Pre-school children with and without developmental delay: behaviour problems and parenting stress over time

Predictors of parenting stress among Vietnamese mothers of young children with and without cognitive delay

BACKGROUND

The study examined whether Vietnamese mothers of children with cognitive delay experienced more parenting stress compared to mothers of children without delay, and the factors that contribute to the parenting stress.

METHOD

The study sample included 225 mothers of children with and without cognitive delays from Hue City in Vietnam. The study protocol included mothers reporting on the scales of parenting stress and perceived social support, and on demographic questions.

RESULTS

Mothers of children with cognitive delay experienced more stress. They were poorer and less educated, and perceived less social support. More mothers of these children had health issues. Having a child with cognitive delay was the strongest predictor of stress after controlling other demographic and psychosocial variables.

CONCLUSION

Special education and early intervention services should be developed and available to educate the children with cognitive delay and support their mothers in Vietnam. Effective services also need to address their poverty and health care needs.

Factors associated with parental distress

PROBLEM

Associations of perceptions of social support, personal control, and child behavioral problems to distress in parents of children with mental health problems were examined.

METHODS

One hundred and fifty-five parents of children 2-19 years old receiving community mental health services participated.

FINDINGS

Stepwise regression analysis identified internalizing and externalizing child behaviors, perceived personal control, and tangible social support as independent predictors of parental distress. Independent predictors of objective distress included internalizing child behaviors, perceived personal control, and intangible social support.

CONCLUSIONS

Internalizing and externalizing child behaviors were significantly associated with parental distress. Perceived personal control moderated the relationship between internalizing child behaviors and parental subjective distress.

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.

Predicting maternal parenting stress in middle childhood: the roles of child intellectual status, behaviour problems and social skills

BACKGROUND

Parents of children with intellectual disabilities (ID) typically report elevated levels of parenting stress, and child behaviour problems are a strong predictor of heightened parenting stress. Interestingly, few studies have examined child characteristics beyond behaviour problems that may also contribute to parenting stress. The present longitudinal study examined the contribution of child social skills to maternal parenting stress across middle childhood, as well as the direction of the relationship between child social skills and parenting stress.

METHOD

Families of children with ID (n = 74) or typical development (TD) (n = 115) participated over a 2-year period. Maternal parenting stress, child behaviour problems and child social skills were assessed at child ages six and eight.

RESULTS

Child social skills accounted for unique variance in maternal parenting stress above and beyond child intellectual status and child behaviour problems. As the children matured, there was a significant interaction between child social skills and behaviour problems in predicting parenting stress. With respect to the direction of these effects, a cross-lagged panel analysis indicated that early parenting stress contributed to later social skills difficulties for children, but the path from children's early social skills to later parenting stress was not supported, once child behaviour problems and intellectual status were accounted for.

CONCLUSION

When examining parenting stress, child social skills are an important variable to consider, especially in the context of child behaviour problems. Early parenting stress predicted child social skills difficulties over time, highlighting parenting stress as a key target for intervention.

The relationship between sources and functions of social support and dimensions of child- and parent-related stress

BACKGROUND

In this longitudinal study, we examined the relationship between the sources and functions of social support and dimensions of child- and parent-related stress for mothers of young children with mild developmental delays.

METHODS

Sixty-three mothers completed assessments of stress and support at two time points.

RESULTS

Multiple regression analyses revealed that parenting support during the early childhood period (i.e. advice on problems specific to their child and assistance with child care responsibilities), irrespective of source, consistently predicted most dimensions of parent stress assessed during the early elementary years and contributed unique variance. General support (i.e. primarily emotional support and validation) from various sources had other, less widespread effects on parental stress.

CONCLUSIONS

The multidimensional perspective of the construct of social support that emerged suggested mechanisms mediating the relationship between support and stress and provided a framework for intervention.

Socioeconomic and psychological variables as risk and protective factors for parental well-being in families of children with intellectual disabilities

BACKGROUND

The first aim of the present study was to estimate the extent to which differences in well-being in parents of children with and without intellectual disability (ID) in Sweden can be accounted for by differences in the presence of the risk factors: (1) child disability; (2) socioeconomic disadvantage; (3) household composition; and (4) parental characteristics. The second aim was concerned with individual variation in well-being within the group of parents of children with ID. The aim was to estimate if protective factors such as parental personality characteristics (sense of coherence), perceived positive impact of the child and satisfaction with participation in different arenas of life explained variation in well-being in mothers and fathers of children with ID over and above that explained by the risk factors.

METHOD

Parents of children with ID (62 mothers and 49 fathers) and control children (183 mothers and 141 fathers) completed postal surveys on well-being, socioeconomic situation, health, sense of coherence, satisfaction with participation in different arenas of life and the child's impact on the family.

RESULTS

The results showed that mothers of children with ID had lower levels of well-being than fathers and control parents, but the presence of a child with ID did not in itself predict poorer maternal well-being. Rather, differences in economic hardship and self-rated health were the strongest predictors for well-being. It was further found that 67.7% of the mothers of children with ID scored within the high well-being group. The predictive power of the model increased significantly for both fathers and mothers when protective factors were added to the model (42 and 78% explained variance compared with 25% with only risk factors).

CONCLUSIONS

Well-being of parents with a child with ID is dependent upon the interplay of risk and protective factors and research needs to address these variables simultaneously.

Adapting Webster-Stratton's incredible years parent training for children with developmental delay: findings from a treatment group only study

BACKGROUND

Children with intellectual or developmental disabilities (ID/DD) are more likely than typically developing children to experience behaviour problems. Parent training, such as the Incredible Years Parent Training (IYPT) series, has been a widely used intervention to support families with children with or at-risk for behaviour problems; yet to date, this programme has not been used with parents with young children with developmental delay or disabilities.

METHOD

This preliminary treatment group only study assessed the feasibility of implementing a modified parent training programme (IYPT-DD) with 25 families with 2-5-year-old children with developmental delay. Intervention consisted of 12 weekly (2.5 h) sessions with topics covering developmentally appropriate play, praise, rewards, limit setting and handling challenging behaviour.

RESULTS

Results suggest preliminary evidence of efficacy in reducing negative parent and child behaviour and increasing parental perceptions of child positive impact.

CONCLUSIONS

This study provides evidence for the feasibility of the DD modifications applied to the IYPT. Although this approach is promising, additional evidence is needed to address the efficacy of IYPT-DD in children with developmental delay.

Children's delayed development and behavior problems: impact on mothers' perceived physical health across early childhood

Mothers of children with developmental delays may experience poorer psychological well-being than other mothers; however, little research has examined how delayed development in children might predict mothers' perceived physical well-being. Children with delayed development manifest heightened behavior problems, which may negatively affect maternal well-being. We examined the associations between developmental delay and behavior problems at child age 3 and mothers' self-perceived physical health at child ages 3, 4, and 5, in families of 218 children with and without developmental delays. The study sample comprised 218 families from central Pennsylvania and Southern California, USA who were recruited through community agencies that provide diagnostic and intervention services for individuals with development difficulties. We found that mothers of children with delayed development at age 3 reported poorer concurrent and later physical health than mothers of children with typical development. Broadening the analyses to include not only child development status (delayed development versus typical development) but also child behavior problems at age 3, only child behavior problems and the interaction of development status and behavior problems, but not development status itself, predicted maternal health. Early child behavior problems contributed to later maternal health above and beyond early maternal health, suggesting a possible causal association between child behavior problems and mothers' physical health. The relation between child behavior problems and maternal health was moderated by mothers' parenting stress and mediated by depressive symptoms. Mothers of children with both delayed development and high behavior problems are a particular risk group that may be especially in need of early intervention. Further research should examine the behavioral and biological pathways by which these child-related stressors influence mothers' physical health.

Stress in parents of children with cerebral palsy: what sources of stress are we talking about?

BACKGROUND

Parents of children with cerebral palsy (CP) often experience high levels of stress. Little is known however on the different sources of stress parents experience. The purpose of the present study was to explore the relation between aspects of parental distress in the parenting role and the child's limitations in functional skills and the child's behavioural difficulties, in parents of children with CP.

METHODS

A cross-sectional study among 42 parents of ambulatory children with CP (age 3-8 years; GMFCS levels I-III) was performed, using the Parenting Stress Index (PSI), the Paediatric Evaluation of Disability Inventory (PEDI) and the Vineland Adaptive Behaviour Scales (VABS).

RESULTS

Regression analysis revealed that the PEDI Functional Skills and VABS Maladaptive behaviour scores explained 27% of the total variance in the PSI Parent domain total stress score. Maladaptive behaviour did significantly contribute to parental stress scores for the Parent domain subscales Attachment, Relationship with spouse, Depression, and, in particular, Sense of competence.

CONCLUSIONS

Parents' functioning can be affected by behavioural aspects of the child with CP, and sense of competence could be an important variable in this relation. This emphasizes the importance of the development of specific interventions that support the family as a whole.

Parent training for young children with developmental disabilities: randomized controlled trial

A randomized controlled trial was used to evaluate a parent training intervention for caregivers with preschool-age children with developmental disabilities. The 21 families in the experimental group received usual care plus the 12-week Incredible Years Parent Training Program with developmental delay modifications. Families in the control group (n = 23) received usual care, including early childhood education and related services. Results suggest that this parent training intervention was superior to usual care for young children with developmental delays or disabilities in reducing negative parent-child interactions and child behavior problems. Participants in the experimental group indicated high satisfaction with treatment. Additional research is necessary to document maintenance and generalization of treatment outcomes.

Parenting Children with Developmental Delays: The Role of Positive Beliefs

Parents of children with developmental delays consistently report higher levels of child behavior problems and also parenting stress than parents of typically developing children. This study examined how mothers' positive beliefs influence the relation between children's behavior problems and mothers' parenting stress among families of children who are developmentally delayed (DD: n = 72) or typically developing (TD: n = 95) and assessed at ages 3, 5, and 7 years. Positive beliefs had a main effect on parenting stress at all ages, which was mediated by child behavior problems for mothers in the DD group at every age and across time. In the TD group, mediation was found at age 3 years. Additionally, support was found for a moderation effect of positive beliefs on the relation between child behavior problems and parenting stress, but only in the DD group at age 3. These findings have implications for interventions drawing on Seligman's (1991) work on learned optimism, the positive counterpart of learned helplessness.

Parenting stress in mothers and fathers of a child with a hemiparesis: sources of stress, intervening factors and long-term expressions of stress

BACKGROUND

In a substantial minority of children with a hemiparesis, motor impairments are accompanied by behavioural problems. This combination confronts parents with several persistent, frequently intense, sources of stress. At the same time, it is likely to reduce the effectiveness of psychosocial resources, such as feelings of competence, which would normally buffer the impact of the stressors. Aim To investigate the association between motor and behavioural problems in children with a hemiparesis and symptoms of stress in their parents, with particular attention to psychosocial factors which may mediate between the child's problems and parents' symptoms of stress.

METHOD

Questionnaires assessing the medical, functional and behaviour problems of the child, and the parents' experience of stress were completed by the mothers and fathers of 108 children with a hemiparesis who were members of the Association for the Motor Handicapped in the Netherlands.

RESULTS

Both parents reported (extremely) high levels of long-term stress significantly more frequently than parents in a normative sample. Indices of long-term stress were associated with the child's behavioural problems and, less strongly, with dysfunctionality in daily life. However, behavioural problems and dysfunctionality also reduced parents' feelings of competence and social support. A mediation analysis showed that feelings of incompetence and social isolation mediated between the child's problems and the parents' symptoms of stress. Fathers and mothers did not differ in level of reported stress, or in the associations between the child's problems and degree of experienced stress.

CONCLUSION

Both parents of a child with a hemiparesis experience high levels of stress, which are strongly associated with feelings of incompetence and social isolation. This suggests that one focus of intervention should be the alleviation of parenting stress with particular attention to increasing perceived competence in the parenting role and reducing feelings of social isolation.

The effectiveness of parent-child interaction therapy for families of children on the autism spectrum

We report the results of a pilot trial of an evidence-based treatment-Parent-Child Interaction Therapy (PCIT; Eyberg et al. Psychopharmacology Bulletin, 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of shared positive affect during the course of therapy on child and parent outcomes. The intervention group showed reductions in parent perceptions of child problem behaviors and child atypicality, as well as an increase in child adaptability. Shared positive affect in parent child dyads and parent positive affect increased between the initial and final phases of the therapy. Parent positive affect after the first phase was related to perceptions of improvement in problem behaviors and adaptive functioning.

Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics

Elevated parenting stress is observed among mothers of older children with autism spectrum disorders (ASD), but little is known about parents of young newly-diagnosed children. Associations between child behavior and parenting stress were examined in mothers and fathers of 54 toddlers with ASD (mean age = 26.9 months). Parents reported elevated parenting stress. Deficits/delays in children's social relatedness were associated with overall parenting stress, parent-child relationship problems, and distress for mothers and fathers. Regulatory problems were associated with maternal stress, whereas externalizing behaviors were associated with paternal stress. Cognitive functioning, communication deficits, and atypical behaviors were not uniquely associated with parenting stress. Clinical assessment of parental stress, acknowledging differences in parenting experiences for mothers and fathers of young children with ASD, is needed.

Parental perspectives during the transition to adulthood of adolescents with a history of specific language impairment (SLI)

PURPOSE

This is the 2nd article of a companion set (the 1st article being on language and independence). It presents research examining parental perspectives on aspects of impairment in their offspring involving families rearing children with specific language impairment (SLI).

METHOD

The same sample as that of the 1st study participated in this investigation: a total of 238 parents and their offspring (120 offspring with a history of SLI and 118 typically developing [TD] offspring). Parents were interviewed using the Transition Daily Rewards and Worries questionnaire (L. M. Glidden & B. M. Jobe, 2007; J. Menard, S. Schoolcraft, L. M. Glidden, & C. Lazarus, 2002). Measures of the adolescents' receptive and expressive language, reading, nonverbal IQ, and socioemotional functioning were obtained.

RESULTS

Parents of adolescents with a history of SLI had more negative expectations in the areas of future/adult life, socialization, and community resources. An exception was family relations, which was a source of reward for both sets of parents.

CONCLUSIONS

Parents of adolescents with SLI have a range of perspectives regarding their offspring; some raise concerns, some are more positive. In addition, there is striking heterogeneity in the experiences of parents in the SLI group. Variables that influence being a concerned parent involve the adolescent's level of independence, quality of peer relations, his or her prosocial behavior, and the presence of conduct problems.

Child health and parental stress in school-age children with a preschool diagnosis of developmental delay

Chronic disorders are known to have a wide-ranging impact on overall health and family dynamics. The objective of this study was to assess child health and well-being and parental stress in a cohort of school-age children diagnosed before school entry with either global developmental delay or developmental language impairment. In total, 65 children with preschool developmental delay were assessed at school age (mean +/- SD age: 7.3 +/- 0.7 years) with the Child Health Questionnaire and Parenting Stress Index, with a mean interval between assessment of 3.9 years. Almost all children who completed testing (60/62) continued to show developmental impairments across domains. On the Child Health Questionnaire, children showed the greatest impairment on the mental health scale (median z score: -0.9). The median Child Health Questionnaire psychosocial health score (40.7) was almost 1 SD below established normative values ( P < .001). More than 40% of parents had a Parenting Stress Index above the 85th percentile (clinically significant parenting stress). Using multiple linear regression analysis, high levels of parenting stress were best predicted by a child's Child Health Questionnaire psychosocial health score (r2 = 0.49, P < .001). Thus, 4 years after a preschool-age diagnosis of developmental delay, poor psychosocial health was a common comorbidity. Almost half the parents showed clinically significant levels of parenting stress. There is a need to both recognize and provide ongoing social and emotional support for young children diagnosed with developmental disability and their families.

Psychological variables as correlates of adjustment in mothers of children with intellectual disabilities: cross-sectional and longitudinal relationships

BACKGROUND

Existing research studies suggest that parenting a child with intellectual disabilities (ID) can be a stressful experience. However, there are few data addressing the question of how or why parents might experience considerable distress. In the present study, psychological variables (acceptance, mindfulness, avoidant coping) are explored that may explain some variance in maternal distress.

METHOD

Questionnaire data were gathered from mothers of children attending special schools at two time points, 18 months apart (n = 91 at Time 1; n = 57 at Time 2). In addition to measures of the child's functioning, the questionnaire pack included: a measure of acceptance of unwanted thoughts/feelings; a measure of attention to the present (mindfulness); a measure of active avoidance coping; measures of maternal anxiety, depression and stress; and a measure of mothers' positive perceptions of their child.

RESULTS

In cross-sectional analysis, acceptance was negatively associated with maternal anxiety, depression and stress, such that mothers who were generally more accepting reported fewer psychological adjustment problems. Longitudinal analysis showed that acceptance is bidirectionally related to anxiety and depression. Mindfulness was not significantly related to maternal distress, and avoidance coping was positively cross-sectionally associated with depression only. There were no associations between psychological variables and maternal positive perceptions.

CONCLUSIONS

These data suggest that acceptance, in particular, may be a construct that explains some variance in maternal distress. Further research could focus on the utility of acceptance-based interventions (e.g. Acceptance and Commitment Therapy) in the support of families with a child with ID.

Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities

Research shows that after training in the philosophy and practice of mindfulness, parents can mindfully attend to the challenging behaviors of their children with autism. Parents also report an increased satisfaction with their parenting skills and social interactions with their children. These findings were replicated and extended with 4 parents of children who had developmental disabilities, exhibited aggressive behavior, and had limited social skills. After mindfulness training, the parents were able to decrease aggressive behavior and increase their children's social skills. They also reported a greater practice of mindfulness, increased satisfaction with their parenting, more social interactions with their children, and lower parenting stress. Furthermore, the children showed increased positive and decreased negative social interactions with their siblings. We speculate that mindfulness produces transformational change in the parents that is reflected in enhanced positive behavioral transactions with their children.

Mental health of children and adolescents with intellectual disabilities in Britain

BACKGROUND

Few studies have employed formal diagnostic criteria to determine the prevalence of psychiatric disorders in contemporaneous samples of children with and without intellectual disabilities.

AIMS

To establish the prevalence of psychiatric disorders against ICD-10 criteria among children with and without intellectual disabilities, the association with social/environmental risk factors, and risk attributable to intellectual disability.

METHOD

Secondary analysis of the 1999 and 2004 Office for National Statistics surveys of the mental health of British children and adolescents with (n=641) and without (n=17 774) intellectual disability.

RESULTS

Prevalence of psychiatric disorders was 36% among children with intellectual disability and 8% among children without (OR=6.5). Children with intellectual disabilities accounted for 14% of all British children with a diagnosable psychiatric disorder. Increased prevalence was particularly marked for autistic-spectrum disorder (OR=33.4), hyperkinesis (OR=8.4) and conduct disorders (OR=5.7). Cumulative risk of exposure to social disadvantage was associated with increased prevalence.

CONCLUSIONS

A significant proportion of the elevated risk for psychopathology among children with intellectual disability may be due to their increased rate of exposure to psychosocial disadvantage.

Dimensions of behavior of toddlers entering early intervention: Child and family correlates

This study examined the nature and correlates of the behavioral characteristics of a nationally representative sample of 1612 toddlers 18-31 months of age entering Part C early intervention services in the U.S. Factor analysis of 15 items describing child behavior collected as part of an extensive telephone interview of parents yielded four dimensions of behavior: difficult behaviors, lack of persistence, distractible, and withdrawn. Demographic and personal characteristics of the child and family were found to be related to the four behavioral dimensions. Parent reports of behavior of toddlers with fair or poor health or those with communication difficulties were less positive for all behavioral dimensions, suggesting the development of toddler behavioral characteristics is influencing or being influenced by other facets of development.

Early Student-Teacher Relationships of Children With and Without Intellectual Disability: Contributions of Behavioral, Social, and Self-Regulatory Competence

We investigated the student-teacher relationships (STRs) of 6-year-old children with (n=58) and without (n=82) intellectual disability (ID). We also examined early (age 3) and concurrent (age 6) child behavioral, self-regulatory, and social characteristics as predictors of age 6 STR quality. Children with ID experienced significantly poorer relationships with their teachers, marked by less closeness and more conflict and dependency, compared to typically-developing children. This group difference was not accounted for entirely by IQ differences. The relation between ID status and STR quality was fully mediated by four age 6 child variables: mother- and teacher-reported behavior problems and mother- and teacher-reported social skills. The quality of children's relationships with teachers was also predicted by child characteristics as early as age 3, including early behavior problems, self-regulation, and behavior during parent-child interactions. The relation of ID status to STR quality at age 6 was fully mediated by children's self-regulatory abilities at age 3. Our findings demonstrate the importance of child behavioral and social characteristics in predicting relationships with teachers for children with and without ID.

Correlates of maternal behaviours in mothers of children with fragile X syndrome

BACKGROUND

The behaviours of 24 mothers of children with fragile X syndrome (FXS) with their affected children were examined during planned observations in their homes. The goal of this study was to describe concurrent maternal interactive behaviour and the factors that influence the type and frequency of these behaviours within this group.

METHODS

The frequency of maintaining, directive and scaffolding behaviours and the extent to which the mothers displayed warm sensitivity and restrictions were examined within a 60-min naturalistic observation and a 10-min toy play observation. Rating scales and parent questionnaires were used to assess selected maternal mental health factors, including depression, anxiety, stress and social support. The cognitive status of mothers and developmental and behavioural abilities of children were also examined.

RESULTS

The women in this study used primarily maintaining behaviours in interactions with their children. Maintaining behaviours and warm sensitivity were consistent across structured and unstructured settings, while directive, scaffolding and restricting were not correlated across the two settings. Child receptive language skills were related to higher rates of maintaining and scaffolding behaviours. The women reported clinically significant levels of stress, depression and anxiety at a prevalence rate higher than that of the general public. Child behaviour problems contributed to maternal stress, and mothers with higher stress engaged in fewer interactions with their children.

CONCLUSIONS

The relations between maternal stress, child problem behaviour and number of interactive behaviours exhibited by the mothers in this study provide information that can inform interventions and provide direction for future research exploring environmental influences on the development of children with fragile X syndrome.

Parenting children with and without developmental delay: the role of self-mastery

BACKGROUND

While parenting behaviours have direct effects on children's behavioural outcomes, other, more distal factors also may be shaping the way a mother handles parenting responsibilities. Dispositional factors are likely to be a major influence in determining how one parents. Although researchers have studied the relationships among maternal dispositional factors, parenting, and child behaviours, few studies have examined these relationships when the child is at developmental risk. Children with developmental delays evidence elevated clinical level behaviour problems, so this group is of primary interest in the search for precursors to psychopathology. The present study examined how the maternal dispositional trait of self-mastery, as well as supportive and non-supportive parenting, relate to behaviour problems in young children with and without developmental delay.

METHOD

Participants were 225 families, drawn from Central Pennsylvania and Southern California. The children, all aged 4 years, were classified as delayed (n = 97) or non-delayed (n = 128). The Self-Mastery Scale measured perceived level of control over life events. The Coping with Children's Negative Emotions Scale measured different ways parents perceive themselves as reacting to their children's distress and negative affect. The Child Behavior Checklist assessed children's behaviour problems.

RESULTS

Delayed condition mothers reported significantly more child behaviour problems than non-delayed condition mothers; the two conditions did not differ in self-mastery, supportive parenting, or non-supportive parenting. Self-mastery, non- supportive parenting reactions, and child behaviour problems all related significantly to one another. For the sample as a whole and within the delayed condition, the association between self-mastery and child behaviour problems was partially mediated by non-supportive parenting reactions, although self-mastery was still significantly associated with problem behaviour. In the non-delayed condition, although significant relationships also were found among the variables of interest, non-supportive parenting did not have a significant main or mediation effect. Delay status moderated the relationship between negative parenting reactions and child behaviour problems, assessed by the Child Behavior Checklist Total and Internalizing scores. When mothers displayed low levels of non-supportive reactions, children in the delayed and non-delayed groups had similar levels of total problem behaviour. However, when mothers were medium or high in non-supportive reactions, children in the delayed group had much higher levels of problem behaviours than those in the non-delayed group.

CONCLUSIONS

The present study extended research on parental dispositional factors and parenting by measuring self-mastery as a global personality trait rather than measuring self-efficacy related specifically to childrearing. Moreover, relationships were examined for both developmentally delayed and non-delayed samples, allowing for a clearer understanding of the influences on problem behaviours in children with developmental delays. The findings support the view that parenting behaviours have a greater impact on children at developmental risk.

22q11.2 deletion syndrome: behaviour problems of infants and parental stress

BACKGROUND

22q11.2 deletion syndrome (22q11.2 DS) can be associated with a variety of somatic symptoms, developmental delays and psychiatric disorders. At present, there is little information on early behaviour problems, and nothing is known about parental stress and possible relations between these factors. Therefore, the aim of this study was to investigate behaviour problems of infants with 22q11.2 DS, and their primary caregivers' stress.

METHODS

Parents of infants with 22q11.2 DS known to the German 22q11.2 deletion syndrome foundation were anonymously asked to fill out several questionnaires, e.g. the Child Behavior Checklist (CBCL) 1.5-5.

RESULTS

The primary caregivers of 22/30 children [12 boys and 10 girls aged 1 year 8 months to 3 years 11 months (mean age: 2 years 9 months)] sent back filled-out questionnaires. Seventeen out of 21 children showed motor, and 15/21 language delay. Five out of 21 children were rated as clinical on at least one CBCL 1.5-5 scale. The patients' age was correlated with anxiety problems, and girls had significantly more sleep problems than boys. Compared with the general population, the primary caregivers did not experience higher levels of strain, and compared with parents of mentally and/or physically handicapped children, their parental stress was significantly lower. Parental stress and strain were correlated to a variety of child behaviour problems, e.g. externalizing and anxious/depressed behaviour.

CONCLUSIONS

Longitudinal studies are required to show whether behaviour problems and parental stress worsen when 22q11.2 DS patients grow older.

Families of children with Down syndrome: responding to "a change in plans" with resilience

The purpose of the present investigation, which was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, was twofold: (a) to describe maternal perceptions of parental and family adaptation in families raising a child with Down syndrome, and (b) to examine linkages between family demands, family resources, family problem solving and coping, and family adaptation in families of children with Down syndrome. Seventy-six mothers completed mailed questionnaires. Seventy percent of the mothers rated their family's overall functioning as either a 4 or a 5 on a 5-point scale (1 = poor; 5 = excellent). In their written comments, most mothers reported that their family was doing well or very well. Three family variables (i.e., family demands, family resources, and family problem-solving communication) were significantly associated with family adaptation. These results provide support for the belief that many families of children with Down syndrome respond to "a change of plans" with resilience. That is, they are able to endure, survive, and even thrive in the face of ongoing challenges associated with raising a child with Down syndrome.

Parental appraisal of the family impact of childhood developmental disability: times of sadness and times of joy

BACKGROUND

Parental positive and negative appraisals of the family impact of childhood disability are tested as early predictors of parental self-esteem and overall family adjustment in households with young children with intellectual and developmental disabilities.

METHOD

Within 103 Canadian families, 103 mothers and 55 fathers independently completed interviews in their home at two time points: 6 months after their child entered childhood disability services (T1), and one year later (T2).

RESULTS

Longer-term family adjustment was found to be predicted by level of parental negative appraisal of the family impact of disability, and by level of self-esteem, for both mothers and fathers. For mothers, positive appraisal of childhood disability was also found to predict early family adjustment and was related to enhanced self-esteem.

CONCLUSIONS

Gender differences in parental appraisal of the family impact of childhood disability appear to merge over time. Both positive and negative appraisals appear to coexist and are predictive of mothers' and fathers' perceived overall family adjustment in the longer term.

Modeling Family Dynamics in Children with Fragile X Syndrome

Few studies have examined the impact of children with genetic disorders and their unaffected siblings on family functioning. In this study, the reciprocal causal links between problem behaviors and maternal distress were investigated in 150 families containing a child with fragile X syndrome (FXS) and an unaffected sibling. Both children's behavior problems appeared to have strong, direct effects on maternal distress, but maternal distress did not appear to have any reciprocal causal effects on either child's behavior problems. Surprisingly, there were no significant differences in the effects of the two children's behavior problems on maternal distress. These data suggest that the problem behaviors of children with FXS, as well as their unaffected siblings, can have a substantial and additive impact on maternal depression and anxiety. Future research efforts should employ longitudinal research designs to confirm these findings.

Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: associations with parental mental health and family functioning

BACKGROUND

Behavioural and emotional problems occur at a high rate in children and adolescents with intellectual disability, often from a young age. Some studies have indicated that children and adolescents with autism present with even higher rates. Less is known about the presentation, development and family impact of these difficulties in young children with autism. This study aimed to explore these issues in toddlers with pervasive developmental disorders (PDDs), those with delay without a PDD, and their families.

METHODS

Participants were 123 children aged 20-51 months, referred to a developmental assessment clinic. Parents completed a checklist on child behavioural and emotional problems, and individual questionnaires on family functioning, their own mental health, and stress in relation to parenting their child. The child's language and cognitive skills, adaptive functioning and behaviour were assessed by standardized measures. Measures were repeated 1 year postdiagnosis. Behavioural and emotional problems in young children with a PDD were compared with those in children with developmental delay without a PDD, and their impact on parental outcomes explored over time.

RESULTS

Initial and follow-up measures of child behaviour and emotional problems, parent mental health problems, parent stress and family functioning were significantly correlated, providing some evidence of stability over time. Child emotional and behavioural problems contributed significantly more to mother stress, parent mental health problems, and perceived family dysfunction than child diagnosis (PDD/non-PDD), delay or gender. Compared with mothers, all fathers reported significantly less stress in relation to parenting their child.

CONCLUSION

Results highlighted the importance of addressing emotional and behavioural problems in very young children with autism and/or developmental delay. The need for early support and intervention for mothers, fathers and families in this context was also evidenced. As research has shown that behavioural and emotional problems persist into adolescence and young adulthood, understanding of these issues in very young children and their parents has important implications for intervention and long-term outcomes.

Socio-economic position, household composition, health status and indicators of the well-being of mothers of children with and without intellectual disabilities

BACKGROUND

Many previous studies have reported that mothers of children with intellectual disabilities (IDs) are more likely to show signs of psychological distress and have lower well-being than mothers of 'typically developing' children. Our aim was to estimate the extent to which these differences may be accounted for by between-group differences in socio-economic position.

METHODS

This study involved secondary analysis of happiness, self-esteem and self-efficacy variables in a nationally representative sample of 6954 British mothers with dependent children under the age of 17 years, 514 of whom were supporting a child with an ID.

RESULTS

Mothers of children with IDs reported lower levels of happiness, self-esteem and self-efficacy than mothers of children without IDs. Statistically controlling for differences in socio-economic position, household composition and maternal characteristics fully accounted for the between-group differences in maternal happiness, and accounted for over 50% of the elevated risk for poorer self-esteem and self-efficacy.

CONCLUSIONS

A socially and statistically significant proportion of the increased risk of poorer well-being among mothers of children with IDs may be attributed to their increased risk of socio-economic disadvantage.

The contribution of marital quality to the well-being of parents of children with developmental disabilities

BACKGROUND

This study examines the contribution of the marital relationship to the well-being of both mothers and fathers of children with developmental disabilities. Parent well-being is conceptualized in terms of mental health, parenting stress and parenting efficacy.

METHODS

These analyses are based on data from 67 families participating in the Early Intervention Collaborative Study, an ongoing longitudinal investigation of the development of children with disabilities and the adaptation of their families. Multidimensional assessment techniques were used to collect data from married mothers and fathers and their child with a disability. Mother and father data were analysed separately using parallel hierarchical regression models.

RESULTS

For both mothers and fathers, greater marital quality predicted lower parenting stress and fewer depressive symptoms above and beyond socio-economic status, child characteristics and social support. In relation to parenting efficacy, marital quality added significant unique variance for mothers but not for fathers. For fathers, greater social support predicted increased parenting efficacy. Child behaviour was also a powerful predictor of parental well-being for both mothers and fathers.

CONCLUSION

The findings support the importance of the marital relationship to parental well-being and illustrate the value of including fathers in studies of children with developmental disabilities.

Psychological distress among parents of children with mental retardation in the United Arab Emirates

This study was designed to identify predictors of parental stress and psychological distress among parents of children with mental retardation in the United Arab Emirates. It examined the relative contributions of child characteristics, parents' sociodemographics, and family environment to parental stress and psychological distress. Participants were parents of 225 mentally retarded children, of whom 113 were fathers and 112 were mothers. Measures of parental stress (QRS-F), psychiatric symptom index (PSI) and family environment scale (FES) were administered in an interview format. Hierarchical multiple regression was used to predict parental stress and psychological distress. The results indicate that the model containing all three predictor blocks, child characteristics, parents' sociodemographics, and family environment, accounted for 36.3% and 22.5% of parental stress and parents' psychiatric symptomatology variance, respectively. The age of the child was significantly associated with parents' feelings of distress and psychiatric symptom status, and parental stress was less when the child was older. Parents reported more psychiatric symptomatology when the child showed a high level of dysfunction. Fathers' work appeared to be a significant predictor of parental stress, indicating that for fathers who were not working the level of stress was higher than fathers who were working. Lower socioeconomic level was associated with greater symptom rates of cognitive disturbance, depression, anxiety, and despair among parents. Among the family environment variables, only the personal growth dimension stood out as a predictor of parental stress. An orientation toward recreational and religious pursuits, high independence, and intellectual and recreational orientations were associated with lower levels of parental stress. On the other hand, parents in achievement-oriented families showed elevated levels of parental stress. Implications for prevention, and intervention as well as parent training and system-oriented counseling programs are discussed.

Parenting stress of mothers and fathers of young children with cognitive delays in Vietnam

BACKGROUND

This research examined the effects of child and family variables on stress experienced by mothers and fathers of young children with cognitive delays in Vietnam.

METHODS

The mothers (n = 106) and fathers (n = 93) whose children (age range = 3-6 years) were identified as having cognitive delays participated in the interview survey. The survey consisted of a set of the standardized questionnaires that were translated into Vietnamese and assessed for the content validity in the Vietnamese context.

RESULTS

Mothers experienced more stress than fathers. Path analyses were conducted for mothers and fathers separately. Mothers with female children, those with children of lower intellectual functioning, and those whose husbands had health conditions experienced more stress than the other mothers. Fathers with lower economic status and a smaller social support network were more stressed than the other fathers. Both mothers and fathers were more stressed when they experienced stronger stigma, although the effects were not significant when other variables were considered together in path analyses.

CONCLUSIONS

The findings revealed traditional gender roles. Mothers were more affected by the child's characteristics and the spouse's functioning; they anticipated future problems related to the child's functioning more than fathers did. Fathers were more affected by concerns about the family's connection to the wider world such as economic issues and the social support network. Longitudinal studies of how social support and stigma affect families would be valuable.

Predictors of stress in parents of children with fetal alcohol spectrum disorders

This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the child"s executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

Longitudinal Relationships Between Sibling Behavioral Adjustment and Behavior Problems of Children with Developmental Disabilities

Siblings of children with developmental disabilities were assessed twice, 2 years apart (N = 75 at Time 1, N = 56 at Time 2). Behavioral adjustment of the siblings and their brother or sister with developmental disability was assessed. Comparisons of adjustment for siblings of children with autism, Down syndrome, and mixed etiology mental retardation failed to identify group differences. Regression analysis showed that the behavior problems of the child with developmental disability at Time 1, but not the change in their behavior over time, predicted sibling adjustment over 2 years. There was no evidence that this putative temporal relationship operated bidirectionally: sibling adjustment did not appear to be related to the behavior problems of the children with developmental disabilities over time.

Caring for children with learning disabilities who present problem behaviours: a maternal perspective

The theoretical cognitive model of stress and coping provides a structure to obtain and analyse maternal perceptions of caring for children with learning disabilities who present severe problem behaviours. The Family Fund database identified 18 families who met the sample criteria of children aged five years to 15 years with severe to moderate learning disability presenting severe problem behaviour. Physical aggression was reported to be the primary behavioural problem for 13 of the children. Interviews undertaken with the main carer of the child at their home were taped and transcribed. The data were analysed using grounded theory techniques which identified 'secondary stressors' for the parent. These were social isolation, conflict, limitation of lifestyle and self-blame. It is proposed that the amalgamated impact of these can weaken parents' coping resources and, therefore, may prove to be as significant to the negative association with maternal wellbeing as the problem behaviour.

The transition to school: adaptation in young children with and without intellectual disability

BACKGROUND

Previous research has highlighted the importance of the transition to school for young children and their families. A child's successful adaptation to school is likely influenced by a number of factors, including academic, social, emotional, behavioural and cognitive competencies. Children with intellectual disability (ID) may be at heightened risk for early school difficulties, in part due to their deficits in cognitive and adaptive behaviours.

METHODS

Factors associated with the adaptive transition to school in young children with (n = 24) and without (n = 43) ID were examined. Adaptive transitions were defined as having few teacher-reported problem behaviours and positive student-teacher relationships. Child self-regulatory skills and both parent- and teacher-reported social skills were evaluated to determine if they predicted positive adaptation in school for 5- to 6-year-old children. Data were gathered from child assessments, parent reports on standardized measures, direct observations of delay of gratification tasks and teacher reports on standardized measures.

RESULTS

Children with ID had significantly more teacher-reported problem behaviour, poorer overall student-teacher relationships, fewer parent- and teacher-reported social skills and fewer self-regulation skills than typically developing children. Self-regulation at child age 36 months (latency to touch a desired toy) was significantly related to adaptation to school, as were parent and teacher reports of social skills. Social skills significantly predicted adaptation to school, even after accounting for the effects of child IQ and adaptive behaviour.

CONCLUSIONS

Children with ID had less positive early school experiences, as indicated by multiple indices of adaptation to school. Fostering early social skills may be an important target for increasing the positive adaptation to school for young children, especially those with ID.

Stability, Change, and Correlates of the Peer Relationships of Young Children With Mild Developmental Delays

The peer relationships of young children with mild developmental (cognitive) delays recruited at 4-6 years of age were examined in a longitudinal study across a 2-year period. Results revealed only modest increases in children's peer interactions, a high degree of intraindividual stability, and the existence of a poorly organized and conflict-prone pattern of peer interactions. Child cognitive and language levels as well as family stress and support were associated with children's peer interactions. A subgroup was identified of initially low interactors who were at especially high risk for future peer interaction problems. These findings further underscore the importance of designing and implementing early intervention programs in the area of peer relationships for children with mild developmental delays.