Parental cognitive impairment and child maltreatment in Canada

"They helped me stand on my own two feet": Canadian parents with intellectual disabilities in child protection

Research on the lived experience of Canadian parents with intellectual disabilities involved in child protection is limited, particularly inclusive research with parents with intellectual disabilities involved in Canada's changing child protection system. This inclusive study was done in collaboration with a co-researcher with intellectual disabilities who had lived experience as a parent. 13 parents from three Canadian regions participated in semistructured interviews about their involvement in child protection. Four major themes emerged in the findings: 1) key supports that contributed to positive outcomes; 2) parents' attitudes toward child protection agencies and perceived attitudes about themselves; 3) systemic barriers impacting accessibility and the child protection experience; and 4) parents' advice to other parents and professionals in child protection. This study provides a promising picture of child protection agencies as a key support despite existing barriers. Implications for social service providers are offered and areas for further exploration are discussed.

Evaluating the Inheritance Risk: Epilepsy Prevalence among Offspring of Adults with Epilepsy in a Tertiary Referral Epilepsy Center

While significant strides have been made in comprehending the pathophysiology and treatment of epilepsy, further investigation is warranted to elucidate the factors impacting its development and transmission, particularly within familial contexts. This study sought to explore the prevalence and risk factors associated with epilepsy in the offspring of patients with epilepsy who were treated at a tertiary epilepsy center. Adult patients with confirmed epilepsy (PWE) receiving outpatient care were consecutively enrolled, starting from January 2021 to January 2023. Data were recorded for various variables, including age, gender, epilepsy pathophysiology, cognitive impairment, and family history of epilepsy. Descriptive statistics, various statistical tests, and multivariate logistic regression analyses were employed to analyze the data. A total of 1456 PWE were included. Among them, 463 patients (31.8%) had children. Twenty-five patients had offspring diagnosed with epilepsy, representing a prevalence of 5.4%. Analysis of the offspring with epilepsy revealed older ages, a higher proportion of parents with idiopathic epilepsy, and a greater prevalence of a positive family history of epilepsy. Multivariate logistic regression analysis demonstrated a significant association between a family history of epilepsy and increased epilepsy risk in offspring. Genetic syndrome-immanent predisposition, advanced age, and a family history of epilepsy were identified as significant risk factors for epilepsy in offspring by means of this mono-center study.

People with intellectual disability and their risk of exposure to violence: Identification and prevention - a literature review

The aim of the literature review was to identify knowledge and knowledge gaps concerning risks of violence toward children, youth, adults and elderly with intellectual disabilities, and how risks can be identified and prevented. The research revealed that children, youths and adults labelled with intellectual disabilities are more exposed to violence than others and that the target group lack knowledge about risks of violence and what it means to be exposed to violence. It was also found that professionals who work with people with intellectual disabilities may lack knowledge about violence, and those who work with violence lack knowledge about intellectual disabilities. There is thus a need to further elaborate routines to identify exposure to violence, and to identify the target group and a need to create collaborative teams with professionals who have in-depth knowledge of violence, and those who have in-depth knowledge about the target group.

Risk and Protective Factors for Parental Involvement and Early Indicators of School Achievement in Alaska

OBJECTIVES

Parental involvement can affect child school readiness, which in turn influences subsequent child learning outcomes. While social support, stress, caregiver psychological distress, and drinking could affect parental involvement, it is unknown whether and how these factors influence downstream child learning outcomes through parental involvement and child school readiness. This study tests those associations.

METHODS

Using de-identified data provided by the Alaska Longitudinal Child Abuse and Neglect Linkage project (N = 683), we use Structural Equation Modeling to assess direct and indirect effects of paths embedded in the proposed model.

RESULTS

This study found statistically significant indirect effects: (1) path linking stress faced by caregivers to child reading proficiency through caregiver psychological distress, parental involvement, and child school readiness, (2) path linking stress faced by caregivers to child reading proficiency through caregiver drinking, parental involvement, and child school readiness, and (3) path linking social support for caregivers to child reading proficiency through caregiver psychological distress, parental involvement, and child school readiness. Post-estimation showed that the sum of the magnitude of total effects of stress and the magnitude of total effects of support is significantly larger than either alone.

CONCLUSIONS FOR PRACTICE

Findings suggest that reducing caregiver stress and offering social support could not only benefit caregivers but learning outcomes of their children as well. For child learning outcomes, simultaneously reducing stress and offering social support for caregivers, rather than just one of them alone, is suggested. These results are important for children, particularly for those raised by caregivers experiencing psychological distress or drinking issues.

Expectant parents with intellectual disabilities in child protection: Risk factors for child safety

BACKGROUND

Newborns of parents with intellectual disabilities face higher risks in their environment for child unsafety, despite parents' good intentions. To help parents prevent unsafe circumstances, a good understanding of the risk factors faced by these parents is needed.

METHODS

This casefile study examined (1) which risk factors were present for expectant parents with intellectual disabilities in child protection, (2) which domains of risk factors, and (3) whether a cumulation of risk factors was related to child safety.

RESULTS

Expectant parents with intellectual disabilities in child protection before the child was born often experienced a cumulation of risk factors. Child, family, and care factors best predicted child safety. A cumulation of risk factors over multiple life domains increased the risks for child unsafety.

CONCLUSIONS

To reduce the risks of unsafe parenting conditions for newborns, preventive interventions for expectant parents with intellectual disabilities should address their needs from an ecological perspective.

Explaining Risk Factors for Successful Family Supervision Orders: Families with Intellectual Disabilities in Child Protection in the Netherlands

Families with mild to borderline intellectual disabilities (MBID) are overrepresented in child protection, and are at higher risk for long and unsuccessful family supervision orders (FSOs). This is worrisome, as many children apparently are exposed to unsafe parenting situations for longer periods of time. Therefore, the present study examined which child and parental factors and child maltreatment are related to the duration and success of an FSO in families with MBID in the Netherlands. Casefile data were analysed of 140 children with an ended FSO. Results from binary logistic regression analyses showed that in families with MBID, young children, children with psychiatric problems, and children with MBID were at higher risk for a longer duration of FSOs. Furthermore, young children, children with MBID and children who were sexually abused had a lower chance of a successful FSO. Unexpectedly, children who witnessed domestic violence or whose parents were divorced, had a higher chance of a successful FSO. The discussion focuses on implications of these results for treatment and care of families with MBID from the perspective of child protection.

Social workers' perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations

Parental capacity is one of the main aspects assessed by social workers as part of child protection investigations. The aim of this study is to explore the social workers' perceptions of assessing the parental capacity of parents with intellectual disabilities in child protection investigations. Four focus group interviews were conducted with twelve social workers in May-October 2021. Data were analysed using an inductive, conventional qualitative content analysis. One overarching theme, "Parental capacity in relation to the child's needs was assessed, not disability of parents" was created. Three main categories and ten sub-categories were identified exploring the social workers' perceptions of assessing parental capacity. The study shows that social workers perceive the assessment of parental capacity in parents with intellectual disabilities as demanding and complex, in which the assessment of what is good enough is perceived as the most difficult task.

Parental mentalising among mothers with intellectual disability or ADHD: Links with experiences of abuse, neglect and psychosocial risk

BACKGROUND

Parental mentalising difficulties are robustly linked to caregiving problems. Mothers with intellectual disability are at risk for caregiving problems, but knowledge on their parental mentalising abilities is lacking. The present study aimed to fill this gap.

METHOD

Thirty mothers with mild intellectual disability, and 61 comparison mothers with ADHD, were assessed for parental mentalising using the Parental Reflective Functioning Questionnaire. Contributions of intellectual disability, maternal exposure to childhood abuse/neglect and psychosocial risk to parental mentalising were examined through hierarchical regression analysis.

RESULTS

Mothers with intellectual disability had a heightened risk for parental mentalising difficulties, in the form of elevated prementalising. Intellectual disability and cumulative childhood abuse/neglect uniquely predicted prementalising among the mothers, whereas cumulative psychosocial risk added to the risk for prementalising specifically among mothers with intellectual disability.

CONCLUSIONS

Our findings support contextual models of caregiving, and suggest a need for mentalisation-based support for parents with mild intellectual disability.

Experiences of Interpersonal Trauma Among Parents With Intellectual Disabilities: A Systematic Review

Research has suggested highly elevated levels of interpersonal trauma (IPT) among parents with intellectual disabilities (ID), and that such experiences may contribute to the caregiving and child developmental problems often seen in this population. Conflicting results have however been reported, and there is no systematic review on this matter. This study therefore systematically reviewed the empirical evidence concerning (a) prevalence of IPT among parents with ID, and links with (b) caregiving-relevant and (c) child developmental outcomes, in accordance with the PRISMA 2020 guidelines. Searches were conducted in MEDLINE, CINAHL, PsycINFO, and PTSDpubs. Peer-reviewed empirical articles reporting exposure to any form of systematically assessed IPT (unspecified IPT, physical, sexual, and emotional abuse, neglect, prolonged childhood separations from caregivers, witnessing abuse in the family) among parents with ID were included, yielding a final selection of 20 studies. Findings consistently indicated markedly elevated levels of IPT among parents with ID, with a majority (>50%) having experienced some form of IPT. Estimates for both unspecified and specific forms were typically higher than corresponding estimates in other groups at elevated risk, and than meta-analytical general population estimates in comparable countries. Findings regarding caregiving-relevant outcomes were mixed but indicated links with adverse outcomes, particularly regarding parental mental health. Reports pertaining to child developmental outcomes were scant and inconsistent. We highlight important limitations in the extant literature and provide directions for future research and clinical practice.

Recurrence of Substantiated Maltreatment Reports between Low-Income Parents With Disabilities and Their Propensity-Score Matched Sample Without Disabilities

Using the Longitudinal Studies of Child Abuse and Neglect dataset, 127 low-income parents with disabilities and a propensity score matched sample of 254 parents without disabilities were compared for the rates of repeated substantiated child maltreatment allegations and potentially distinct risks for substantiated child maltreatment recurrence. The number of substantiated child maltreatment allegations was not significantly higher for low-income parents with disabilities (M = 1.17, SD = 1.83) than their matched sample (M = .93, SD = 1.44) (t = -1.29, p = .197). Findings from the negative binomial regression indicated that parental disability was also not a significant predictor for repeated substantiated child maltreatment allegations among low-income parents after controlling other risk factors (Exp(B) = 1.16, p < .353). In both groups, black parents were more likely to have repeated substantiated maltreatments than white parents. For parents with disabilities, being an older parent, receiving SNAP benefits, having a daughter, and having a child in continued out-of-home care significantly increased the risk for repeated substantiations while having a GED or higher education degree and living with a larger number of family decreased the risk. For parents without disabilities, family instability was the only additional risk factor for repeated maltreatment substantiations.

Childhood Adversity, Cognition, and Response to Cognitive Remediation in Major Depressive Disorder

ABSTRACT

Cognitive impairment is experienced by many individuals with major depressive disorder (MDD) and is significantly related to sustained disability. Recent work has begun to explore the relationship between childhood adversity (CA) and cognitive impairment in MDD, but this work is limited by unreliable measures of CA. Furthermore, no previous research has examined whether CA relates to cognitive remediation response. The current study clarifies how CA and clinical characteristics of illness explain cognitive variance. In addition, we investigate whether CA is associated with response to cognitive remediation. Thirty-nine individuals who completed cognitive remediation were rerecruited to complete a retrospective interview on CA. Results showed that CA, repeated depressive episodes, and earlier age at diagnosis were associated with poorer cognition. We did not observe a difference in treatment response based on CA. Findings suggest that CA is an important variable to consider when examining the expression of depressive illness and areas for intervention.

Accessibility of child protection investigations during pandemic: A qualitative analysis of court proceedings

BACKGROUND

Qualitative research using published court records to examine contextual factors that contribute to child protection decisions in cases involving parents with intellectual disabilities is limited, particularly during the COVID-19 pandemic.

METHOD

The present study conducted qualitative content analysis on 10 published Ontario court cases to study child protection decision-making between 2019 and 2021.

RESULTS

The findings corroborated previous literature with nine out of 10 cases resulting in loss of child custody. Four major themes emerged from content analysis: (1) Impact of COVID-19 pandemic on cases; (2) Systemic barriers to accessibility; (3) Attitudes and bias toward parents with intellectual disabilities; and (4) Ultimate reliance on intellectual disability status for final custody decision.

CONCLUSIONS

Conducting content analysis on published court cases is useful in learning about accessibility barriers for parents with intellectual disabilities and may help in understanding the impact of the COVID-19 pandemic on the child protection system.

Reasonable Efforts? Child Maltreatment Investigations and Service Referrals of Parents With Ascribed Cognitive Impairments in Canada

Parents with ascribed cognitive impairment (CI) are more likely than parents without CI to have their children removed by child protective services (CPS). Inequitable access to parenting and family supports and services is thought to be a contributing factor. Utilizing data on a 3-month sample of 15,980 child maltreatment investigations across Canada, including 1,244 cases featuring parents with CI, this study investigated service referrals and non-referrals. The results of this secondary data analysis suggest that, relative to need, parents with CI are less likely to be referred for matched services, including home based\reunification services post child removal. It is unclear whether disparate rates of referral are driven by a lack of inclusive services, and/or the conflation of parental CI with perceived parenting deficits. When perceived parenting deficits are attributed to parental CI, CPS may wrongly assume that these are irremediable. The findings highlight the need for building inter-sectoral service pathways in order to render appropriate assistance to parents with CI in the performance of their childrearing responsibilities.

Barriers and requirements for parenting supports and mental health care among mothers with intellectual disabilities: Health and social service-provider perspectives

BACKGROUND

Mothers with intellectual disability (ID) experience high rates of mental illness, but these needs are not adequately addressed.

AIMS

We examined health and social service-provider perceptions of barriers to parenting and mental health care among mothers with ID and strategies for building good practice capacity.

METHODS AND PROCEDURES

In this qualitative study in Ontario, Canada, we interviewed 13 service-providers working with mothers with ID about their experiences supporting parenting and mental health in mothers with ID, including barriers to services and strategies for building good practice capacity. Data were analyzed via inductive, semantic-level thematic analysis.

OUTCOMES AND RESULTS

Perceived barriers to care provision were the vulnerable social context of women with ID, distrust of "the system" by women with ID, and siloed services. Increased training of service-providers, making accommodations in existing services, and building a community of support for women with ID were offered as strategies for good practice capacity.

CONCLUSIONS AND IMPLICATIONS

Efforts to improve mental health among mothers with ID should focus on improving service-provider capacity and accommodations in existing services, and enhancing coordination of care. WHAT THIS PAPER ADDS?: Mothers with intellectual disability (ID) experience high rates of mental illness, but supports for mothers with ID typically focus on parenting skills, and women's mental health care services do not consider the unique needs of those with ID. Health and social service-providers have reported inadequate training, fragmented services, high caseloads, and lack of practical supports as barriers to providing quality care to mothers with ID. However, no studies have examined service-providers' perceptions of needs related specifically to parenting and mental health among mothers with ID. This study provides new information on barriers to parenting and mental health care among mothers with ID and strategies for good practice capacity, from the perspectives of service-providers. Perceived barriers to care provision include social determinants of health, a distrust of "the system" by women with ID, and siloed services. Providers recommended that providing better training, including accommodations in existing services, and building a community of support could be beneficial to improving practice capacity in the context of mental health care and parenting supports. These factors need to be addressed to improve mental health among mothers with ID.

Child protection involvement of children of mothers with intellectual disability

BACKGROUND

Children born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research.

OBJECTIVES

To investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data.

PARTICIPANTS AND SETTING

A cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia.

METHODS

Cox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated.

RESULTS

Children born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70-5.12)) and placement in out-of-home care (HR: 6.21 (4.73-8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk.

CONCLUSIONS

Intellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs.

The devolution of eugenic practices: Sexual and reproductive health and oppression of people with intellectual disability

Early 20th century eugenicists propagated a system of ideas, values and dispositions that constituted adults with intellectual disability as the antithesis of the paradigmatic citizen, and a biological threat to society. The eugenic schema was encoded in sex-segregated institutionalization and, in many places, forced sterilization. These eugenic practices are no longer sanctioned. However, eugenic practices did not disappear. In this paper we argue that the eugenic schema is now encoded and purveyed through a multiplicity of social arrangements and practices that deny adults with intellectual disability the respect, opportunity and means necessary to participate on a par with others in social life. Such practices include, for example, covert or coerced contraception, and discriminatory child welfare interventions leading to high rates of custody deprivation. Drawing on relational theory, we problematize normative assumptions of embodiment and citizenship, which give rise to attributions of incapacity, and argue that adults with intellectual disability need what all other adults need to make and effect choices concerning their sexuality, relationships and parenthood, i.e., recognition, opportunity and support.

Family Risk Factors That Jeopardize Child Development: Scoping Review

The obligation to protect children is defined by law. However, there is fragility in identifying actual or potential situations that jeopardize their development. This review aims to identify the family risk factors that jeopardize child development. A scoping review was conducted following the Joanna Briggs Institute for Evidence-Based Practice framework and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The research was carried out on the electronic databases PubMed, CINAHL, Nursing & Allied Health Collection: Comprehensive, MEDLINE Complete, and MedicLatina, with a time limit of 2010 to 2021. The search was restricted to documents written in Portuguese, English, and French. A total of 3998 articles were initially identified. After selecting and analysing, 28 risk factors were extracted from 29 articles. Four categories of risk factors were identified—namely, patterns of social and economic interaction, family characteristics, caregiver’s characteristics, and parenting. The results of this review allow the identification of family risk factors that jeopardize child development. This is significant for Child Protective Services workers as they carry out their risk assessments. This assessment is the first step in avoiding an accumulation of harm to at-risk children and allowing the development of interventions for minimising harm’s impact on children’s development.

Mothers and fathers with intellectual and developmental disabilities who use US disability services: prevalence and living arrangements

BACKGROUND

Little information is available on the prevalence of mothers and fathers with intellectual and developmental disabilities among US disability-service users. Child removal is a key issue for these parents.

METHODS

We analysed 2018-19 National Core Indicators data from 35 states on US adults with intellectual and developmental disabilities being a parent. For parents of a child under 18, we examined whether the child lived with them.

RESULTS

Prevalence of parenthood was 3.7% (6.0% women, 2.1% men). Among parents of a child under 18, 44.0% had their child living with them. Being a mother, being married and living with family were positively associated with child co-residence. Parents with co-resident children mainly lived in their own home (59.7%) or their family's home (32.3%).

CONCLUSIONS

Our prevalence estimate suggests a national total of 33 794 US parents who use intellectual and developmental disabilities services. For parents living with their child, a critical task for disability services is to enable parents and children to live in a family setting.

Caregiver Vulnerabilities Associated With the Perpetration of Substantiated Child Maltreatment in Canada: Examining the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) 2008

Most of the research on caregiver vulnerabilities associated with the perpetration of child maltreatment (CM) focuses on perpetrators of child physical or sexual abuse. Less is known about the association of specific caregiver vulnerabilities and the risk of other CM types or how these vulnerabilities are related to child harm. The aim of the study was to examine the association of caregiver's vulnerabilities with types of substantiated CM and child physical and mental/emotional harm as a result of maltreatment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect collected in 2008 (CIS-2008). The CIS-2008 consisted of investigations of children aged 15 years and younger from 112 child welfare sites across Canada (N = 15,980). Descriptive statistics and logistic regression were used to examine relationships between caregiver vulnerabilities and outcomes of interest. Caregiver vulnerabilities were prevalent among cases of CM substantiated by child welfare agencies across Canada. Low social support, domestic violence, mental health issues, and substance abuse problems were noted among a substantial proportion of abusive caregivers. Caregiver cognitive impairments and domestic violence perpetration were associated with increased odds of child physical harm, but only among children aged 0 to 4 years. Most individual types of caregiver vulnerabilities were associated with increased odds of child mental or emotional harm across all child age groups. Insight into caregiver vulnerabilities associated with the perpetration of CM may help inform intervention targets prior to a family's involvement in the child welfare system.

Personalizing Child Protection: The Value of Responsivity Factors

Personalization is an important strategy for enhancing the effectiveness of treatment that is aimed at reducing the risk of child maltreatment. In recent years, a growing body of research has appeared on how child protection can benefit from the principles of the Risk-Need-Responsivity model, but no attention has yet been paid to the implementation of the responsivity principle in child protection. Put simply, this principle states that treatment must be tailored to individual characteristics of clients to optimize its effectiveness. This study was the first to address how the responsivity principle can be of value in child protection. First, a systematic review of responsivity factors in forensic care was performed. Second, the relevance of applying each factor in child protection was examined through interviews with clinical professionals working in the field, who also provided suggestions on how treatment can be tailored to each of these factors. This resulted in an overview of seven responsivity factors all related to caregiver characteristics: problem denial, motivation to cooperate with treatment, psychological problems, cognitive abilities, cultural background, practical barriers such as financial problems and social support, and barriers to specific treatment types such as group therapy. Implications and recommendations for strengthening clinical practice are discussed.

"Someone will come in and say I'm doing it wrong." The perspectives of fathers with learning disabilities in England

When people with learning disabilities have children and become parents, they sometimes need good support to help them.Research about parents with learning disabilities and the support they get is usually about mothers and not fathers. There is not very much written about dads with learning disabilities.This paper is about interviews with eight dads with learning disabilities who told us about what it was like to be a dad and about the kind of support they had got.We think more support needs to be given to parents with learning disabilities and that dads should be included in this.

ABSTRACT

Background: This article reports on the perspectives of fathers with a learning disability in England about being fathers and the support they have received. Although there is an established literature that considers parenting with a learning disability, few studies have focused on the perspectives of fathers.Method: We adopted a qualitative approach for this study, using semi-structured interviews with eight fathers with learning disabilities, recruited through learning disability organisations and social media. The data were analysed using thematic analysis.Results: Being a father was important to participants and the findings are presented in three themes: descriptions of fatherhood; challenges of fatherhood; and support with fatherhood.Conclusion: We discuss how fathers' perspectives on fatherhood relate to wider transformations of fatherhood in society, the impact of these on fathering with a learning disability and the implications for services.

Child Maltreatment Investigations in Canada: Main and Moderating Effects of Primary Caregiver Cognitive Impairment

Children of parents with cognitive impairment are overrepresented in the child protection system (CPS). The aim of this study was to examine the relationship between primary caregiver cognitive impairment (CCI) and CPS investigation outcomes using the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008). The CIS-2008 includes process and outcomes data on a national sample of CPS investigations involving a total of 15,980 children under the age of 16 years. This secondary data analysis found that primary CCI was noted in 6.3% of all investigations. When primary CCI was noted, investigations were 3-4 times more likely to result in child removal and court action. The results further suggest that some case characteristics, including case history variables, are weighted differently in decision making depending on whether or not primary CCI is indicated. A systematic, national strategy is needed to build capacity in government and community sectors for the provision of research-informed child and youth protection and family support services for these parents and their children.

Recent Trends and Future Directions in Research Regarding Parents with Intellectual and Developmental Disabilities

Purpose of Review

This report updates research on parents with IDD and their children published since 2014.

Recent Findings

Since 2014, a plethora of studies using large administrative databases in different countries support a contextual approach to understand why parents with IDD and their children may have worse outcomes than other families. In most studies, increased risk of ill health in women with IDD and health and developmental problems in their children were fully or partially accounted for by socioeconomic and psychosocial hardships. New research has found that pregnant women with IDD tend to have risk factors for pregnancy, birth, and postpartum complications that may contribute to adverse child outcomes. Intervention research is gradually becoming more contextualized.

Summary

More studies are needed on multicultural aspects of parenting, programs that could help parents with IDD overcome social and health disadvantages, comprehensive and coordinated service models that start during pregnancy, innovative parent support arrangements, parenting education for teens and young adults with IDD, use of technology, and dissemination and implementation of evidence-based programs.

A Factorial Survey Investigating the Effect of Disclosing Parental Intellectual Disability on Risk Assessments by Children's Social Workers in Child Safeguarding Scenarios

Literature suggests that, as parents, people with intellectual disabilities experience disproportionately high rates of child removal compared to other groups. A factorial survey of 191 children's social workers investigated the effect of disclosing parental intellectual disability (ID) upon risk assessments in a range of hypothetical child safeguarding scenarios. The case scenarios depicted a range of child safeguarding situations and parents' ID status was randomly included as an additional item of information. The data were fitted into a generalised ordinal logistic regression model. Findings indicate that when presented with scenarios considered to be less risky, the parental ID disclosure contributed significantly to a higher risk assessment score. However, when presented with scenarios that were considered more risky, the additional parental ID disclosure did not significantly contribute to a higher score. These findings indicate that the risk associated with parental ID is not fixed but relative to the situation in which it is encountered. The research concludes that in cases of low risk, the effect of parental ID is identified as a support need, whereas the lesser contribution of the disclosure to assessments of higher risk cases may indicate that parental ID is overlooked.

Teaching young adults with intellectual disabilities about early parent-child attachment behaviors using an educational DVD

Background: Previous research has largely focused on evaluating the impact of teaching practical parenting skills to parents with intellectual disabilities. Teaching them about the importance and nature of early attachment behaviors has not yet been explored. This study investigates whether knowledge of early attachment behavior of young adults with an intellectual disability who are not yet parents, can be increased using an educational DVD. Method: A sample of students with intellectual disabilities (N = 25) were asked to complete the 'parent-child questionnaire' at three stages: pre-intervention, post-intervention, and two to three week follow-up. The questions that make up this questionnaire relate to early attachment behaviors. Results: Statistical analyses show that there was a statistically significant increase in knowledge of attachment behavior following the intervention (t(24) = -3.48, p < 0.05) and this increase was maintained at follow-up (t(24) = -3.27, p < 0.05). Increase in knowledge was not significantly associated with any of the demographic factors (gender, age, intelligence quotient, main carer, number of siblings, family history of intellectual disabilities, and previous teaching on childcare). Conclusion: It is concluded that the use of an educational DVD is an effective way of teaching young adults with an intellectual disability about early attachment behaviors between parents and young babies.

Maternal Intellectual or Developmental Disability and Newborn Discharge to Protective Services

BACKGROUND

Approximately half of women with intellectual and developmental disabilities (IDDs) lose custody of their children at some point in their child's development, but their rates of and risk factors for newborn discharge to child protective services from the birth hospitalization are relatively unknown.

METHODS

We conducted a population-based study of newborns of 3845 women with IDDs and 379 834 women without IDDs in Ontario, Canada (2002-2012). We used modified Poisson regression to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for discharge to child protective services directly from the birth hospitalization (1) comparing newborns of women with and without IDDs and (2) among newborns of women with IDDs according to sociodemographic, health, service, and perinatal characteristics.

RESULTS

Approximately 5.7% of newborns of women with IDDs, compared with 0.2% of newborns of women without IDDs, were discharged to child protective services (aRR 8.10; 95% CI 6.51-10.09). Among newborns of women with IDDs, risk factors were maternal psychotic disorder (aRR 2.58; 95% CI 1.90-3.50), social assistance receipt (aRR 2.55; 95% CI 1.87-3.47), failure to receive an ultrasound by 20 weeks' gestation (aRR 1.76; 95% CI 1.32-2.34), and receipt of <4 prenatal visits by 36 weeks' gestation (aRR 1.71; 95% CI 1.05-2.78).

CONCLUSIONS

Although women with IDDs are at risk for custody loss immediately postdelivery, certain subgroups are at higher risk than others. Women with vulnerabilities related to comorbid psychotic disorders, poverty, and inadequate prenatal care may benefit from tailored, behavior-based parenting interventions before and during pregnancy to prevent maternal-newborn separations.

An intervention using the Parenting Toolkit "Children-What does it involve?" and the Real-Care-Baby simulator among students with intellectual disability-A feasibility study

BACKGROUND

There is limited knowledge about how young people with intellectual disability can be facilitated in their process of deciding about parenthood. This study aimed to evaluate the feasibility of an upcoming trial to evaluate an intervention using the Toolkit "Children-what does it involve?" and the "Real-Care-Baby" (RCB) simulator among students with intellectual disability.

METHODS

Six students with intellectual disability participated in an intervention with eight educational sessions and a 3-day caring session with the RCB simulator. Data were collected with questionnaires and interviews.

RESULTS

The study showed that it is possible to evaluate an intervention using these instruments among students with intellectual disability in order to provide them with further insights about parenthood.

CONCLUSION

It is feasible to evaluate the Toolkit and the RCB in a cluster-randomized study and that such a study could add to our knowledge about possible intervention strategies regarding reproduction and parenting among students with intellectual disability.

How are parental functioning and single parenthood associated with court outcomes? An analysis of child protection cases

Impaired parental functioning and single parenthood are considered risk factors for child maltreatment and being involved in the child protection context. Past research has shown that an impaired mental functioning and being a single parent are indicators of limited parenting resources. These risk factors are likely to be considered by family judges, which might lead to more intrusive court decisions concerning parental custody. To date, court data have rarely been investigated. The present study examined parental mental health and single parenthood using data from family law proceedings. The role of the fathers has been understudied and the few existing studies yielded contradictory results with respect to fathers' involvement as risk or protective factor. Therefore, the study included both fathers' data and mothers' data. A total of 220 child protection court files with 343 affected children were coded using a category system. Parental mental health was coded as parental functioning in daily life and was significantly associated with the court outcome. Multilevel mediation analyses showed a significant indirect effect of maternal functioning on the intrusiveness of the court decisions via child maltreatment. Single motherhood moderated the effect: The indirect effect was more pronounced for single mothers. This study contributes to a better understanding of the population getting before court and the judicial process. Psychological attributes do play a role in the decision-making of judges; and taking the role of the fathers into account is necessary.

Effects of video-feedback intervention on harmonious parent-child interaction and sensitive discipline of parents with intellectual disabilities: A randomized controlled trial

BACKGROUND

This study tested whether video-feedback intervention based on attachment and coercion theory increased harmonious parent-child interaction and sensitive discipline of parents with mild intellectual disabilities or borderline intellectual functioning.

METHODS

Observer ratings of video-recorded structured interaction tasks at home formed pretest, post-test, and 3-month follow-up outcome data in a randomized controlled trial with 85 families. Repeated measures analyses of variance and covariance were conducted to test for the intervention effect and possible moderation by IQ and adaptive functioning.

RESULTS

The intervention effect on harmonious parent-child interaction was conditional on parental social adaptive behaviour at pretest, with lower adaptive functioning associated with stronger intervention benefit at post-test and follow-up compared to care as usual. Intervention effects were not conditional on parental IQ. Intervention effects for sensitive discipline were not found.

CONCLUSION

Although the video-feedback intervention did not affect observed parenting for the average parent, it may benefit interaction between children and parents with lower parental adaptive functioning.

Home and the social worlds beyond: exploring influences in the lives of children of mothers with intellectual disability

BACKGROUND

Mothers with intellectual disability are likely to raise their children in socially disadvantaged circumstances, and many face social isolation; however, the impact of a potentially restricted home context on children's social worlds has not been examined. This study was conducted to explore influences in the social worlds of children of mothers with intellectual disability from a child's perspective.

METHODS

Seven children aged 7 to 11 years took part in at least two semi-structured interviews over a year. Narrative accounts of each child's social interactions were analysed to ascertain if a pattern was present across the group.

RESULTS

Home was found to influence the children's social interactions elsewhere by providing (or not) predictable routines and rules, and support from a significant adult other than a mother. Home environments were found to influence other social worlds by establishing a foundation for children's expectations about social interactions.

CONCLUSIONS

The social worlds of school-aged children of mothers with intellectual disability are shaped by influences in the home that cannot be attributed exclusively to having a parent with intellectual disability. Significant adults provide an important support role and can be fulfilled by social service workers when a family-centred approach is applied.

The role of formal support in the lives of children of mothers with intellectual disability

BACKGROUND

Mothers with intellectual disability face socioeconomic disadvantage and social isolation, which is associated with poorer child outcomes. Social services feature prominently in the lives of mothers with intellectual disability especially those without informal support; however, the role of formal support in the lives of their children has not been explored.

METHODS

Seven children aged 7-11 years took part in semi-structured interviews to explore their social experiences. Stories about interactions at home, school and with peers were analysed to illuminate influences, including social support, in their lives.

RESULTS

Formal support can provide an enduring relationship for children from socially restricted homes when it focuses on the child's abilities, interests and needs as distinct from those of their mother. Child-focused support can be from a paid worker or volunteer.

CONCLUSIONS

Family support services need to apply a child focus to improve the well-being of children in vulnerable families.

Increased risk for mental illness, injuries, and violence in children born to mothers with intellectual disability: A register study in Sweden during 1999-2012

Several studies have demonstrated that mothers with intellectual disability (ID) have a higher prevalence of mental health illness, lower socio-economic status, and a higher risk of alcohol and drug use compared to mothers without ID. The children of mothers with ID are over-represented in child protection and legal proceedings but are generally a less studied group than the mothers. The aim of this study was to investigate if children born to mothers with ID had an increased risk of being diagnosed with mental illness, injuries, and violence compared with children of mothers without ID. The study comprised a population-based cohort of children born in Sweden between 1999 and 2005. Data were collected from the Medical Birth Register and linked with two other national registers; ICD-10 codes were used for medical diagnoses, including ID. The children were followed from birth to seven years of age. In total, 478,577 children were included, of whom 2749 were born to mothers with ID. Children of mothers with ID were at a greater risk of having mental health problems (adjusted odds ratio (OR)=2.02; 95% confidence interval (CI)=1.74-2.35) and ID (OR=4.14; CI=2.95-5.82) in early childhood. They had an increased risk for injuries due to falls (OR=1.15; Cl 1.04-1.27). The largest risk related to trauma was violence and child abuse (OR=3.11; CI=1.89-5.12). In conclusion, children of mothers with ID had an increased risk for injuries, violence, and child abuse. We therefore suggest that parents with ID should receive evidence based support so that their children receive the best care and protection.

Parents with intellectual disability

Questions around parents with intellectual disability have changed according to sociocultural shifts in the position and rights of people with intellectual disability. The early research focus on capacity for parenting has given way to a contextual model of parenting and child outcomes, increasingly tested in population-based samples. Epidemiological research shows that contextual variables such as low income, exposure to violence, and poor mental health partly account for negative outcomes. As theoretical models developed for other at risk populations prove increasingly helpful for understanding the challenges of parenting with intellectual disability, it becomes viable to adapt existing evidence-based parenting interventions and test these for this population. Ultimately, parenting research should become fully inclusive.

Child protection services and parents with intellectual and developmental disabilities

BACKGROUND

Information about parents with intellectual and developmental disabilities (IDD) in the child protection system (CPS) continues to evolve. This study examined characteristics, experiences and representation of parents with IDD across three CPS decision points, as compared to parents with other disabilities and parents without disabilities in the United States.

METHODS

The sample consisted of 303,039 individuals: 2,081 were individuals identified as parents in a CPS investigation; 1,101 had children in out-of-home care (OHC); and 308 experienced termination of parental rights (TPR). Descriptive statistics, chi-square analysis, disparity indices and logistic regression were employed.

RESULTS

Parents with IDD were significantly more likely than parents without disabilities (but not significantly more likely than parents with other types of disabilities) to experience disproportionately representation.

CONCLUSIONS

Parents with IDD are generally over-represented within CPS; however, this representation is dependent upon the comparison group utilized and other risk factors. CPS system-level changes are necessary.

Judicial Reliance on Parental IQ in Appellate-Level Child Welfare Cases Involving Parents with Intellectual and Developmental Disabilities

BACKGROUND

Parents with intellectual and developmental disabilities (IDDs) are over-represented in child welfare cases. Although IQ per se is an invalid indicator of parenting abilities, this study examined the prevalence of judicial consideration of parental IQ test evidence in US appellate cases.

METHODS

The present authors conducted Boolean searches of Westlaw Corporation's case database since 1999. The present authors used a six-question checklist to survey the 42 most recent American appellate cases involving termination of parental rights (TPR) decisions that included evidence of parental intellectual and developmental disabilities based on IQ.

RESULTS

In 86% of cases, parental low IQ was presented as a barrier to parenting competence. Higher courts uphold TPR decision in 81% of cases involving parents with intellectual and developmental disabilities.

CONCLUSIONS

Parental IQ scores are routinely relied upon to judge parenting capacity in custody cases where parents have intellectual and developmental disabilities. The present authors recommend more comprehensive assessments examining a broader range of contextual variable that may impact on parenting abilities.

Negotiating parenthood: Experiences of economic hardship among parents with cognitive difficulties

People with cognitive difficulties often have scarce economic resources, and parents with cognitive difficulties are no exception. In this article, parents' experiences are put forth and discussed, for example, how does economic hardship affect family life? How do the parents experience support, what kind of strain does the scarce economy put on their situation and how are their children coping? The data consist of interviews with parents living in this often problematic situation. Experiences of poverty and how it can be related to - and understood in the light of - cognitive difficulties and notions of parenthood and children's agency are scarcely addressed in the current research. The findings suggest that experiences of poverty are often associated with the limitations caused by cognitive difficulties. Poverty may thus be articulated as one aspect of the stigma they can experience due to their impairments, not least in relation to their children and naturalized discourses on parenthood.

Mothers with intellectual impairment and their 9-month-old infants

BACKGROUND

Few studies have utilised population-based data to examine the lives of families headed by parents with intellectual impairment. This study examined the health and social context of mothers with intellectual impairment compared with their peers without intellectual impairment, and the 9-month developmental outcomes of their infants.

METHOD

Secondary analysis of the first wave of the United Kingdom's Millennium Cohort Study (MCS). Wave 1 data were collected when the child was 9 months of age and recorded in-depth information of maternal health, the social context in which the families live, and developmental outcomes of the infants.

RESULTS

Of the 18 189 mothers, 74 (0.4%) were classified as mothers with intellectual impairment. The findings show evidence of widespread disadvantage in terms of social context and poorer self-reported physical health for mothers with intellectual impairment compared with their peers without intellectual impairment. Maternal mental health and the developmental outcomes of their 9-month infants were not markedly different between the two groups.

CONCLUSIONS

The cross-sectional analyses used in this study shows the differences in the lives of mothers with intellectual impairment and their young infants compared with their peers. Longitudinal analyses across subsequent waves of the MCS will allow protective and risk factors in the early years that influence later developmental outcomes to be identified.

Tailoring a video-feedback intervention for sensitive discipline to parents with intellectual disabilities: a process evaluation

Parenting support programs for the general population may not be effective for parents with intellectual disabilities (ID). A videobased intervention program based on attachment and coercion theory (Video-feedback Intervention to promote Positive Parenting with additional focus on Sensitive Discipline; VIPP-SD) was tailored to parents with ID and the implementation of the adapted program was evaluated by the home visitors conducting the program. Home visitors (N = 17) of 36 families rated the intervention process during each session. Home visitors' evaluations showed a significant increase in positive ratings of parents' easiness to work with, amenability to influence, and openness. Cooperation remained stable. A case example illustrated this process, showing how feedback using video facilitated changes in the perceptions and attributions of a mother with mild ID.

Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement.

Parents with Intellectual Disability in a Population Context

Parenting by people with intellectual disability continues to confront societal sensibilities. On the one hand, parents with intellectual disability engage in the valued social role of raising children; on the other, their parenting attracts (typically negative) attention based on an expectation of their limited capacities to parent. The literature primarily addresses the question of whether or not parents with intellectual disability can be adequate parents or reports on methods for improving their parenting skills. An emerging trend in the literature over the last decade takes a different perspective. Rather than concentrating exclusively on parents with intellectual disability, this perspective focuses on their parenting situation compared to that of other parents more generally. This paper reviews the current state of knowledge about parents and parenting with intellectual disability in this broader population context. The focus of the paper is on the use of larger scale datasets to understand the situation of parents with intellectual disability compared with other parents and to examine the contextual variables that influence their parenting.

Expecting change: mindset of staff supporting parents with mild intellectual disabilities

This study of staff supporting parents with mild intellectual disabilities or borderline intellectual functioning (MID) focused on staff mindset regarding the extent to which parenting skills of parents with MID can change (an incremental mindset) or are static (an entity mindset). Staff mindset was tested as a predictor of two outcome variables: quality of the working alliance and parental waiting time to ask professional support. In addition, mindset was tested as a moderator of associations between parental adaptive functioning and the two outcome variables. A small majority of staff (56%) held a more incremental oriented mindset. A more incremental oriented mindset was associated with a shorter intended waiting time to seek professional support. Staff mindset moderated the association between parental adaptive functioning and working alliance, that is, lower levels of parental adaptive functioning were associated with lower working alliance quality, but the association was less strong when staff held a more incremental oriented mindset. The results of the current study show that staff mindset might be important for the quality of support for parents with MID and for reducing the risks for families where parents have MID. Attention is due to staff mindset in improving support for parents with MID.

Parents with intellectual disabilities seeking professional parenting support: the role of working alliance, stress and informal support

Delaying or refraining from seeking advice and support in difficult parenting situations is identified as an important risk factor for child abuse and neglect. This study tested whether the extent of delays in support seeking is associated with working alliance for parents with mild intellectual disabilities (MID) and whether the importance of working alliance may depend on parenting stress and availability of informal support. Delays in support seeking were measured as parental latency (time waited) to approach the support worker. This latency was assessed in the intended response to hypothetical situations (vignettes) and in the reported behavioral response to real life difficult parenting situations from the preceding weeks. Multiple regression analyses were conducted for testing main and interaction effects of predictors on latency for support seeking. Better quality of the working alliance was associated with shorter intended latency to seek support for parents with MID, if parents had little access to informal support. Higher parenting stress predicted a shorter latency for intended support seeking. Parental support seeking intentions were positively associated with support seeking behavior. A good quality of the working alliance might be important to connect needs of parents with MID to resources that professional support can offer, in particular for the most vulnerable parents. Parental reluctance to seek professional support may be the result of a combination of risk and protective factors and is not always a sign of poor working alliance. Implications for risk assessment and support practice are discussed.

Association of maternal developmental disorder traits with child mistreatment: a prospective study in Japan

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child mistreatment. Maternal PDD and ADHD were assessed through a self-administered questionnaire (N=846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child mistreatment score were analyzed using linear regression models adjusted for covariates. Mothers who exhibited stronger PDD traits showed significantly higher child mistreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child mistreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits. Mothers who showed PDD and ADHD traits during pregnancy were more likely to mistreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.

A review of findings from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS)

OBJECTIVE

This article critically assesses and reviews analyses derived from three cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) published between 2001 and October 2011.

METHODS

Articles were retrieved from the Public Health Agency of Canada's data request records, which tracked database access and ensuing publications. The included articles were reviewed and appraised independently by the authors.

SYNTHESIS

Overall, 37 peer-reviewed articles using CIS data were included in the review. These articles revealed an increased likelihood of substantiation or placement if investigations 1) uncovered the presence of emotional or physical harm in a child, 2) involved older children, 3) identified the presence of risk indicators in caregivers, or 4) documented unstable or unsafe housing. A similar proportion of articles used a descriptive or multivariate approach to analyze CIS data, and strengths and limitations were identified.

CONCLUSION

Researchers have analyzed and interpreted the CIS extensively, although several issues are understudied - such as neglect and emotional maltreatment - especially using multivariate approaches. We hope this review will contribute to helping address gaps in the CIS literature.