Psychological Well-Being of Mothers and Siblings in Families of Girls and Women with Rett Syndrome

Psychological aspects of being a parent of an individual with Rett syndrome: A scoping review

BACKGROUND

Rett syndrome (RTT) causes multiple disabilities with a lifelong need for substantial care, placing a tremendous lifelong responsibility on the parents. Parenting an individual with RTT can therefore be challenging. Research on the psychological aspects of parenting individuals with RTT is limited and unclear. We aimed to identify and map the existing literature on this subject.

METHOD

A scoping review was conducted with systematic searches in PubMed, PsycINFO and CINAHL.

RESULTS

Eighteen studies were included. Negative and positive psychological aspects were described with the majority focusing on the negative. Three factors seemed to especially affect the parents: severity of the diagnosis, time (increasing age of parents or individual with RTT; years of caretaking), work-status of the mother.

CONCLUSIONS

Seemingly, parents are highly affected; however, the literature is scarce and has several gaps. Future research should include older parents, fathers, parents of individuals living in group homes, and positive aspects.

Developmental regression in children: Current and future directions

Developmental regression describes when a child loses previously established skills, such as the ability to speak words and is most recognised in neurodevelopmental conditions including Autism; Developmental Epileptic Encephalopathies, such as Landau Kleffner syndrome, and genetic conditions such as Rett syndrome and Phelan McDermid syndrome. Although studies have reported developmental regression for over 100 years, there remain significant knowledge gaps within and between conditions that feature developmental regression. The certainty of evidence from earlier work has been limited by condition-specific studies, retrospective methodology, and inconsistency in the definitions and measures used for classification. Given prior limitations in the field, there is a paucity of knowledge about neurocognitive mechanisms, trajectories and outcomes for children with developmental regression, and their families. Here we provide a comprehensive overview, synthesise key definitions, clinical measures, and aetiological clues associated with developmental regression and discuss impacts on caregiver physical and mental health to clarify challenges and highlight future directions in the field.

Scoping review: quality of life of siblings of children who are deaf and hard of hearing, have a vision or motor impairment

This study identified the current state of knowledge about the Quality of Life (QoL) of siblings of children who are deaf and hard of hearing (DHH), have a vision impairment (VI) or motor impairment (MI). Additionally, factors associated with individual variation in QoL were examined. A scoping review was performed using PsycInfo, ERIC, Web of Science, and CINAHL. Empirical studies with siblings (age 0-18 years) of children who are DHH, have a VI or MI that investigate the QoL of siblings were included. A total of 1746 studies were identified of which 11 met the inclusion criteria. The results showed that QoL has different interpretations and various measurement tools are used. The findings showed both positive and negative outcomes for the QoL of siblings. For example, family cohesion was found as a positive consequence. A negative consequence could be a higher score on problem behavior. Personal and parental characteristics such as age and parental availability were two main factors related to individual variation in QoL. Insight in the factors related to individual variation may help researchers to consider the research perspective. In addition, healthcare providers can use the information to be either aware or intervene on specific factors that are related to the QoL of the children who are DHH, have a VI or MI and their siblings.

Assessing the Burden on Caregivers of MECP2 Duplication Syndrome

BACKGROUND

MECP2 duplication syndrome (MDS) is a rare neurogenetic disorder characterized by severe neurodevelopmental disorder, refractory epilepsy, recurrent infections, and functional gastrointestinal problems. Because of the significant clinical problems and lifelong disability of children with this disorder we hypothesized that the burden on parents/caregivers of these children is significant. However, there are no reports of the impact on caregivers of individuals with MDS.

METHODS

We developed and validated a burden scale to investigate the challenges of caregivers of children and adults with MDS and identified factors contributing to the burden on caregivers. We developed a Health Insurance Portability and Accountability Act-compliant patient registry for families with MDS and delivered caregiver burden survey through the registry.

RESULTS

Of 237 completed surveys, 101 were eligible for the study. We identified increased levels of self-perceived anxiety, depression, and emotional exhaustion in caregivers that correlated with higher burden scores. Epilepsy was the only clinical feature that caused a higher burden in caregivers of individuals with MDS. In addition, a higher burden was found in Hispanic caregivers. The duration of care negatively correlated with burden score.

CONCLUSIONS

This is the first study to investigate the burden on caregivers of individuals with MDS and identify several factors contributing to increased burden. Addressing these concerns has the potential to improve the health of individuals with MDS and contribute to the well-being of their caretakers.

The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities

Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.

Peer mentor training: Pathway to competency for facilitators of Healthy Mothers Healthy Families workshops

BACKGROUND

Healthy Mothers Healthy Families (HMHF) is a women's health and empowerment programme designed to promote the health and well-being of mothers of children with a disability. An ongoing need to extend the reach of HMHF to more mothers, and increase scalability, resulted in development of a training programme based in principles of adult and transformative learning, to credential mothers as HMHF facilitators. The current study evaluated the process and outcomes of the competency training programme for new facilitators.

METHODS

A pretest and posttest design with midway data collection point was implemented to evaluate the facilitators' competence following the training programme. Surveys contained specifically designed demographic questions, open-ended questions, self-report of competency and estimation of need for education/training. Fifteen predetermined criteria enabled self-ratings. Training of facilitators occurred alongside delivery of 23-day HMHF workshops. Workshop participants provided anonymous objective evaluation of the facilitators' competencies. Triangulation enabled comparison of self-ratings, workshop participant ratings and author evaluation of new facilitators.

RESULTS

Facilitators (N = 7) completed all theory and practical elements of the HMHF facilitator education package and were successfully credentialed in May 2020. Overall, facilitators' competency ratings were highest at Time 3, which followed successful co-facilitation of at least three HMHF workshops. As expected, facilitators rated their highest need for education/training at baseline. At Time 3, facilitators self-reported a lower need for education/training for all competency criteria. All facilitators received mean anonymous competency ratings from workshop participants (N = 294), above the predetermined benchmark that was required to become credentialled.

CONCLUSIONS

The HMHF competency training programme, based on principles of adult and transformative learning, was effective in training seven HMHF facilitators who were mothers and had suitable professional backgrounds to deliver HMHF workshops. Training supports the fidelity of the HMHF intervention. Further research to evaluate maternal outcomes for participants attending the facilitator-lead workshops is warranted.

Parental Stress and Disability in Offspring: A Snapshot during the COVID-19 Pandemic

Parenting a child with a disability, such as neurodevelopmental disorders and genetic syndromes, implies a high level of stress. During the COVID-19 outbreak—as a period implying additional challenges—few studies have specifically investigated caregivers’ distress among neurodevelopmental disabilities. The objective of the study is to investigate whether during the COVID-19 pandemic, the level of parental stress differs between four disability groups including neurodevelopmental disorders (autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD)) and genetic syndromes (Rett syndrome (RTT), Sotos syndrome (SS)) in comparison to families with typical development offspring (TD). In total, 220 Italian parents of children affected by neurodevelopmental disabilities (74 ASD, 51 ADHD, 34 SS, 21 RTT, 40 TD; age M 9.4 ± SD 4.2) underwent a standardized evaluation for stress related to parenting through the self-report questionnaire, Parental Stress Index-Short Form (PSI-SF). The main findings show greater levels of parental stress—mainly linked to child behavioral characteristics rather than parental sense of competence—in parents of children affected by a disability in comparison to children with typical development. This study highlights the need to support not only individuals with special needs but also their own caregivers: core figures in the management and outcome of children disorders.

Childhood Disintegrative Disorder (CDD): Symptomatology of the Norwegian Patient Population and Parents' Experiences of Patient Regression

Childhood Disintegrative Disorder (CDD) is a rare and little researched developmental disorder characterised by regression in language and social skills after a period of seemingly normal development until at least the age of 2 years. The study contacted all parents of CDD patients in Norway to assess patient symptomatology and parents’ experiences of regression via questionnaire or interview. There were 12 participants. Symptomatology was in-line with previous studies, with universal regression in language and social skills and onset predominantly at 2–4 years. Regression was connected to feelings of ‘loss’ and uncertainty over the prognosis for CDD patients. The study supported CDD diagnostic criteria and showed that CDD patient regression has profound implications for parental well-being.

Parental stress and adjustment in the context of rare genetic syndromes: A scoping review

Chromosomal abnormalities are now considered a common cause of intellectual disability. With increased genetic testing, phenotyping and technological advancements, many new syndromes have been identified. This review sought to explore parental stress and adjustment in the context of rare genetic syndromes to evaluate their clinical impact. A systematic review of English peer-reviewed literature across three databases (PsycINFO, Medline, CINAHL) was completed and 69 articles were included. Parents of children with rare genetic syndromes experienced greater distress relative to other disabilities. Differences in parental wellbeing were syndrome-specific relative to ASD thus demonstrating the need to consider the contribution of syndrome-specific phenotypes. Child emotional and behavioural difficulties were the most consistent predictor of parental distress. Research reflecting other factors such as physical health, syndrome-specific behaviours, benefit finding and, parental appraisal in the context of a rare genetic aetiology is required in order to support parental adjustment in these conditions.

Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial

INTRODUCTION

Neurodevelopmental disability (ND) represents an adverse condition for infants' socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens' development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation.

METHODS AND ANALYSIS

Dyads will be randomly assigned to the video-feedback Intervention Group or Control Group ('dummy' intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T₀, baseline; T₁, post-intervention; T₂, short-term follow-up (3 month); T₃, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups.

ETHICS AND DISSEMINATION

Ethics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences.

TRIAL REGISTRATION NUMBER

NCT03853564; Pre-results.

Parenting girls with Rett syndrome: An investigation on self-perceived levels of stress

BACKGROUND

Although lives of parents of girls with Rett syndrome (RTT) are centred on the process of care, in the current literature their perceived levels of stress have been rarely investigated.

METHODS

We analysed levels of stress in a sample of 79 fathers and mothers parenting girls with RTT, who were required to compile the Parenting Stress Index (PSI) questionnaire.

RESULTS

We found clinical levels of stress in about 39% of fathers, as compared with 44% of the mothers. Severity of RTT, but not other factors such as the genetic domain, presence of epilepsy or scoliosis, predicted Total Stress scores in both fathers' subsample and mothers' subsample. A cumulative effect of caring, that is association of higher levels of stress with longer process of care, did also emerge from estimation of smoothing splines.

CONCLUSIONS

Fathers' resources should be taken more into account, especially in the rehabilitation and socialization process of adults with RTT.

Non-medical interventions for individuals with Rett syndrome: A systematic review

BACKGROUND

Research into Rett syndrome has included various medical interventions. Non-medical interventions are relatively under-researched. Recent technological communication intervention advances have contributed to the evidence base in Rett syndrome.

METHOD

The Embase, PsycINFO and MEDLINE were systematically searched for peer-reviewed papers describing non-medical interventions for Rett syndrome. All identified papers were evaluated for methodological quality.

RESULTS

Thirteen studies of adequate methodological quality were reviewed (across N = 60 participants). Interventions were primarily communication interventions including music, assistive technology, augmentative and alternative communication strategies, attentional training and cognitive rehabilitation training. All studies reported positive outcomes across communication, quality of life, brain stem activity, physical fitness and a reduction in stereotyped behaviour. However, methodological challenges to generalizability, standardization, lack of follow-up and/or small-N samples were common.

CONCLUSIONS

The review highlights the paucity of high-quality research. Future research is needed to build on current research and improve validity and generalizability of interventions.

Siblings of children with Williams syndrome: Correlates of psychosocial adjustment and sibling relationship quality

BACKGROUND

Previous research has examined adjustment in parents of children with Williams syndrome (WS), but little is known about sibling outcomes.

AIMS

To explore sibling adjustment and relationship quality, and their demographic, psychological and behavioural phenotypic correlates from the perspective of caregivers and siblings in families of children with WS.

METHODS AND PROCEDURES

Forty-one caregivers of children with WS participated in this questionnaire study on the adjustment and relationship quality of the siblings. In 31 of these families, self-report data were also provided by the siblings themselves. Data were also gathered on potential correlates, including anxiety and social functioning in the child with WS, caregiver mental health, and sibling social support.

OUTCOMES AND RESULTS

Sibling adjustment was similar to population norms, though significantly increased caregiver-reported emotional difficulties were found. Siblings reported greater behavioural, emotional and relationship difficulties than caregivers perceived them to have. Some significant associations were found between the behaviour of the child with WS, sibling behaviour problems and sibling relationship quality.

CONCLUSIONS AND IMPLICATIONS

A picture of relatively positive sibling adjustment and relationships emerged, but findings of individual differences and some emotional difficulties emphasise the need for an individualised approach to support in families of children with WS.

Longitudinal effects of caregiving on parental well-being: the example of Rett syndrome, a severe neurological disorder

Little longitudinal research has examined parental well-being in those with a child with specific genetic developmental disorder although the associated severe neurological impairments and multiple physical comorbidities likely place substantial burden of caregiving on the parent. We aimed to examine longitudinally the well-being of parents of individuals included in the Australian Rett Syndrome Database over the period from 2002 to 2011 using the Short Form 12 Health Survey. Residential remoteness, the child being a teenager at baseline, having frequent sleep disturbances or behavioural problems, and the type of MECP2 gene mutation were each associated with later poorer parental physical well-being scores. Being a single parent or on a low income was also associated with later poorer physical well-being, while the child having enteral feeding was associated with later poorer emotional well-being. Both the physical and emotional well-being of the parent improved if the child was living in out-of-home care. Our findings suggest that some opportunities do exist for clinicians to help optimise parental well-being. Being alert to the possibility and need for management of a child's sleep or emotional disturbance is important as is awareness of the additional likely parental burden as the child moves through adolescence into early adulthood and their need for additional support at that time. However, the findings also highlight the complex nature of parental well-being over time in parents of children with a severe neurological disorder and how they may be affected by a range of inter-related family and child factors.

The effectiveness of music therapy for individuals with Rett syndrome and their families

BACKGROUND

Patients with Rett syndrome (RTT) present characteristic regression in communication and hand skills, which eventually leads to intellectual and physical disability. Moreover, caregivers of patients with RTT face stressors related to patients' medical and developmental concerns. Given the indications from case reports, this pilot study investigated the effectiveness of music therapy on RTT patients, as well as on parental stress for families of children with RTT.

METHODS

Families in the study group were enrolled in a twice-weekly 120-minute music therapy program for 24 weeks (n = 11), whereas families in the control group did not receive music therapy (n = 12). Participants were administered the Vineland Adaptive Behavior Scales, Rett Syndrome Clinical Severity Scale, Rett Syndrome Motor Behavioral Assessment, and Parenting Stress Index for caregivers of RTT children before and after the music therapy program.

RESULTS

Music therapy improved receptive language, verbal and non-verbal communication skills, and social interaction for RTT patients. In addition, purposeful hand function, breathing patterns, and eye contact were significantly improved. Of note, music therapy also decreased the frequency of epileptic seizures. Lastly, caregivers in the study group exhibited significantly lower stress following the program.

CONCLUSION

The 24-week music therapy program was effective in improving social interaction, communication skills, eye contact, hand function, and reducing seizure frequency among RTT patients. Additionally, music therapy was effective in relieving parenting stress, which may help healthcare providers initiate early intervention strategies that can prevent parenting stress and reduce the risk of depression.

The Face-to-Face Still-Face (FFSF) Paradigm in Clinical Settings: Socio-Emotional Regulation Assessment and Parental Support With Infants With Neurodevelopmental Disabilities

Background: The Face-to-Face Still-Face (FFSF) paradigm is a well-acknowledged procedure to assess socio-emotional regulation in healthy and at-risk infants. Although it was developed mainly for research purposes, the FFSF paradigm has potential clinical implications for the assessment of socio-emotional regulation of infants with neurodevelopmental disabilities (ND) and to supporting parenting. Aim: The present paper describes the application of the FFSF paradigm as an evaluation and intervention tool in clinical practice with infants with ND and their parents. Methods: Theoretical and methodological insights for the use of the FFSF paradigm in the clinical setting are provided. Single-case vignettes from clinical practice further illustrate and provide exemplifications for the use of the FFSF with infants with ND and their parents. Results: From a clinical point of view, the use of the FFSF paradigm (1) offers a unique observational perspective on socio-emotional regulation in infants with ND and (2) enhances parents' sensitivity to their infants' behavior. Discussion: The FFSF paradigm appears to be a useful tool for clinical assessment of socio-emotional regulation in infants with ND and promote the quality of parenting and early parent-infant interaction.

Effect of Epilepsy on Families, Communities, and Society

The effect of epilepsy extends beyond those with the diagnosis and impacts families, communities and society. Caregiver and sibling quality of life is often negatively affected by frequent seizures, comorbid behavioral and sleep disorders and stigma surrounding the diagnosis. Furthermore, the negative effects can be magnified by individual coping styles and resources available to families of those with epilepsy. Beyond the family and immediate caregivers, epilepsy affects local communities by drawing additional resources from education systems. The direct costs of caring for an individual with epilepsy and the indirect costs associated with decreased productivity place financial strain on individuals and health care systems throughout the world. This review details factors affecting family and caregiver quality of life and provides several approaches through which health care providers may address these concerns. Furthermore, we examine the financial effect of epilepsy on society and review emerging strategies to lessen health care use for individuals with epilepsy.

The construct of maternal positivity in mothers of children with intellectual disability

BACKGROUND

Despite the elevated levels of stress, anxiety and depression reported by mothers of children with intellectual disabilities (ID), these mothers also experience positive well-being and describe positive perceptions of their child. To date, maternal positivity has been operationalised in different ways by using a variety of measures. In the present study, we tested whether a latent construct of maternal positivity could be derived from different measures of positivity.

METHOD

One hundred and thirty-five mothers of 89 boys and 46 girls with ID between 3 and 18 years of age completed measures on parental self-efficacy, their satisfaction with life, family satisfaction, their positive affect and their positive perceptions of their child with ID. We conducted a confirmatory factor analysis of latent positivity and subsequently tested its association with child social skills and behaviour problems, and maternal mental health.

RESULTS

A latent maternal positivity factor achieved a statistically good fit by using the five observed indicators of positivity. Parental self-efficacy had the strongest loading on the latent factor. Maternal positivity was significantly negatively associated with maternal psychological distress, maternal stress and child problem behaviours and positively associated with child positive social behaviour.

CONCLUSIONS

These findings lend support to the importance of examining parental positivity in families raising a child with ID, and using multiple indicators of positivity. Associations with negative psychological outcomes suggest that interventions focused on increasing parental positivity may have beneficial effects for parents. Further research is needed, especially in relation to such interventions.

Change over a 16-month period in the psychological well-being of mothers of girls and women with Rett syndrome

PURPOSE

There is an emerging research literature on the experiences of family members of girls and women with Rett syndrome (RTT), but a lack of longitudinal data.

METHODS

Fifty mothers whose daughters had RTT were surveyed 16-17 months after an earlier cross-sectional study. Measures completed at both time points focused on maternal positive and negative psychological well-being and their daughters' behavioral and emotional problems and RTT behavioral phenotype severity.

RESULTS

Maternal stress, anxiety, and depression demonstrated at least moderate levels of stability. Maternal positive perceptions were also moderately stable over 16-17 months. Longitudinal analyses suggested that their daughters' behavioral and emotional problems rather than RTT behavioral phenotype severity predicted later maternal well-being.

CONCLUSION

Mothers with RTT daughters experience chronic stress (persisting over time) but also ongoing positive perceptions. Practitioners should recognize positive perceptions and also consider targeted behavioral parent training to reduce behavior problems in individuals with RTT.

Impacts of caring for a child with the CDKL5 disorder on parental wellbeing and family quality of life

Background

Although research in this area remains sparse, raising a child with some genetic disorders has been shown to adversely impact maternal health and family quality of life. The aim of this study was to investigate such impacts in families with a child with the CDKL5 disorder, a newly recognised genetic disorder causing severe neurodevelopmental impairments and refractory epilepsy.

Methods

Data were sourced from the International CDKL5 Disorder Database to which 192 families with a child with a pathogenic CDKL5 mutation had provided data by January 2016. The Short Form 12 Health Survey Version 2, yielding a Physical Component Summary and a Mental Component Summary score, was used to measure primary caregiver’s wellbeing. The Beach Center Family Quality of Life Scale was used to measure family quality of life. Linear regression analyses were used to investigate relationships between child and family factors and the various subscale scores.

Results

The median (range) age of the primary caregivers was 37.0 (24.6–63.7) years and of the children was 5.2 (0.2–34.1) years. The mean (SD) physical and mental component scores were 53.7 (8.6) and 41.9 (11.6), respectively. In mothers aged 25–54 years the mean mental but not the physical component score was lower than population norms. After covariate adjustment, caregivers with a tube-fed child had lower mean physical but higher mean mental component scores than those whose child fed orally (coefficient = −4.80 and 6.79; p = 0.009 and 0.012, respectively). Child sleep disturbances and financial hardship were negatively associated with the mental component score. The mean (SD) Beach Center Family Quality of Life score was 4.06 (0.66) and those who had used respite services had lower scores than those who had not across the subscales.

Conclusions

Emotional wellbeing was considerably impaired in this caregiver population, and was particularly associated with increased severity of child sleep problems and family financial difficulties. Family quality of life was generally rated lowest in those using respite care extensively, suggesting that these families may be more burdened by daily caregiving.

Family functioning mediates adaptation in caregivers of individuals with Rett syndrome

OBJECTIVE

The objective of this study was to investigate factors related to family functioning and adaptation in caregivers of individuals with Rett syndrome (RS).

METHODS

A cross-sectional quantitative survey explored the relationships between demographics, parental self-efficacy, coping methods, family functioning and adaptation. A forward-backward, step-wise model selection procedure was used to evaluate variables associated with both family functioning and adaptation. Analyses also explored family functioning as a mediator of the relationship between other variables and adaptation.

RESULTS

Bivariate analyses (N=400) revealed that greater parental self-efficacy, a greater proportion of problem-focused coping, and a lesser proportion of emotion-focused coping were associated with more effective family functioning. In addition, these key variables were significantly associated with greater adaptation, as was family functioning, while controlling for confounders. Finally, regression analyses suggest family functioning as a mediator of the relationships between three variables (parental self-efficacy, problem-focused coping, and emotion-focused coping) with adaptation.

CONCLUSION

This study demonstrates the potentially predictive roles of expectations and coping methods and the mediator role of family functioning in adaptation among caregivers of individuals with RS, a chronic developmental disorder.

PRACTICE IMPLICATIONS

A potential target for intervention is strengthening of caregiver competence in the parenting role to enhance caregiver adaptation.