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

Fathers of children with or without ID: understanding long-term psychological symptoms

BACKGROUND

Researchers have primarily relied on mother report to understand the parenting contexts of rearing children with intellectual disabilities. Fathers are increasingly being considered as equally important reporters of their child's behaviours, as they have unique and independent relationships with their children. The purpose of this study was to understand how one source of stress - reports of child behaviour problems - along with spousal support related to parenting tasks, associated with fathers' reports of psychological symptoms over time.

METHOD

One hundred eighty-two father participants completed measures of child behaviour problems, spousal support and psychological symptoms. Growth curve modelling was employed to examine paternal psychological symptoms over the child's developmental trajectory.

RESULTS

Fathers' reports of child behaviour problems predicted initial levels of paternal psychological symptoms but did not predict change in paternal psychological symptoms over time. Spousal support further reduced initial levels of paternal psychological symptoms.

CONCLUSIONS

Child behaviour problems are more important than disability status in predicting father's psychological symptoms. Spousal support predicts paternal psychological symptoms and can be viewed as an additional resource for fathers. Implications for research and practice are discussed.

Depression and anxiety among parents of phenylketonuria children

Objective:

To investigate the existence of depression and/or anxiety with underlying risk factors among parents of children with classical phenylketonuria (PKU).

Methods:

This cross-sectional study was conducted in the Division of Pediatric Metabolism, Ankara Children’s Hospital, Dokuz Eylul University, Kırıkkale University, and Erzurum Local Research Hospital, Turkey, between January and July 2014. Parents of 61 patients and 36 healthy controls completed the self-report questionnaires. We used Beck Depression Inventory (BDI) to assess the parental depression and State-Trait Anxiety Inventory S-T (STAI S-T) to assess parental anxiety.

Results:

Depression and anxiety scores were significantly higher in the case group (BDI 12.3±9.1; STAI-S: 38.2±9.6; STAI-T: 43.2±6.9) than controls (BDI: 5.4±4.1 p=0.000; STAI-S: 31.8±7.6 p=0.001; STAI-T: 37.0±7.2 p=0.000). Mothers of the patients had higher scores than the other parental groups (BDI: p=0.000, STAI-S: p=0.001 and STAI-T: p=0.000). Logistic regression analysis showed that low educational level of the parent was the only independent factor for depression (OR 9.96, 95% CI: 1.89-52.35, p=0.007) and state anxiety (OR: 6.99, 95% CI: 1.22-40.48, p=0.030) in the case group.

Conclusion:

A subset of parents with PKU patients have an anxiety or depressive disorder. Supportive services dealing with the parents of chronically ill children such as PKU are needed in order to reduce the level of anxiety.

Relationship Between Self-Reported Health and Stress in Mothers of Children with Autism Spectrum Disorders

The current study explore the relationship between various forms of experienced stress (general stress and parenting stress) and both health-related quality of life (QoL) and reported physical health symptoms. One hundred and twenty-two mothers of children with autism spectrum disorder responded to an online survey included questionnaires on general stress, parenting stress, health-related QoL, and physical symptoms. The results suggested that perceived general stress as associated with both a reduced health-related QoL and more physical symptoms. However, parenting stress was only associated with a reduced health-related QoL, and not with physical health. These results are discussed in relation to the complex impact of prolonged and predictable parenting stress on the cortisol response and immune system.

Physical maltreatment of children with autism in Henan province in China: A cross-sectional study

The aim of this study was to investigate the frequency of child physical maltreatment (CPM) in children with autism aged 2-5 years in Henan province (China), and to explore the risk factors for severe CPM in these children. This cross-sectional study was performed at the Psychology Clinic of the Third Affiliated Hospital of Zhengzhou University between September 2012 and September 2013 with 180 parents of children with autism. Children and parents had no history of any cognitive therapy. The childhood autism rating scale (CARS) was used to evaluate the severity of autism in children. Data on parental CPM during the past 3 months were collected from parental self-reporting. Logistic regression was used to investigate the risk factors of severe CPM. CPM was self-reported by 88% of the parents of children with autism. One hundred and fifty four of these cases were in the minor CPM group (86%) and 64 in the severe CPM group (36%). Most cases of severe CPM were unlikely to have caused injury. Univariate analyses showed that child's age (p=.018), age started to speak (p=.043) and CARS score (p=.048) were associated with severe CPM. Child's age (p=.011) and CARS score (p=.041) were independently associated with severe CPM. The risk of severe CPM increased with age and CARS score. Our findings showed that CPM is widespread in families of children with autism in Central China and more knowledge should be provided to parents of children with autism, particularly in cases of severe autism (those with high CARS scores).

The Influence of Children's Cognitive Delay and Behavior Problems on Maternal Depression

OBJECTIVE

To determine the impact of children's cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families.

STUDY DESIGN

Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the children's behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the children's behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes.

RESULTS

At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the children's behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the children's behaviors were assessed by their primary nonparental care providers.

CONCLUSION

Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the child's behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the children's behavior.

Feasibility of Mindfulness-based Stress Reduction Intervention for Parents of Children with Developmental Delays

Mindfulness-based stress reduction (MBSR) interventions are popular as a treatment strategy for myriad diagnoses in various settings, and may be beneficial for parents of children with developmental delays (DD). However, prior research suggests extreme levels of stress and extraordinary demands on time among these parents, making the feasibility of effectively implementing MBSR with this population questionable. This study examined the feasibility of administering standard MBSR to a diverse community-based sample of parents of young children with DD. The potential impact of MBSR interventions includes improvement in parents' mental health, and collateral benefits for the family environment, including improved child behavior. Nurses may have an integral role in interdisciplinary teams providing MBSR.

Mothers' expressed emotion towards children with autism spectrum disorder and their siblings

BACKGROUND

Expressed emotion (EE) is a construct used to measure the emotional climate within families. EE is of interest to researchers in the field of autism spectrum disorder (ASD) because of its putative implications for child development. The aim was to explore whether maternal EE differs towards a child with ASD and a non-disabled sibling.

METHODS

We adopted a within-family design with 143 mothers of children with ASD and a non-disabled sibling. EE was measured using the Five-Minute Speech Sample.

RESULTS

Wilcoxon signed-rank tests were utilised. Mothers were coded as significantly more critical and less warm towards their child with ASD than towards the sibling. There were no significant differences in maternal emotional overinvolvement or overall EE towards the child with ASD and a sibling.

CONCLUSIONS

The data support the results of previous research suggesting that EE is linked to the relationship a mother has with individual children, rather than being evidence of the character disposition of mothers. More research is needed to understand the emotional dimensions of parent-child relationships in families with children with ASD.

Cultural and child-related predictors of distress among Latina caregivers of children with intellectual disabilities

The objective of this article is to examine associations among socioeconomic, cultural, and child factors and maternal distress among families of children with intellectual disabilities (ID). Latino and nonLatino White (NLW) mothers of children with and without ID (N  =  192) reported on familism, language acculturation, maternal distress, child adaptive functioning, and child behavior problems. Among mothers of children with ID, higher levels of child behavior problems mediated the association between Latina ethnicity and elevated maternal distress. Associations between child behavior problems and maternal distress in Latina mothers of children with ID were moderated by single-parent marital status, higher familism, and lower English usage. Thus, child and cultural factors contribute to elevated distress among Latina mothers of children with ID.

Risk factors associated with the mental health of fathers of children with an intellectual disability in Australia

BACKGROUND

Raising a child with a disability places considerable demands and stress on parents, which can contribute to mental health difficulties. Research has primarily focused on mothers' mental health, and our understanding of the effects on fathers remains limited. The factors that place fathers at increased risk of mental health difficulties are also poorly understood. This study aimed to redress these gaps by reporting on the mental health of a large sample of fathers of children with an intellectual disability (ID) (aged 3-15 years), comparing this to published Australian norms and mothers of children with ID. The second aim of the study was to explore risk factors associated with fathers' mental health.

METHOD

The data for this study come from 315 Australian fathers of children (aged 3-15 years) with ID, who participated in the large-scale evaluation of the Signposts for building better behaviour programme. Fathers completed a range of self-report questionnaires at baseline including the Depression Anxiety Stress Scale (DASS).

RESULTS

Fathers in the present sample reported significantly more symptoms of depression and stress than the Australian normative data, with approximately 6-8% reporting symptoms in the severe to extremely severe range. The strongest predictors of fathers' mental health difficulties were children's behaviour problems, daily stress arising from fathers' own needs and children's care needs, and low parenting satisfaction. Socio-economic factors did not predict mental health difficulties.

CONCLUSION

This study is among one of the first to report the mental health of fathers of children with a disability in Australia. Findings highlight that some fathers of children with ID are at heightened risk of experiencing mental health difficulties, underscoring the importance of the provision of information and interventions to promote their mental health.

Quality of life in mothers of preschoolers with high-functioning pervasive developmental disorders

BACKGROUND

Parents of children with pervasive developmental disorders (PDD) are likely to experience serious distress. The aims of this study were to (i) assess distress among mothers of preschoolers with high-functioning PDD (HFPDD); and (ii) examine its relation to the child's behavioral characteristics.

METHODS

Participants were 30 mothers of preschoolers with HFPDD, and 30 mothers of a matched control group. Short Form 36 Health Survey Questionnaire (version 2), and the Strengths and Difficulties Questionnaire were used for assessment. The children's autistic traits were assessed using the total number of items for the DSM-IV-TR autistic disorder diagnosis.

RESULTS

Mothers in the HFPDD group were more distressed mentally than physically. Neither physical nor mental distress in the group was related to the child's autistic traits, while their mental distress was significantly related to the child's behavior problems.

CONCLUSIONS

Mothers in the HFPDD group were at increased risk of impaired mental wellbeing. Maternal mental distress in the group was significantly related to general behavior problems, but not to autistic traits in the child.

Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years

Parents of children with developmental disabilities (DD) are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Few studies have considered the reverse direction of effects, however, in families where a child has a DD. The present study investigated transactional relations between child behavior problems and maternal stress within 176 families raising a child with early diagnosed DD. There was evidence of both child-driven and parent-driven effects over the 15-year study period, spanning from early childhood (age 3) to adolescence (age 18), consistent with transactional models of development. Parent-child transactions were found to vary across different life phases and with different domains of behavior problems.

Parenting stress does not normalize after child's epilepsy surgery

PURPOSE

This study aimed to investigate parenting stress expressed by parents before and two years after their children's epilepsy surgery.

SUBJECTS

Parents of 31 consecutively included surgery patients with epilepsy and parents of 31 healthy sex- and age-matched control children were the subjects of this study. Materials and procedure: The questionnaire 'Parenting Stress Index', which distinguishes a Parent domain (stress leading parents to feel themselves inadequate) from a Child domain (child features felt by parent to cause stress) was completed before surgery of the patients and two years thereafter. At both time points, intelligence examination of the child was part of a comprehensive neuropsychological assessment, as were evaluations of recent stress-enhancing life events and epilepsy severity.

RESULTS

Prior to surgery, total parenting stress was significantly higher in parents of patients than in parents of controls. Two years after surgery, total parenting stress had decreased significantly in parents of patients. The scores on parent-related subscales Role Restriction and Spouse and on the child-related subscale Distractibility/Hyperactivity, all relatively high before surgery, decreased significantly. Still, parents of patients experienced significantly more stress compared with parents of controls mainly because of persistently higher stress scores in parents of patients on the subscale Role Restriction (Parent domain) and on five of six subscales in the Child domain. Intelligence of the child was associated with parenting stress: the lower the child's intelligence, the higher the stress score on the subscale Distractibility/Hyperactivity and the lower the stress score on the subscale Mood. Stress decreased more in parents of patients who became seizure-free after surgery than in parents of patients with recurrent seizures.

CONCLUSIONS

Parenting stress decreases but does not normalize in the first two years after epilepsy surgery. Parents should be offered counseling on epilepsy-related intricacies contributing to parenting stress, immediately after diagnosis as well as after epilepsy surgery, notwithstanding the resulting seizure status of the child.

Families referred to a Child Assessment Team: the Campbelltown experience

AIM

To study the socio-demographic and psychosocial risk factors of families presenting with their children for a diagnostic developmental assessment.

METHODS

Socio-demographic details of children who had a multidisciplinary developmental assessment with the Child Assessment Team at Campbelltown Hospital between January 2009 and December 2010 were collated and compared with census data.

RESULTS

In 2009 and 2010, 277 families were seen by the Child Assessment Team. A detailed socio-demographic profile was available for 251 (91%) families. Parents seen in the clinic were more likely to be younger, single, born overseas, have less post-school education, identify as Aboriginal and/or live in public housing compared with the district rates.

CONCLUSIONS

Families presenting to the developmental clinic have more socio-economic disadvantage compared with the referring district. This has implications for service delivery and clinical presentation, and highlights the importance of the social worker's role in a developmental diagnostic team.

Attributions, criticism and warmth in mothers of children with intellectual disability and challenging behaviour: a pilot study

BACKGROUND

Associations between parental expressed emotion (EE) or parental attributions and the problem behaviours of children with intellectual disability (ID) have been explored in ID research. However, a more detailed examination of the attributional model of EE has not been reported. In the present study, we partially replicated and extended research focused on mothers of typically developing children with behaviour problems.

METHODS

Twenty-seven mothers of children with ID and behaviour problems aged 4-9 years were interviewed about their most problematic behaviours exhibited by their child, and completed a Five Minute Speech Sample. Interview transcripts and speech samples were coded for maternal EE and spontaneous causal attributions regarding the child's behaviour problems. Data were also collected on maternal well-being, and the child's behaviour problems.

RESULTS

Mothers typically made attributions that were internal to the child, controllable by the child, personal to the child and stable for the child. Maternal attributions of being able to control the child's behaviour were associated with high maternal criticism and low warmth. Maternal depression was more strongly associated with the child's behaviour problems when mothers were coded as high in criticism or low in warmth.

CONCLUSIONS

Patterns of maternal attributions about their child's behaviour problems and their consequences for maternal well-being and maternal-child relationships require more research attention. Implications for practice are discussed, including the potential for maternal attributions to be incompatible with the focus of positive behaviour supports offered to families.

Riding the rapids: living with autism or disability--an evaluation of a parenting support intervention for parents of disabled children

Evidence on the effectiveness of interventions to support parents of disabled children to manage their child's behaviour problems is limited. The aim of this study was to evaluate a group-delivered intervention (Riding the Rapids) which was specifically developed for parents of a child with a disability or autistic spectrum condition. This programme has been routinely delivered by a community-based mental health team across an urban, multi-ethnic locality for a number of years. A non-randomised controlled study design comprising an intervention group (n=48) and comparator (no intervention) group (n=28) was used to evaluate the effects of the intervention on child behaviour (Eyberg Child Behaviour Inventory; parent-set goals) and parenting efficacy and satisfaction (Parents Sense of Competence Scale) at post-intervention and six-month follow-up. Data on costs to the service provider of delivering the intervention were also collected. Receipt of the intervention was associated with significant reductions in parent-reported behaviour problems and significant improvements in parenting efficacy and satisfaction. At six-month follow-up, progress towards achieving parent-set child behaviour goals and parenting satisfaction had been maintained. Post hoc analysis suggests parents who do not have English as a first language may not benefit as much as other parents from this intervention. Findings suggest this is a promising intervention for parents of a child with a disability that is likely to be less resource intensive to service providers than individually delivered interventions. Limitations and implications for future research are discussed.

Predictors of quality of life for fathers and mothers of children with autistic disorder

A constant challenge for Quality of Life (QoL) research is tapping the most predictive indicators for a specific population. This study has sought to examine predictors of QoL for fathers and mothers of children with Autistic Disorder. Two multiple regression analyses were performed for fathers (N=70) and mothers (N=114) of children with Autistic Disorder. Six predictors were entered into the regression equation: Parental Distress (PD), Parent-Child Dysfunction Interaction (PCDI), Difficult Child Characteristics (DC), Household income, and the child's with Autistic Disorder age and number of siblings. The analyses revealed that only PD was a significant predictor for both parent's QoL, whereas DC, household income, and number of siblings were able to predict only mothers' QoL. To our knowledge, this is the first study to focus on predictors of QoL among both fathers and mothers of children with Autistic Disorder. The results from the current study can have several implications for professionals and researchers targeting the primary force contributing to the wellbeing of children with Autistic Disorder, the parents.

The clinical profile of mentally retarded children in India and prevalence of depression in mothers of the mentally retarded

BACKGROUND

Mental retardation (MR) has a varied phenomenology in different parts of the world. While studying MR, psychological issues of caretakers are equally relevant. A study to investigate the phenomenology of MR in Indian children and the prevalence of depression in their mothers was planned in a teaching institute in Madhya Pradesh with an attached tertiary care hospital.

OBJECTIVES

The objective of the following study is to study the clinical profile of mentally retarded children in the study sample, prevalence of depression in the mothers and investigate various factors affecting it.

STUDY DESIGN

A cross-sectional study.

MATERIALS AND METHODS

A total of 60 patients diagnosed as MR were included in the study. Objective data was collected in a special proforma and mothers of these individuals were subjected to evaluation with Beck's Anxiety Inventory and the 17 item Hamilton Rating Scale for Depression.

RESULTS

The mean age of patients in the sample was 11.6 years, had received an average of 2.42 years of schooling, mean age at diagnosis of MR was 6.5 years and their mean IQ was 53. Out of the total 60 patients, 88% of the patients had significant co-morbidities. The prevalence of depression in mothers was 85% and it was more in mothers of, the ones with significant co-morbidities (OR = 2.67), severer forms of retardation and with higher levels of anxiety in the mother.

CONCLUSIONS

Prevalence of depression in mothers of mentally retarded children in India seems to be much greater than those reported from studies around the world. Medical services offered to the mentally retarded should move from an individual level to the family level, especially toward the mothers, who are the main caretakers. Counseling services, treatment if required and regular screening of mothers of the mentally retarded should be included in the protocol for management of mental retardation.

Quality of life among parents of children with autistic disorder: a sample from the Arab world

BACKGROUND

A growing body of research has sought to examine issues associated with the Quality of Life (QoL) of parents of children with Autistic Disorder. However, no studies have examined the QoL of Arab parents whose parenting experience is expected to be substantially different from that of their western counterparts. Therefore, the purposes of this study were: (1) to examine differences in the QoL between fathers and mothers of children with Autistic Disorder in a sample from an Arab country, and (2) to examine the psychosocial correlates of the QoL of Arab parents of children with Autistic Disorder.

METHODS

Self-administered questionnaires on parents' QoL, stress, coping strategies, and demographic characteristics were completed by 184 parents of children with Autistic Disorder. The participants were recruited using the convenience sampling design.

RESULTS

Fathers and mothers of children with Autistic Disorder showed no significant differences in their physical, psychological, social, and environmental health. Further, both parents showed almost similar bivariate correlations between the reported QoL levels and their parenting stress, coping strategies, and demographic characteristics.

CONCLUSION

This is the first study to examine the QoL of parents of children with Autistic Disorder in the Arab world and, in doing so, it highlighted the distinct lack of research in this area. The QoL of Arab parents of children with Autistic Disorder crosses lines with their stress levels, coping strategies, demographic characteristics, and to some extent their cultural context.

Behavioral profile in RASopathies

Here, we describe neurobehavioral features in patients with RASopathies (i.e., Noonan syndrome, LEOPARD syndrome, Costello syndrome, and cardiofaciocutaneous syndrome), developmental disorders caused by mutations in genes coding transducers participating in the RAS-MAPK signaling cascade. Parents of 70 individuals with a RASopathy were asked to fill out the following questionnaires: Child Behavior Checklist (CBCL), Social Communication Questionnaire version lifetime (SCQ-L), and Modified Checklist for Autism in toddlers (M-CHAT). Data analysis indicated high rates of internalizing (37%) and externalizing problems (31%) on CBCL. Scores over the cut-off were documented in 64% of patients with cardiofaciocutaneous syndrome, 44% with Costello syndrome, and 12% with Noonan syndrome on SCQ-L/M-CHAT. Our findings indicate that mutations promoting dysregulation of the RAS-MAPK cascade mark an increased psychopathological risk and highlight that autistic-like behavior could be underdiagnosed in patients with RASopathies.

Parenting stress in parents of children with cochlear implants: relationships among parent stress, child language, and unilateral versus bilateral implants

Little attention has been focused on stress levels of parents of children with cochlear implants (CIs). This study examined the stress experience of 70 parents of children with CIs by comparing stress levels in this group of parents to those in parents of children without disabilities, identifying primary stressors, examining the relationship between parent stress and child language, and comparing stress in parents of children with bilateral and unilateral CIs. Parents completed a parent stress questionnaire, and the receptive vocabulary and language abilities of the children were evaluated. Results indicated that these parents had a higher incidence of stress than the normative population. Parent stress levels and child language outcomes were negatively correlated. Child behavior and lack of spousal and social support were the prime causes of parent stress. Parents of children with bilateral CIs were significantly less stressed than were parents of children with unilateral CIs.

The prevalence of at-risk development in children 30 to 60 months old presenting with disruptive behaviors

OBJECTIVE

This study assessed the prevalence of failed developmental screens in 30- to 60-month-old children who presented with a behavioral complaint of disruptive behavior to a referral clinic.

METHODS

A retrospective chart review was performed in a specialty behavioral pediatric clinic. Outcome measures were obtained from children referred to the clinic with parental concern of disruptive behavior.

RESULTS

Out of 151 patients, 66% (99/151) had been screened for developmental delays with a formal screening instrument. Of these, 71% (70/99) failed developmental screening in one or more domains.

CONCLUSIONS

Preschoolers referred to a behavioral clinic for parental concerns of disruptive behaviors were more than 4 times more likely to be at risk for developmental delays than the general population, with a majority of suspected delays in communication and problem-solving domains. This finding suggests that developmental screening should be a part of the initial workup for children with disruptive behaviors.

Types of disability in children and maternal depressive symptoms: Is there any relationship?

Objective:

To investigate the level of depressive symptoms in mothers of children with intellectual developmental disabilities (IDD) and the variations of these symptoms between mothers of children with different categories of IDD.

Methods:

This descriptive, cross-sectional study was conducted among 162 mothers of children with IDD in Tehran, Iran. The Beck Depression Inventory-II (BDI-II) and a demographic questionnaire were used to gather the required data.

Results:

Mothers of children with IDD experienced depressive symptoms of varying degrees of severity. BDI-II scores of the mothers who had children with IDD were high (18.15 ± 10.62) but depressive symptoms were not significantly associated with the children's type of disability.

Conclusion:

Mothers of children with IDD, in general, reported a mild level of depressive symptoms. As a result, one can suggest that they should be provided with regular psychological support.

The lived experience of mothers of multiple children with intellectual disabilities

In this study, we explored the lived experience of Japanese mothers who have delivered multiple children with intellectual disabilities (ID), using interpretative phenomenological analysis. We identified three superordinate themes and seven subordinate themes from the narrative data collected from 10 participants. The superordinate themes were: abandoned hope for having an ordinary family, accumulating physical and mental fatigue, and searching for positive experiences in parenting multiple children with disabilities. How they perceived the birth of children with disabilities for the second time differed depending on the disability types; specifically, whether they detected the disabilities early or not. Encountering the disability in another child overwhelmed mothers, especially when the disabilities were diagnosed after several years with or without suspicion; they struggled to accept the fact. Despite mothers facing extreme difficulties in parenting multiple children with disabilities, they tried to alter the negative perceptions and find an optimistic way of living.

A Stress Model for Couples Parenting Children With Autism Spectrum Disorders and the Introduction of a Mindfulness Intervention

Parents of children with autism spectrum disorders (ASD) are at an increased risk for acute and chronic stress compared to parents of children with other developmental disabilities and parents of children without disabilities. It is plausible that the stressors of having a child with ASD affect the couple relationship; however, few researchers have focused on this dynamic within these families. In this article, we seek to develop a model for how stress operates in families with children with ASD. In developing this new stress model, we describe the characteristics of ASD, discuss stressors that are pronounced in families of children with ASD as supported by the literature, and highlight the limitations of Perry's (2004) model in application to this population. Our expanded stress model includes the addition of parenting couple resources and parenting couple outcomes. Finally, we demonstrate how to apply the model using a mindfulness intervention to promote positive outcomes and strengthen the couple relationship.

Mindfulness-based stress reduction for parents of young children with developmental delays: implications for parental mental health and child behavior problems

BACKGROUND

Parents of children with developmental delays (DD) typically report elevated levels of parental stress compared with parents of typically developing children. Children with DD are also at high risk for exhibiting significant behaviour problems. Parental stress has been shown to impact the development of these behaviour problems; however, it is rarely addressed in interventions aimed at reducing child behaviour problems. The current study examined the efficacy of mindfulness-based stress reduction (MBSR) for parents of children with DD by investigating whether this intervention is effective in reducing parenting stress and whether decreases in parenting stress lead to reductions in behaviour problems among children with DD.

MATERIALS AND METHODS

Forty six parents of children with DD were randomly assigned to an immediate treatment or wait list-control group. Participants completed questionnaires assessing parental stress and child behaviour problems at intake and at a second assessment, which took place after only the immediate treatment group had received the MBSR.

RESULTS

Parents who participated in MBSR reported significantly less stress and depression as well as greater life satisfaction compared with wait list-control parents. Regarding child outcomes, children whose parents participated in MBSR were reported to have fewer behaviour problems following the intervention, specifically in the areas of attention problems and ADHD symptomatology.

DISCUSSION

Results indicated that MBSR may be an effective intervention for ameliorating parental stress and mental health problems among parents of children with DD. Additionally, these benefits may 'spill over' and improve behaviour challenges among these children.

Effectiveness of occupational performance coaching in improving children's and mothers' performance and mothers' self-competence

OBJECTIVE

This study examined the effectiveness of occupational performance coaching in improving children's and mothers' occupational performance and mothers' parenting self-competence.

METHOD

A one-group time-series design was used to evaluate changes in children's (n = 29) and mothers' (n = 8) occupational performance at four time points: (1) pre-wait list, (2) preintervention, (3) postintervention, and (4) follow-up.

RESULTS

Significant improvements in occupational performance occurred postintervention for children, F(1, 78) = 153.72, p < .001, η² = .86, and mothers, F(1, 78) = 153.72, p < .001, η² = .86, that were maintained 6 wk after intervention. Mothers' self-competence in parenting also improved, F(1, 72) = 17.36, p < .001, η² = .42.

CONCLUSION

Findings provide preliminary evidence supporting the effectiveness of occupational performance coaching in improving children's and mothers' occupational performance and mothers' parenting self-competence. Improvements were sustained and appeared to generalize to other areas of performance.

The impact of children with disabilities on parent health-related quality of life and family functioning in Kelantan and its associated factors

OBJECTIVES

Caring for children with disabilities brings about a significant impact on the parents and families. The purposes of this study were to determine the impact of having children with disabilities on parents' health-related quality of life (HRQOL), family functioning, and total family impact and to identify the associated factors.

METHOD

A total of 425 parents/caregivers of children with disabilities who were registered to community-based rehabilitation centers in 5 districts in Kelantan, Malaysia, participated in this study. The Malay version of PedsQL Family Impact Module was used as research instrument. General linear regression was applied to analyze the association between family impact scores (Total Impact, Parent HRQOL Summary, and Family Functioning Summary) and study factors using Stata/SE 11 software.

RESULTS

The mean (SD) Total Impact Score and Parent HRQOL Summary Score of the parents/caregivers was 75.1 (16.85) and 75.0 (18.74) respectively, and the median (IQR) of Family Functioning Summary Score was 84.4 (28.13). Mothers, non-Malays, and widowed parents/caregivers, parents/caregivers having male children with disabilities, and children with more complex disability had significantly lower parent HRQOL and family functioning.

CONCLUSIONS

Both parents/caregivers' characteristics and children's characteristics contributed to family impact in local setting. Results of this study emphasize the importance of the whole family involvement as the focus of services and supports by health care providers.

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.

Family functioning in families with a child with Down syndrome: a mixed methods approach

BACKGROUND

This study aimed to explore the factors that predict functioning in families with a child with Down syndrome using a mixed methods design. The quantitative component examined the effect of maladaptive and autism-spectrum behaviours on the functioning of the family while the qualitative component explored the impact of having a child with Down syndrome on family holidays, family activities and general family functioning.

METHODS

Participants in this study were 224 primary caregivers of children with Down syndrome aged 4-25 years (57.1% male; 42.9% female) currently residing in Western Australia (74.0% in metropolitan Perth and 26.0% in rural Western Australia).

RESULTS

Maladaptive and autism-spectrum behaviour were associated with poorer family functioning. Mean total scores on the measures of family functioning and marital adjustment were comparable to that of families of typically developing children. Consistent with the quantitative findings, normality was the most common theme to emerge in the qualitative data. Child problem behaviours were also identified by parents/carers as having a negative impact on the family.

CONCLUSIONS

This study has implications for the development of programs to support families with a child with Down syndrome and may dispel some of the myths surrounding the impact of intellectual disability on the family.

Financial well-being of single, working-age mothers of children with developmental disabilities

Understanding the financial well-being of single mothers who care for children with developmental disabilities is important to ensure that public policies can be effectively targeted to support these vulnerable families. The authors analyze data from the Survey of Income and Program Participation to describe income poverty, asset poverty, income, net worth, and liquid assets of U.S. single, working-age mothers (n  =  242) of children and adult children with developmental disabilities. The well-being of these mothers was compared to the situation of married mothers of children with developmental disabilities (n  =  345) and of single mothers who did not have children with developmental disabilities (n  =  6,547). Compared with both married mothers of children with developmental disabilities and single mothers without children with developmental disabilities, single mothers of children with developmental disabilities had markedly worse financial well-being across a range of income- and asset-based measures. Single mothers caring for children with developmental disabilities face adverse financial well-being as compared with other mothers. Policy makers should consider targeted measures to improve the financial well-being of these parents.

Marital quality and psychological adjustment among mothers of children with ASD: cross-sectional and longitudinal relationships

Using data drawn from a longitudinal study of families of children with ASD, the current study examined the impact of marital quality on three indicators of maternal psychological adjustment: depressed mood, parenting efficacy, and subjective well-being. Multiple regression analyses indicated marital quality to be a significant cross-sectional and longitudinal predictor of maternal adjustment. In the cross-sectional regressions, marital quality negatively predicted maternal depression and positively predicted parenting efficacy, and well-being, while in the longitudinal regressions, initial levels of marital quality negatively predicted maternal depressed mood and positively predicted well-being at follow-up. Longitudinal regression results also revealed that marital quality mediated the relationship between family SES and maternal well-being. Study limitations and implications are discussed.

Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

BACKGROUND

It is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them.

METHODOLOGY

A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis.

RESULTS

The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child's illness.

CONCLUSION

Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.

Utilising behavioural family therapy (BFT) to help support the system around a person with intellectual disability and complex mental health needs: a case study

There is a higher incidence of mental health problems amongst people with intellectual disabilities. Family members and support staff who provide support to people with intellectual disabilities with mental health difficulties are more likely to experience increased stress. In the mainstream mental health literature it has been demonstrated that psycho-educational family interventions have a positive impact on the person with mental health difficulties and on the family members who support them. This article uses a case study to illustrate the implementation of a family intervention with the support system around someone with intellectual disabilities, autism and chronic mental health difficulties. Following intervention the family member reported a marked decrease in levels of strain. Both the family and team members reported improvement in functioning within the support system.

Challenging behaviors among children with autism spectrum disorders and multiple disabilities attending special schools in Singapore

This study sought to understand the profile of and the factors which impact upon challenging behaviors among children with autism spectrum disorders (ASD) and multiple disabilities (MD). Teachers of 322 and 132 children with ASD and MD, respectively, attending special schools in Singapore, completed the Developmental Behavior Checklist, Teacher Version (DBC-T; Einfeld & Tonge, 1995). The findings suggest that children with ASD exhibit elevated levels of challenging behavior in all areas, relative to children with MD. Multiple regression analyses also indicate that diagnostic category was associated with all aspects of challenging behavior measured by the DBC-T. In addition, age was associated with only disruptive/antisocial behaviors in this study. Theoretical and practical implications were discussed.

Parenting stress and child behavior problems: a transactional relationship across time

Parenting stress and child behavior problems have been posited to have a transactional effect on each other across development. However, few studies have tested this model empirically. The authors investigated the relationship between parenting stress and child behavior problems from ages 3 to 9 years old among 237 children, 144 of whom were typically developing and 93 who were identified as developmentally delayed. Behavior problems and parenting stress covaried significantly across time for both groups of children. Cross-lagged panel analyses generally supported a bidirectional relationship between parenting stress and child behavior problems for mothers and fathers.

Review: the development of family quality of life concepts and measures

Historically, intervention programmes in intellectual and developmental disabilities have targeted the individual's special needs independent of the family and environmental context. This trend has been changing over the past two decades. This paper presents a literature review on changing trends in family support and the development of family quality of life (FQOL) and intellectual disability from a construct to a theory. The evolution of research in quality of life from the perspective of the individual with the disability to the family is described. A description of the development of FQOL measures is included, specifically an introduction and comparison of the two leading comprehensive initiatives on measuring FQOL - international FQOL project and the FQOL initiative of the Beach Center on Disability, in the USA. This paper provides the conceptual background and context to the other papers presented in this special issue, which focus on FQOL measurement in specific contexts.

Children born to women with intellectual disabilities - 5-year incidence in a Swedish county

BACKGROUND

Families with parental intellectual disabilities (ID) are likely to need support in achieving a decent family life. In order to accurately plan for such support services, society needs data regarding the occurrence of those parents and their children. The aim of this study was to investigate the 5-year incidence of children born to women with ID in a county in Sweden.

METHODS

Women born between 1975 and 1989 were identified from school registers for children and adolescents with ID in the county of Blekinge. The women's personal identification numbers were, in 2010, linked and matched with the Swedish Medical Birth Register.

RESULTS

In total, 98 women with ID were identified. Nine of these had given birth to children; one woman to two children and eight women to one child each. The 10 children were born between 2004 and 2008.

CONCLUSION

The incidence rate calculated as a result of the present study indicates that approximately 2.12 per 1000 children are born per year to women with ID. For the whole of Sweden that rate indicates an incidence of approximately 225 children each year. On the basis of this, the prevalence of children (aged 0-18 years) being born to women with ID is estimated at about 4050.

Stresses and coping strategies of Chinese families with children with autism and other developmental disabilities

Data from 368 families of children with autism and other developmental disabilities in the People's Republic of China were gathered to understand the stresses that families experience and the coping strategies they employ. Chinese families of children with developmental disabilities perceived high levels of stress related to pessimism, child characteristics, and parent and family problems. Regarding coping strategies, acceptance, active coping, positive reinterpretation and growth, suppression of competing activities, and planning were the most frequently employed coping strategies. Parents of children with autism experienced more stress and used planning as a coping strategy to a greater degree than parents of children with other developmental disabilities. The implications and limitations of these findings are discussed.