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

Prevalence and early-life predictors of adverse childhood experiences: Longitudinal insights from a low-income country

BACKGROUND

A sizeable literature shows that adverse childhood experiences (ACEs) are associated with poor health outcomes in later life. However, most studies on the prevalence and predictors of ACEs have been carried out in high-income countries using cross-sectional approaches.

OBJECTIVE

The present study explores the prevalence and predictors of ACEs in Malawi, a low-income country, using prospective longitudinal data collected on adolescents.

PARTICIPANTS

We use data on 1375 adolescents and their biological mothers from the Malawi Longitudinal Study of Families and Health (MLSFH). ACEs were reported by adolescents over two survey waves, in 2017-18 and 2021. Predictors were reported by mothers in 2008 and 2010.

METHODS

Multivariate ordinary least square and logistic regression analyses of ACEs exposure reported by adolescents on indicators of family arrangements and resources.

RESULTS

Adolescents report having been exposed to nearly seven ACEs on average. Among indicators of family arrangements and resources, the only significant predictors of cumulative ACEs exposure are polygyny (linked to parental absence) and mother's SF-12 mental health score (linked to physical abuse and witnessing domestic violence).

CONCLUSIONS

ACEs are much more prevalent in the low-income country under study than in middle- and high-income countries surveyed in prior research. Despite adversity being widespread, most indicators of family arrangements and resources highlighted in prior studies are not associated with adolescents' cumulative ACEs exposure in this context. Mothers' mental health in childhood nevertheless emerges as a significant predictor of adolescents' self-reported ACEs. These findings inform efforts aimed at preventing ACEs in high-adversity contexts.

Caring by default: experiences of caregivers of children with developmental disabilities in Ghana mirrored in the context of the stress process model

BACKGROUND

Caring for a child with developmental disabilities (DD) is associated with significant stress and burden. Caregivers' experiences are influenced by factors such as poverty, stigma, and the lack of accessibility to services, equipment, and assistive devices. These factors are prevalent in a low-resource setting like Ghana which ultimately influences the experiences of caregivers. The aim of the study was to explore the experiences of caregivers of children with DD in the context of the Stress Process Model.

METHODS

The study employed a descriptive phenomenological design Caregivers of children with DD attending the Neurodevelopmental Clinic of a Teaching Hospital were purposively sampled. Data collection involved semi-structured interviews, reaching saturation with 14 participants. The interviews were audio-recorded transcribed verbatim and analysed using thematic analysis.

RESULTS

Four main themes emerged: perception of caregiving, stressors faced by caregivers, negative health outcomes and coping strategies. Perception of caregiving had two sub-themes as stressful nature of caregiving and time-consuming. Six sub-themes were linked to stressors faced by caregivers: the child's ADL needs, communication barrier, managing challenging behaviour, child's health needs, unmet educational needs, and economic burden. Negative health outcomes had three sub-themes: decline in physical, mental and social well-being. While some caregivers used maladaptive coping strategies like blaming, others employed adaptive coping strategies like religious coping through prayer, self-encouragement and support from other family members.

CONCLUSION

The study highlights the complex interaction between caregivers' perception of their caregiving situation, the stressors they experience, their coping resources,  and the negative health outcomes associated with caregiving. These findings underscore the need for context-specific caregiver programmes to mitigate the negative impacts of caregiving.

The role of women in the field of early intervention

This study examines the intersection of early intervention and the role of women as primary caregivers for children with disabilities. Studies for this analysis were collected through a meticulous search in the Web of Science (WoS) and Scopus databases. This process ensured the inclusion of a wide range of relevant literature from the field of study. A rigorous procedure of identification, selection, eligibility assessment, and inclusion of potentially relevant studies in this research area was conducted. We analyzed 130 articles, identifying 8 key research areas. Significant factors include the impact on parental interactions, communication skills, the role of women in developmental disabilities, mothers' understanding of their children's disabilities, emotional overload, parental stress, and psychological aspects. These factors significantly affect the well-being and development of mothers and children with disabilities. The study also considers the impact on women's careers. While research on psychological aspects and maternal overload is well-developed, establishing early intervention systems to optimize resources for proper child development is a challenge. The findings have high social value, paving the way for improving the quality of early childhood services.

The Impact of Autism Spectrum Disorder on Parents in Arab Countries: A Systematic Literature Review

Background

Having a child with autism spectrum disorder can have significant psychological effects on parents. This systematic review summarizes the current state of literature underscoring the impact of autism spectrum disorder (ASD) on parents in Arab countries.

Methods

A systematic search of seven databases (PubMed, Scopus, ProQuest, Google Scholar, ERIC, Academic Search Complete, and PsycINFO) was performed, which identified 24 studies (20 quantitative studies and four qualitative studies) that included 3,299 parents or caregivers of children with ASD. These studies were conducted in 10 Arab countries (Saudi Arabia, Jordan, Egypt, Kuwait, Bahrain, Oman, Emirates, Palestine, Qatar, and Lebanon).

Results

The majority of the included studies found that ASD has a significant negative impact on the mental health and wellbeing of Arab parents. It was found that parents of children with ASD have a poor quality of life (QoL) and an increased risk of psychological disorders. These findings were in contrast to findings of parents of typically developing children and children with other developmental disorders. Challenges faced by parents of children with ASD were associated with several child- and parent-related factors. The most common coping strategy used by parents was religious coping.

Conclusion

The impact of ASD on parents has only recently gained traction among researchers in Arab countries. Despite several knowledge gaps, published studies have provided useful information outlining the impact of ASD on parents in some of these countries. Further research comprising larger random samples and using varied research and data-collection methods is required to understand the multifaceted challenges experienced by parents raising children with ASD in Arab countries.

Psychological treatment strategies for challenging behaviours in neurodevelopmental disorders: what lies beyond a purely behavioural approach?

PURPOSE OF REVIEW

Challenging behaviour shown by individuals with neurodevelopmental disorders (NDDs) has a major negative impact. There is robust evidence for the efficacy of treatments based on applied behaviour analysis. However, such approaches are limited in important ways - providing only part of the whole solution. We reviewed the literature to provide an overview of recent progress in psychological treatments for challenging behaviour and how these advance the field beyond a purely behavioural approach.

RECENT FINDING

We identified 1029 articles via a systematic search and screened for those implementing a psychological intervention with individuals with NDD (or caregivers) and measuring the potential impact on challenging behaviour. Of the 69 included studies published since 2018, more than 50% implemented a purely behavioural intervention. Other studies could generally be categorized as implementing parent training, meditation, skill training or technology-assisted interventions.

SUMMARY

Greater consideration of the interplay between behavioural and nonbehavioural intervention components; systematic approaches to personalization when going beyond the behavioural model; mental health and broad social communication needs; and models that include cognitive and emotional pathways to challenging behaviour; is needed to advance the field. Furthermore, technology should not be overlooked as an important potential facilitator of intervention efforts.

Parents' perceptions regarding couple relationships of their adult children with intellectual disabilities

BACKGROUND

A particular challenge facing parents of children with intellectual disabilities occurs when their adult children with intellectual disabilities has an interest in pursuing couple relationships. This study explores parents' perceptions regarding the nature of couple relationships, the right of their adult children with intellectual disabilities to pursue such relationships, the difficulties their children encounter and their own role in providing support.

METHOD

Interviews were conducted with 30 parents of adults with intellectual disabilities who had left home for independent and semi-independent living arrangements. A thematic content analysis was conducted.

RESULTS

Whereas parents used "mutual support" to characterize couple relationships in general, they viewed their children with intellectual disabilities as primarily focused on "physical intimacy" and the couple relationship as a "status symbol," as well as expressed reservations about their becoming parents.

CONCLUSIONS

Parents should be helped to adopt a more consistent and positive attitude towards their intellectual disabilities children's pursuit of couple relationships.

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.

Utility-based quality of life in mothers of children with behaviour problems: A population-based study

AIM

To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health.

METHODS

Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years; demographic data were collected at child age 8 months.

RESULTS

HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P < 0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P < 0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P < 0.001).

CONCLUSIONS

Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing.

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

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

Adverse health in parents of children with disabilities and chronic health conditions: a meta-analysis using the parenting stress index's health sub-domain

BACKGROUND

Compared with parents of same-aged children without disabilities, parents of children with disabilities and with chronic health conditions (CHC) show higher levels of stress and depression. Fewer studies, however, examine the physical health of these parents, and studies report mixed findings. Many studies, however, report mother's self-reported health using the Health Sub-domain of Abidin's Parenting Stress Index (PSI). We therefore conducted a meta-analysis comparing the physical health of parents of children with developmental disabilities (DD) and CHC vs. parents of children without DD/CHC in studies utilising this measure.

METHODS

Eligible studies used the long form of the PSI and reported results from the 5-item Health sub-domain. Group comparison effect sizes were synthesised in a meta-analysis, and we also examined the potential relations of child, parent, and study characteristics. Our search yielded 19 eligible studies.

RESULTS

Compared with parents of children without DD/CHC, parents of children with DD/CHC reported higher PSI health problem scores, with a weighted mean effect size of 0.39 (95% CI = 0.23-0.55). Effect sizes ranged from -0.13 to 1.46 and there was evidence of heterogeneity in the effect sizes (τ2  = 0.07; Q18  = 48.64, P < 0.01; I2  = 63.0%). Studies with higher numbers of reporting quality indicators generally reported larger effects and more recent studies showed smaller effects. Although several child and parent characteristics were moderately associated with effect sizes, none reached statistical significance.

CONCLUSIONS

Practitioners should be alerted to the need for health prevention and treatment in this at-risk parent group.

Child problem behaviours are associated with obesity in parents caring for children with developmental disabilities

Epidemiological evidence suggests that obesity and depression are highly co-morbid. In a national cohort study, we examined whether parents caring for children with disabilities were more likely to be classified as obese compared to parents of children without disabilities and if obesity was associated with depressive symptoms or child behaviour characteristics. Using data from the Growing Up in Ireland National Longitudinal Study of Children (2006 to date), 627 parents of children with developmental disabilities were compared with 7941 parents of typically developing children on objectively measured levels of obesity (body mass index ≥30kg/m²), depression, health behaviours, chronic health conditions, socio-demographic and child behavioural characteristics. Parents of children with disabilities were more likely to be classified as obese compared to control parents (24.5% vs. 19.6%, p=0.005, Cramer's V<0.1). Depression was not associated with obesity. However, the odds of obesity increased with increasing child problem behaviour (OR 1.05, 95% CI 1.03-1.06). Over half (57%) of obese parents caring for children with disabilities reported trying to lose weight often or very often. This study has confirmed, in a population-based sample, the high risk of obesity in parents caring for children with disabilities after adjusting for the presence of depression and other health behaviours; increasing child problem behaviours were predictive of obesity. Importantly, given the negative health correlates of obesity, it is imperative that health professionals pay attention to weight issues in these parents and support their efforts in managing these issues.

Psychological and practical difficulties among parents and healthy siblings of children with Duchenne vs. Becker muscular dystrophy: an Italian comparative study

This study explored the burden in parents and healthy siblings of 4-17 year-old patients with Duchenne (DMD) and Becker (BMD) muscular dystrophies, and whether the burden varied according to clinical aspects and social resources. Data on socio-demographic characteristics, patient's clinical history, parent and healthy children burden, and on parent's social resources were collected using self-reported questionnaires administered to 336 parents of patients with DMD (246) and BMD (90). Parents of patients with DMD reported higher burden than those of patients with BMD, especially concerning feeling of loss (84.3% DMD vs. 57.4% BMD), stigma (44.2% DMD vs. 5.5% BMD) and neglect of hobbies (69.0% DMD vs. 32.5% BMD). Despite the burden, 66% DMD and 62.4% BMD parents stated the caregiving experience had a positive impact on their lives. A minority of parents believed MD has a negative influence on the psychological well-being (31.0% DMD vs. 12.8% BMD), and social life of unaffected children (25.7% vs. 18.4%). In the DMD group, burden correlated with duration of illness and parent age, and burden was higher among parents with lower social contacts and support in emergencies. In DMD, difficulties among healthy children were reported as higher by parents who were older, had higher burden and lower social contacts. In both groups, burden increased in relation to patient disability. These findings underline that the psychological support to be provided to parents of patients with MD, should take into account clinical features of the disease.

Environmental risk factors associated with the persistence of conduct difficulties in children with intellectual disabilities and autistic spectrum disorders

We investigated the association between exposure to environmental risks in early childhood and the prevalence and persistence of conduct difficulties (CD) in children with intellectual disability (ID) who did not have autistic spectrum disorder (ASD), children with ASD and typically developing (TD) children. Results indicated that: (1) exposure to risk was associated with elevated prevalence of CD at age three and, for TD children and children with ID, increased risk of CD persisting to ages five and seven; (2) at all levels of risk, children with ASD were more likely to show persistent CD than other children; (3) children with ID were no more likely to show persistent CD than TD children at low levels of exposure to environmental risk.

Resilient parenting of children at developmental risk across middle childhood

This paper focuses on factors that might influence positive parenting during middle childhood when a parent faces formidable challenges defined herein as "resilient parenting." Data were obtained from 162 families at child age 5 and 8 years. Using an adapted ABCX model, we examined three risk domains (child developmental delay, child ADHD/ODD diagnosis, and low family income) and three protective factors (mother's education, health, and optimism). The outcome of interest was positive parenting as coded from mother-child interactions. We hypothesized that each of the risk factors would predict poorer parenting and that higher levels of each protective factor would buffer the risk-parenting relationship. Positive parenting scores decreased across levels of increasing risk. Maternal optimism appeared to be a protective factor for resilient parenting concurrently at age 5 and predictively to age 8, as well as a predictor of positive change in parenting from age 5 to age 8, above and beyond level of risk. Maternal education and health were not significantly protective for positive parenting. Limitations, future directions, and implications for intervention are discussed.