. Findings also suggest mothers and their transition-age children need emotional and practical support from social workers and other mental health professionals.

Mothers' perceived physical health during early and middle childhood: relations with child developmental delay and behavior problems

The self-perceived physical health of mothers raising children with developmental delay (DD; N=116) or typical development (TD; N=129) was examined across child ages 3-9 years, revealing three main findings. First, mothers of children with DD experienced poorer self-rated physical health than mothers of children with TD at each age. Latent growth curve analyses indicated that mothers in the DD group experienced poorer health from age 3 but that the two groups showed similar growth across ages 3-9 years. Second, cross-lagged panel analyses supported a child-driven pathway in early childhood (ages 3-5) by which early mother-reported child behavior problems predicted poorer maternal health over time, while the reversed, health-driven path was not supported. Third, this cross-lagged path was significantly stronger in the DD group, indicating that behavior problems more strongly impact mothers' health when children have developmental delay than when children have typical development. The health disparity between mothers of children with DD vs. TD stabilized by child age 5 and persisted across early and middle childhood. Early interventions ought to focus on mothers' well-being, both psychological and physical, in addition to child functioning.

[Psycho-emotional impact of a child's disability on parents]

Care for a child with a disability is a stressful experience for parents. It triggers a range of emotions and feelings that require a set of behaviors and attitudes to manage daily life. To face this situation, parents use coping strategies. The purpose of this study was to assess the psychological reactions (depression and anxiety) of parents and the impact of a child's disability on their quality of life (QOL), and to determine their coping strategies. A survey of 50 parents of handicapped children, treated in the neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in September 2010. The Beck Depression Inventory (BDI), the State Trait Anxiety Inventory (STAI), the SF-36, and the Brief COPE were used to assess, respectively, depression, anxiety, QOL, and coping strategies in parents. Among the group of parents studied, the anxiety and depression rates were, respectively, 68% and 52%. Depression was more frequent among mothers and was correlated with low educational and socioeconomic levels. Anxiety was found in 70.7% of mothers and 55.6% of fathers with no significant correlation. There was a correlation between anxiety and increased family burden related to the presence of a similar case in the family. The range of coping strategies used includes religion (16%), active coping (16%), planning (16%), acceptance (20%), focus and venting of feelings (10%), and seeking emotional social support (10%). Parents used emotion-focused coping in 68% of cases and problem-centered coping in 32% of cases. The coping strategy choice was significantly correlated with gender. Mothers preferentially used emotion-focused coping. Depressed or anxious parents more frequently used emotion-focused strategies. Religious faith was correlated with a strategy centered on religious coping. The length of follow-up (more than 2years) was correlated with a strategy focused on acceptance. Emotion-focused coping was also correlated with low levels of education and socioeconomic status. We found correlations between depression and different types of emotion-focused coping such as emotional support. Impaired QOL was higher among mothers (58.5% versus 33.3%). It was correlated with depression, anxiety, and the use of emotional coping. Also, it was correlated with low educational and socioeconomic levels and increased family burden related to the presence of a similar case in the family. The size most commonly impaired in mothers was limited due to mental health (56.9% versus 44.4% for fathers). Social functioning (D6) was significantly correlated with the presence of a mental disability, the functional dependence of the child, and increased family burden related to the presence of a similar case in the family. Impaired QOL was found in 66.8% of parents dissatisfied with the explanations given by the medical team. More problem-focused coping was found in parents satisfied with the information given by the medical team compared to those inadequately informed (42.1% versus 25.8%). The presence of a disabled child causes profound changes in the family. The impact of anxiety and depression on parents and on their QOL are considerable. This is a situation that involves an adaptation process. At first, parents may be tempted to use coping strategies focused on religion, a choice related to Arab-Muslim fatalism. Parents should be encouraged to use active coping strategies to support their disabled child better. In addition, adequate information given by the healthcare staff would help them to deal with the child's handicap and would contribute to improving their QOL.

Disability, health and generation status: how Hispanics in the US fare in late life

Using prospective data from a cohort of elderly Hispanics, this study explores how first-, second- and 1.5-generation Latinos differ in their levels and trajectories of disability. The results indicate that compared to second-generation elderly Hispanics, first- and 1.5-generation Hispanics had higher levels of disability. In addition, 1.5-generation elderly Hispanics had higher average ADL and IADL limitations than second-generation Hispanics at the beginning, and over time, this difference increasingly diverged. Currently married individuals had lower levels of disability than formerly married Hispanics. Also, marriage at any point in time significantly limits variability in disability in the sample, indicating that readily available spousal support is significant in diminishing generation differences in disability. Implications from these findings for future research are discussed.

Satisfaction with Life Scale (SWLS) in caregivers of clinically-referred youth: psychometric properties and mediation analysis

This paper presents the psychometric evaluation of the Satisfaction with Life Scale (SWLS; Diener et al. in J Personal Assess 49:71-75, 1985) used with a large sample (N = 610) of caregivers for youth receiving mental health services. Methods from classical test theory, factor analysis, and item response theory were utilized. Additionally, this paper investigated whether caregiver strain mediates the effect of youth symptom severity on caregiver life satisfaction (N = 356). Bootstrapped confidence intervals were used to determine the significance of the mediated effects. Results indicated that the SWLS is a psychometrically sound instrument to be used with caregivers of clinically-referred youth. Mediation analyses found that the effect of youth symptom severity on caregiver life satisfaction was mediated by caregiver strain but that the mediation effect differed based on the type of youth symptoms: caregiver strain was a partial mediator when externalizing symptoms were measured and a full mediator when internalizing symptoms were measured. Implications for future research and clinical practice are discussed.

The impact of caring for adults with intellectual disability on the quality of life of parents

BACKGROUND

Because of an increase in life expectancy and de-institutionalisation, many adults with intellectual disability (ID) live with and are cared for by their parents throughout their adult lives. Because of caring demands, the quality of life (QOL) of parents may be affected. The study explored the impact of caring for an adult with ID on the QOL of parents.

METHODS

Participants were 12 parents who were the full-time carers of an adult with ID. Participants were interviewed about the effect of caring on their QOL. Interviews were analysed thematically.

RESULTS

Caring had a positive impact on QOL by enabling participants to develop relationships and receive support, participate in leisure activities, achieve a sense of personal satisfaction and enable a more positive appraisal of their lives. Caring had a negative impact on participants' QOL by restricting their relationships, leisure activities and employment opportunities. Caring was also associated with financial insecurity, frustrations at the service system and fear of what the future held for their offspring.

CONCLUSIONS

Caring for an adult with ID had both positive and negative effects on parents' QOL. Improving services and service delivery, including the provision of residential services and respite, would address many of the issues that were reported to have a negative impact on parents' QOL.

Caregiver life satisfaction: relationship to youth symptom severity through treatment

This study utilized the Satisfaction with Life Scale to investigate the life satisfaction of caregivers for youth receiving mental health services (N = 383). Specifically, this study assessed how caregiver life satisfaction relates to youth symptom severity throughout treatment. Hierarchical linear modeling with a time-varying covariate was used to estimate the linear trajectory of caregiver life satisfaction and how it relates to youth symptom severity as rated by caregivers, youth, and clinicians. Results found initial caregiver life satisfaction was inversely related to caregiver and clinician rated youth symptom severity. In addition, subsequent caregiver life satisfaction demonstrated a small but significant relationship to changes in youth symptom severity during treatment where a decrease in youth symptoms corresponded to an increase in caregiver life satisfaction, and vice versa. Caregiver background characteristics related to higher life satisfaction included being (a) married, a birth parent, and younger than 40 years old, and (b) having the absence of previous diagnoses of an emotional, behavioral, or substance use disorder. Despite significant change over time, caregivers of clinically referred youth demonstrated low levels of life satisfaction throughout youth treatment. Given the bidirectional influences on one another, tending to the well-being of caregivers may positively influence both caregivers and youths.

Midlife and aging parents of adults with intellectual and developmental disabilities: impacts of lifelong parenting

Using population data, this study included parents of individuals with intellectual and developmental disabilities (n  =  220) and parents of individuals without disabilities (n  =  1,042). Parents of individuals with intellectual and developmental disabilities were further divided into those who co-resided with their adult child and those whose adult child lived elsewhere, and the 3 groups were compared regarding parental patterns of attainment, social participation, psychological functioning, and health in midlife and early old age. In midlife, parents of individuals with intellectual and developmental disabilities were similar in general to comparison parents. However, by early old age, these parents had poorer health and mental health. Co-residence between the adult with intellectual and developmental disabilities and the parent was prevalent during midlife (51.4%) and in the early years of old age (38.6%), and there were different patterns of parental outcomes, depending on the residential status of the adult with intellectual and developmental disabilities.

Trajectories of emotional well-being in mothers of adolescents and adults with autism

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families.

Parenting a Child with a Disability: The Role of Social Support for African American Parents

This paper examines: (1) the impact of having a child with a disability on parents' mental and physical health among urban-dwelling African Americans and (2) the extent to which positive and negative social interactions with family other than the spouse moderate the impact of child's disability on parental adaptation. Analyses are based on a probability sample of African Americans living in Milwaukee, Wisconsin. The analytic sample includes 48 parents of a child with a disability and 144 comparison group parents of non-disabled children. Results showed that having a child with a disability is associated with more somatic symptoms. However, the negative consequences of the child's disability on parents' mental health are reduced when parents receive greater positive support from family.

Depressive symptoms in older female carers of adults with intellectual disabilities

BACKGROUND

This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID).

METHOD

In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self-reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers.

RESULTS

Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self-reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self-reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms.

CONCLUSIONS

The factors identified in this study as correlating with self-reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high-risk group.

Mothers' everyday experiences of having an adult child who suffers from long-term mental illness

This paper aims to describe everyday life experiences of mothers who have an adult child with a long-term mental illness. Sixteen mothers were interviewed. A content analysis resulted in one main theme: My adult child who is struggling with mental illness is always on my mind, and three subthemes: (1) living a life under constant strain, (2) living with an emotional burden, and (3) seeing light in the darkness despite difficulties. Knowledge of mothers&#x2019; everyday life experiences is of great importance in order to support them and thereby increase the possibility of these mothers being a source of strength for their child.

Parenthood, Childlessness, and Well-Being: A Life Course Perspective

This article reviews recent research (1999 - 2009) on the effects of parenthood on wellbeing. We use a life course framework to consider how parenting and childlessness influence well-being throughout the adult life course. We place particular emphasis on social contexts and how the impact of parenthood on well-being depends on marital status, gender, race/ethnicity, and socioeconomic status. We also consider how recent demographic shifts lead to new family arrangements that have implications for parenthood and well-being. These include stepparenting, parenting of grandchildren, and childlessness across the life course.

Clinical management of behavioral characteristics of Prader-Willi syndrome

Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder caused by an abnormality on the long arm of chromosome 15 (q11-q13) that results in a host of phenotypic characteristics, dominated primarily by hyperphagia and insatiable appetite. Characteristic behavioral disturbances in PWS include excessive interest in food, skin picking, difficulty with a change in routine, temper tantrums, obsessive and compulsive behaviors, and mood fluctuations. Individuals with PWS typically have intellectual disabilities (borderline to mild/moderate mental retardation) and exhibit a higher overall behavior disturbance compared to individuals with similar intellectual disability. Due to its multisystem disorder, family members, caregivers, physicians, dieticians, and speech-language pathologists all play an important role in the management and treatment of symptoms in an individual with PWS. This article reviews current research on behavior and cognition in PWS and discusses management guidelines for this disorder.

Psychosocial and biological markers of daily lives of midlife parents of children with disabilities

Using daily telephone interviews, 82 midlife parents (mean age = 57.4) of children with disabilities (mean age = 29.9) were compared with a closely matched sample of unaffected parents (N = 82) to elucidate the daily experience of nonnormative parenting. In addition, salivary cortisol samples were obtained to examine whether parents of children with disabilities had dysregulated diurnal rhythms and the extent to which the amount of time spent with children was associated with divergent patterns of cortisol expression. We found that parents of children with disabilities had similar patterns of daily time use and similar likelihood of positive daily events as the comparison group, but they had elevated levels of stress, negative affect, and physical symptoms, all reported on a daily basis. In addition, their diurnal rhythm of cortisol expression differed significantly from the comparison group, a pattern that was strongest for parents of children with disabilities on days when they spent more time with their children.

MOTHERS AND FATHERS TOGETHER: CONTRASTS IN PARENTING ACROSS PRESCHOOL TO EARLY SCHOOL AGE IN CHILDREN WITH DEVELOPMENTAL DELAYS

Much of our understanding of families and parenting of children with intellectual disabilities (ID) reflects the thoughts, beliefs, attitudes, and behaviors of mothers with relatively little focus on the ways in which fathers contribute to and are affected by this unique context. In this chapter, we address the importance of fathers as a source of critical developmental influence, and contrast fathers and mothers of children with ID along three important dimensions of parent functioning (stress, well-being, and interactive behavior). The contrasts explore the developmental trajectories of these parenting constructs over time from the perspective of an emerging new complexity in conceptual models of family and parent adaptation. Data from the Collaborative Family Study are used to explore paternal and maternal stress, well-being, and behavior across the preschool through transition to school-age developmental period, and findings are discussed within the context of the broader literature in each area.

Setting a public health research agenda for Down syndrome: summary of a meeting sponsored by the Centers for Disease Control and Prevention and the National Down Syndrome Society

On November 8-9, 2007, a meeting entitled "Setting a Public Health Research Agenda for Down Syndrome" was held to review current knowledge, identify gaps, and develop priorities for future public health research related to Down syndrome. Participants included experts in clinical and molecular genetics, pediatrics, cardiology, psychiatry, psychology, neuroscience, epidemiology, and public health. Participants were asked to identify key public health research questions and discuss potential strategies that could be used to address those questions. The following were identified as priority areas for future public health research: identification of risk and preventive factors for physical health and cognitive outcomes, focusing on understanding the reasons for previously recognized disparities; improved understanding of comorbid conditions, including their prevalence, clinical variability, natural history, and optimal methods for their evaluation and treatment; better characterization of the natural history of cognition, language, and behavior; identification of mental health comorbidities and of risk and protective factors for their development; identification of strategies to improve enrollment in research studies; development of strategies for conveying up-to-date information to parents and health professionals; identification of interventions to improve cognition, language, mental health, and behavior; understanding the impact of educational and social services and supports; identification of improved methods for diagnosis of and interventions for Alzheimer disease; and understanding the effects of different types of health care on outcomes. Participants strongly supported the development of population-based resources for research studies and resources useful for longitudinal studies. This agenda will be used to guide future public health research on Down syndrome.