Parenting children with down syndrome: An analysis of parenting styles, parenting dimensions, and parental stress

Efficacy of a Parent-Implemented Pivotal Response Treatment for Children with Autism Spectrum Disorder

PURPOSE

Pivotal response treatment (PRT) is a well-established intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as a key component. The current study aimed to examine the effects of PRT parent training on parent fidelity and provide descriptive analyses of parent-child interactions before and after parent training. It also probed parental acceptance and satisfaction with the program.

METHODS

A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the parent training program. Four parents (range 32-47 years old) and their children with ASD participated in the study. The intervention comprised 12 one-on-one parent training sessions over six consecutive weeks. The visual analysis and effect size calculation (Tau-U) were used to evaluate functional relationship between independent and dependent variables. The descriptive analysis was used to analyze parent-child interaction data.

RESULTS

The findings reveal that all parents learned and maintained PRT with a high level of fidelity, they also enhanced awareness to create more opportunities for interactions during free play, and the parents were very satisfied with the program. The results also indicate that the six-week parent training program is effective in teaching parents to implement PRT with their children.

CONCLUSION

These results suggest that the parent training program may be a promising treatment model that is effective, efficient, and cost-effective. Implications for future research and practice are then discussed.

The Efficacy of a Culturally-Adapted Group-based Parent Coaching Program for Autistic Children in China via Telehealth: A Randomized Controlled Trial

The study aimed to examine the efficacy of a culturally-adapted, group-based parent coaching program for autistic children in China delivered via telehealth. A randomized controlled trial was conducted, with 18 parents allocated to the self-directed group that received the intervention through an online learning platform, and 19 parents allocated to the web + group therapy group, which included the same program along with weekly 1.5-hour group coaching sessions via videoconferencing. The primary outcomes were parents' mental health and children's adaptive functioning, while the secondary outcomes focused on the child behaviors, parenting stress and parenting style, and family quality of life. Linear Mixed Models were used to evaluate treatment effects across time and to model longitudinal trajectories of outcomes in both children and parents. Both intervention groups showed significant improvements in children's communication skills (F (1, 60.27) = 29.86, p < 0.001) and social engagement (F (1, 60.07) = 11.73, p = 0.001), as well as reductions in parenting stress (F (1, 59.07) = 8.76, p = 0.004) and anxiety levels (F (1, 57.62) = 4.84, p = 0.032). Additionally, the group-based parent coaching via videoconferencing was associated with greater improvements in children's quality of life (F (1, 59.95) = 5.90, p = 0.018) and parents' anxiety outcomes (F (1, 57.62) = 4.84, p = 0.032). This study demonstrated the efficacy of a culturally adapted telehealth intervention for both autistic children and their parents. The preliminary findings suggest positive outcomes in children's adaptive functioning and parents' mental well-being. Group-based parent coaching through videoconferencing could be a promising and practical model for in-home services, particularly for families with limited access to in-person services.

Psychological wellbeing in parents of children with Down syndrome: A systematic review and meta-analysis

We report a review examining the psychological wellbeing of parents of children with Down syndrome (DS) relative to that of parents of typically developing (TD) children. A systematic search identified 57 relevant studies, which were synthesised meta-analytically. Relative to their counterparts with TD children, mothers and fathers of children with DS reported higher levels of parenting stress (mothers: g = 0.57, 95% CI [0.33, 0.81]; fathers: g = 0.40, [0.24, 0.56]), depressive symptoms (mothers: g = 0.42, [0.23, 0.61]; fathers: g = 0.25, [0.02, 0.48]) and psychological distress (mothers: g = 0.45, [0.30, 0.60]; fathers: g = 0.63, [0.26, 0.99]). Small effects were found for anxiety for mothers (g = 0.16, [0.03, 0.29]), with no differences for fathers (g = 0.03, [-0.25, 0.32]). No group differences were found for positive impact of parenting (mothers: g = -0.09, [-0.25, 0.07]; fathers: g = -0.04, [-0.30, 0.22]), while evidence concerning other positive wellbeing outcomes was limited. No significant moderating effects of child age range, country income level, or group differences in parental education level were identified, but limited subgroup analyses were possible. Raising a child with DS may be associated with elevated stress, depressive symptoms, and psychological distress for mothers and fathers. However, levels of parenting reward appear equivalent to those experienced by parents raising TD children.

Family Self-Support in Managing Down Syndrome Children: A Qualitative Study

Background and Aim. Down syndrome (DS) is the most common reason for disabilities caused by genetic disorders. Due to the special nature of this disease and the special needs of children with Down syndrome, they are required to receive their families' support. Therefore, the recognition of their problems and needs and also the alternatives for resolving them and promoting their life quality are very useful. Also, since very limited qualitative studies have been conducted, it seems necessary to design a qualitative study. Method. This qualitative study was conducted by the content analysis method and through purposeful sampling method with the participation of 26 participants including 15 mothers, 6 fathers, 3 sisters, and 2 brothers of DS children in 2022-2023. The data were collected through semi-structured interviews. Findings. Using the content analysis method of Graneheim and Lundman (2004), the main theme was "Family self-supporting in protecting Down syndrome children." The subthemes were seven including "trying to find information-support resources," "Giving importance to child's health," "religious beliefs of the family," "child moral education, helping to child's relative self-support," "developing familial support," and "developing child's social interactions." Conclusion and Recommendations. The findings of this study showed that family is the main source of fulfilling the needs of children and their life challenges through using efficient self-support methods. This study introduced family self-support methods in terms of DS children in a way that other families can also manage the problems of their children more efficiently. The present study can be used by trustees of DS to support them and their families. Considering the existence of many problems in children with Down syndrome and the involvement of families, it is suggested that policymakers and community health managers provide the basis for receiving services and social support. For example, it is possible to strengthen the screening systems in the country to diagnose the disease on time and take quick action to solve this problem. Also, by increasing the health insurance coverage and fair distribution of the support resources needed by these people, it promoted the quality of life for them and their families. Also, health policymakers in Iran can take action to increase life expectancy and reduce deaths caused by DS by improving the equitable distribution of health resources and services. Also, public policies should enhance supportive intermediation for prevention and life quality promotion and also decrease health challenges. They are also supposed to lessen the costs of health care. Furthermore, to support social organizations, health service providers and researchers should consider the development of intermediations for the health enhancing and life quality promoting of DS children.

The effectiveness of parent-Child observation in parent-Mediated programmes for children with developmental disabilities and externalizing disorders: A systematic review and meta-analysis

This systematic review evaluated the treatment effects of communication-focused parent-mediated interventions (CF-PMT), a form of intervention that involves therapists observing parent-child interactions and giving feedback to parents on how they can practice positive parenting strategies to prevent or reduce externalizing behaviours in children with developmental disabilities. A literature search was conducted on three electronic databases. To be included in the review, studies had to: evaluate CF-PMT where therapists give feedback after observing parent-child interactions; examine changes in externalizing behaviours amongst children with any forms of developmental disability; and adopt a randomised controlled trial study design. Fifteen studies met eligible criteria for the literature review, of those, 13 studies had available data on changes in the primary (child externalizing behaviours) and secondary outcomes (parental stress, child linguistic abilities and child social responsiveness). We found significant treatment effects for CF-PMT in reducing child externalizing behaviours (d = -.60) but not for any of the secondary outcomes. A sensitivity analysis showed a small but significant treatment effect for parental stress (d = -.18). Considerable bias was observed due to the lack of available information reported by studies on aspects measured by the Mixed Methods Appraisal Tool. Overall, we found evidence to support the benefits of complex interventions which incorporate direct parent-child observations and feedback to improve behavioural outcomes amongst children with developmental disabilities.

Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities

Introduction

The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue.

Methods

This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress.

Results

Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors.

Discussion

These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.

Parenting a child with Down syndrome: A qualitative study on parents' experiences and behaviors from a self-determination theory perspective

PURPOSE

Raising a child with Down syndrome (DS) brings unique challenges to parents' psychological functioning. Extensive quantitative research has shown that these parents tend to experience higher levels of parental stress and lower well-being. However, a more in-depth and balanced insight is essential to fully grasp the complexity of parenting a child with DS. To address this gap, this study uses a qualitative approach to explore the experiences and behaviors of parents raising a child with DS.

DESIGN AND METHODS

By adopting the Self-Determination Theory as a comprehensive theoretical framework, this study attends to both opportunities and challenges for parents' psychological needs of autonomy, relatedness, and competence, and provides insights into how they support the psychological needs of their child with DS. Eleven in-depth interviews were conducted with parents of a child with DS (aged 4 to 23 years).

RESULTS

Through thematic analysis, six themes of parental experiences and three themes of parenting behaviors were distinguished.

CONCLUSIONS

The findings indicated that parents experience many opportunities for need satisfaction, predominantly in their need for relatedness. However, raising a child with DS also involves challenges for the parents' family relationships, personal freedom, professional ambitions, and feelings of competence. Regarding their parenting behaviors, parents considered stimulating independence, tuning into the child's mental world, and being patient as essential practices when raising a child with DS.

PRACTICAL IMPLICATIONS

This study provides important clues to promote parents' well-being as well as their engagement in need-supportive parenting practices towards their child with DS.

Observations of feeding practices of US parents of young children with Down syndrome

Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.

Profiles of the parenting experience in families of autistic children

LAY ABSTRACT

Research shows that parents of autistic children, on average, are stressed; however, there is likely an array of factors that characterize the parenting experience in the context of autism other than stress. Understanding the diversity in the parenting experiences of both mothers and fathers of autistic children is important in the development of family-based intervention. A total of 188 co-habiting couples with an autistic child described their parenting experiences using a series of questionnaires examining their feelings of stress, parenting competence, and parenting attitudes and behaviors. We then sorted responses into profiles-three for mothers and four for fathers. We found that children of parents who reported the least amount of stress, highest feeling of competence, and use of responsive and directive parenting strategies (the Adaptive profile) had children with the least severe behavioral problems and autism symptoms. It was not necessary for both parents to be in the Adaptive category for child emotional and behavioral problems to less severe. We found that children did just as well when one parent was Adaptive compared with when both parents fell into this category.

A pilot randomised controlled trial on the effectiveness of infant massage on the acceptance, commitment and awareness of influence in parents of babies with Down syndrome

BACKGROUND

The emotional state of parents of babies with Down syndrome affects their babies' development and their parent-child bonding. The aim for this study was to conduct a pilot randomised controlled evaluation of the effect of infant massage on parents of babies with Down syndrome.

METHODS

This pilot study compared two groups (intervention and control), each with 16 parents of babies with Down syndrome. Indices of acceptance, engagement and awareness of influence were measured at two different time points (pre-test and after 5 weeks) using the 'This Is My Baby' Interview. The allocation of families to each group was randomised. The experimental group performed infant massage, applied by the parents, for 5 weeks, every day for at least 10 min. The massage protocol was based on the methodology created by Vimala McClure. Parents in the control group received the intervention after completion of the study.

RESULTS

The indices of acceptance, commitment and awareness of influence improved in the experimental group and in the control group. The 2 × 2 mixed-model analysis of variance indicates a statistically significant group-by-time interaction for all indices (P < 0.001), which was significantly higher in the experimental group than in the control group.

CONCLUSIONS

The application of infant massage, by parents to their babies, improves the rates of acceptance, commitment and awareness of influence of parents of babies with Down syndrome in the short term.

"Life-altering": A qualitative analysis of social media birth stories from mothers of children with Down syndrome

Perinatal depression/anxiety is a significant concern for mothers of children with Down syndrome. This is influenced by the way the Down syndrome diagnosis is shared with parents. This study examined social media posts from mothers regarding experiences of the birth of their child with Down syndrome. Forty-three total stories were coded using thematic content analysis. Results highlighted the experiences of mother's who received a diagnosis of Down syndrome for their newborn. Two themes were found with relevant subthemes (i.e., receiving the diagnosis-mother's intuition, confirmation of the diagnosis, influence of potential health concerns, initial emotions, impact of the medical professional; Processing the diagnosis-life-altering, child not meeting expectations, reframing the diagnosis, impact of partner and others). Findings highlight the need for medical personnel to understand this identity-changing process, as perinatal depression/anxiety looks different for these mothers. There is also a need to help them engage in services accordingly.

Permissive parenting mediates parental stress and child emotions in families of children with Down syndrome

BACKGROUND

Parenting styles mediate parental stress and child emotions in families of typically developing (TD) children. Our main aim was to study these relations in families of children with Down syndrome (DS), who in past research reported increased parental stress and permissive parenting.

METHOD

Our sample included 100 parents of children with DS and 72 parents of TD children age 4-12 years. Parents completed online surveys of parental adjustment and emotion regulation (ER), parenting styles, and child ER and mood.

RESULTS

Parents of children with DS reported more distress and permissive parenting than parents of TD children. Within parents of children with DS, there was an indirect effect of parental stress on child emotions through permissive parenting. This effect was partly conditional upon parental ER and positive adjustment.

CONCLUSIONS

Results have implications for distressed parents of children with DS whose families may benefit from improved coping strategies and increased support.

[Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD)

Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.

Eating behaviors in children with down syndrome: Results of a home-use test

Children with Down syndrome (DS) display a disproportionate number of health challenges, including feeding and swallowing difficulties and food texture sensitivities. To start addressing food texture challenges early in life, the aim of this research was to understand mealtime behaviors and identify preferred food textures of children with DS. Children (aged 11 to 58 months) with DS (n = 111) and without (typically developing, TD; n = 107) participated in a home use test evaluating snack products of varying textures. Parents recorded their children's reactions to each food product; a panel of trained coders coded videos for mealtime behaviors. Children were also identified as food texture sensitive (TS) or non-texture sensitive (NTS). Results showed that age, TS, the presence of a DS diagnosis and the TS*DS interaction influenced the child's behaviors to the food products. Children with DS were more likely to increase distance from the food, mouth/suck on the food, and less likely to chew/much on the food compared to children TD. Children with DS also ate significantly less than typically developing children. Similar mealtime behaviors were observed between the children with TD/<30 months of age and children with DS regardless of age (p < .05). While children with DS/TS had a higher disposition for the dissolvable texture, along with products that were salty and cheesy, children with DS/NTS had a greater tolerance for more textures in general, including crunchy and grainy. Overall, this research identified mealtime behaviors in children with DS, determined overall disposition of children with DS to foods of differences sensory properties, and demonstrated the influence of TS on a child's disposition to a food. This research will be extended to develop acceptable and innovative food products for children with DS/TS.

"Thanks to my child, I discovered that I am strong and I grew up with my child": Personal growth in mothers of children with Down syndrome in Turkey

This study aims to examine the impact of a Down syndrome diagnosis on mothers' experiences in Turkey and to understand how they construct their mothering in the context of personal growth despite the emotional and social difficulties they encounter. Grounded theory was used in this study. Data were taken from in-depth interviews with 15 mothers, and analysed using a systematic and hierarchical approach based on a constant comparative method. There also emerged three primary categories: reconstruction of mothering; factors affecting the process; and response to the changing life. The mothers explained that they experienced personal growth, such as feeling stronger, improving their ability to communicate, and becoming "closer to God". More cultural research is needed to explore the unique nature of the experiences and personal growth processes of mothers of children with Down syndrome.

Maternal perception of spousal support in raising children with developmental disability in the context of family and child variables

OBJECTIVE

The purpose of this study was to examine the relationship between the variables of mental, physical, and emotional problems in children with developmental disabilities (DDs) and the spousal support perceived by the mothers of those children.

METHODS

One hundred forty-three children diagnosed with autism spectrum disorder (ASD, n:43), intellectual disability (ID, n:28), cerebral palsy (CP, n:47), or Down syndrome (DS, n:25) were included in this study. The support that mothers received from their spouses was evaluated using the Spousal Support Scale (SSS). Aggressive behavior in the children was evaluated using the anger-aggression subscale of the Social Competence and Behavior Evaluation Scale (SCBE-30). The data obtained were then subjected to statistical comparisons.

RESULTS

Multiple comparisons revealed no significant difference between the DD diagnosis groups (ID, CP, ASD, and DS) in terms of spousal support or spousal support sub-dimension scores (p > 0.05). Significant negative correlation was found between anger-aggression subscale scores and SSS sub-parameters (emotional support r = -0.315 p < 0.001, financial and informational support r = -0.285 p < 0.001, appreciation r = -0.299 p < 0.001, social support r = -0.381 p < 0.001, and spouse support score r = -0.389 p < 0.001).

CONCLUSION

Children's anger-aggression levels were adversely affected by a lack of spousal support for their mothers.

Parenting Stress in Mothers of Children and Adolescents with Down Syndrome

Parenting stress has deleterious effects on parents, children, and overall family functioning. Parents of children with intellectual disability, including Down Syndrome (DS), show higher levels of parenting stress than parents of typically developing children. This research aimed to (i) evaluate parenting stress levels in a group of mothers of youths with DS using a parent-report questionnaire, (ii) identify children’s individual and clinical features associated with maternal stress, and (iii) identify specific situational life/demographics factors related to maternal stress. Seventy-eight youths with DS underwent a neuropsychological evaluation, whereas mothers completed questionnaires for the assessment of parenting stress and of the child’s emotional and behavioral problems. We found that Parent–Child Difficult Interaction was the domain with the highest percentage of clinical scores (39.7%). Both internalizing and externalizing problems correlated with maternal stress, as well as autistic symptoms. The levels of maternal stress were not associated with any socio-demographic variable. After controlling for child-related correlates of maternal stress and for mothers’ age and education level, unemployed mothers exhibited higher levels of parental distress than employed mothers. The present study highlights that unemployment is related with parenting stress and potentially amenable to policy interventions supporting parents in combining work and family care.

Parenting Sense of Competence in Parents of Children With and Without Intellectual Disability

Our study aims to examine the relationship of child’s intellectual disability, parental education, employment and perceived stress with parenting sense of competence (satisfaction and self-efficacy). Three groups of parents (children without intellectual disability, children with mild intellectual disabilities, and children with moderate/severe intellectual disability) completed measures of perceived stress, parenting sense of competence and socio-demographic questions. Results show that child’s intellectual disability affects parenting satisfaction but not parenting self-efficacy. Parental employment predicted parenting satisfaction, but not parenting self-efficacy, while perceived stress predicted parenting satisfaction and self-efficacy. Results further suggest that parental employment moderates the relationship of child's disability with parenting satisfaction and perceived stress. Result suggest a need for interventions aimed at supporting parents in dealing with emotional consequences of their child’s disability.

The Role of Parenting Practices on the Parent Perceived Impact of Child Oral Health on Family Wellbeing

Background: Family characteristics and parenting practices could significantly influence child oral health and the impact of child oral health on family wellbeing. Aim: To determine the association between parenting practices and parent-perceived impact of children’s oral health condition on family wellbeing. Design: A cross-sectional survey was conducted among 1539 school children in India. Parents answered the short form of FIS (Family Impact Scale), and PCRQ (parent–child relationship questionnaire) to assess the impact of the child’s oral health on family and parenting practices, respectively. Two factors emerged on factor analysis of PCRQ: ‘Positive parenting’ and ‘Power assertive parenting’. The intra-oral examination was conducted for children to assess their dental caries experience and gingival health status. Unadjusted linear regression and hierarchical multiple regression analysis were used to determine the influence of parenting practices on FIS. Results: An increase in power assertion (B = 1.16) parenting was associated with increased FIS scores indicating a higher adverse impact of the child’s oral health on family wellbeing when parents used more power assertive parenting practices. On the other hand, an increase in positive parenting (B = −1.27) was associated with decreased FIS scores, indicating a lesser impact of child’s oral health on family wellbeing when parents used more positive parenting practices. Conclusions: Parenting practices were associated with parents’ perceptions of the effect of children’s oral health on family wellbeing.

Support needs, coping, and stress among parents and caregivers of people with Down syndrome

BACKGROUND

Caregiving for an individual with Down syndrome (DS) results in needs that can impact the stress and wellbeing of the entire family. These needs may also vary over the lifespan of the individual with DS. Coping strategies may affect stress levels and reduce the effects of unmet needs.

AIMS

(1) Do important unmet needs (IUNs), coping, and stress vary between parents and caregivers of adults compared to children with DS? (2) What is the relationship between stress, coping, and needs for parents and caregivers of people with DS?

METHODS

152 parents and caregivers of people with DS of various age groups completed an online survey including: demographic information, Family Needs Survey - Revised, Questionnaire on Resources and Stress - Friedrich Version, and the Family Crisis Oriented Personal Scales. Comparisons of IUNs, coping and stress between caregivers of adults and caregivers of children with DS were conducted. Relationships between stress, coping, and needs were explored using correlations and multiple regression.

RESULTS

IUNs were greater for parents and caregivers of children than for parents and caregivers of adults. Stress level was positively correlated with the number of IUNs, and great use of coping strategies were associated with less stress and fewer IUNs. The coping styles that predicted stress were different for caregivers of children versus adults.

CONCLUSION

The results of this research highlight the importance of considering age in relation to needs and stress among families with a child with DS. Fostering effective coping strategies, including acquiring social support, is likely to support positive outcomes for caregivers of people with DS.

Survey of the Home Music Environment of Children with Various Developmental Profiles

Families with young children with and without developmental disabilities often create a musically rich home environment. Parent-child music engagement, like singing play songs, is associated with positive outcomes for children, parents, and their relationship. However, little is known about if the home music environment differs across diagnostic groups and if parent-child music engagement relates to parent-child affective attachment across families of diagnostically diverse children. Using an online questionnaire, the current study examined the home music environment of 340 families with young children with typical and atypical development. A variety of musical activities were common in all diagnostic groups. Diagnostic groups differed in active musical engagement, potentially relating to the differing phenotypes of various developmental disabilities. Parent-child music engagement was associated with parent-child affective attachment, even when controlling for relevant variables. Promoting musical engagement at home and through parent-child therapy may be an accessible way to support parent-child relationships.

Expressed Emotion in Families of Children With and Without Autism Spectrum Disorder, Cerebral Palsy and Down Syndrome: Relations with Parenting Stress and Parenting Behaviors

This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.

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.

Caregivers' perceptions and experience of caring for persons with Down syndrome in Kuwait: a qualitative study

Aim and Objective: This study aimed to explore how caregivers of persons with Down syndrome (DS) believe caring had an impact on their own lives. A secondary objective was to understand their experience of seeking educational, social, and health care services for the persons with DS. Methods: This qualitative exploratory study was conducted with 21 caregivers of persons with DS in Kuwait. Results: Caregivers struggled to accept the diagnosis initially that led them to search for answers to many of their concerns about raising a person with DS. For the caregivers, who mostly comprised of mothers, dealing with health conditions that persons with DS suffered from was initially difficult. Caring for these individuals led to heavy impact upon their caregivers' own lives who took extraordinary efforts to cope with the burden. Seeking quality education for the persons with DS and participation in social activities was also challenging, and the caregivers believed that better services, facilities, and benefits for the families of persons with DS may help them better cope with the socioeconomic and psychological burden. Conclusions: Improving the availability of specialized services, the delivery of guidance and counselling, and social integration may help overcome challenges of raising a person with Down Syndrome.

Family Variables and Quality of Life in Children with Down Syndrome: A Scoping Review

The purpose of this scoping review was to identify the family and child quality of life variables that have been studied in relation to one another in children with Down syndrome, the frequency with which different relationships have been studied, and the extent to which family variables were the focus of the research aims. A literature search was conducted to find studies published between January 2007 and June 2018. The initial search yielded 2314 studies; of these, 43 were selected for a final review. Researchers most often addressed family resources and family problem-solving and coping concerning child personal development and physical well-being. Little attention to child emotional well-being was observed, with none considering family appraisal of child emotional well-being. The relationship between family variables and child QoL rarely was the primary focus of the study. Methodologically, most reviewed studies used cross-sectional designs, were conducted in North America and based on maternal report. From future research considering the issues found in this review, healthcare providers can obtain an in-depth understanding of relationships between children and family variables.

The Mediating Role of Social Support in the Relationship Between Parenting Stress and Resilience Among Chinese Parents of Children with Disability

Few studies have examined the relationships among parents' resilience, parenting stress, and social support. This study surveyed 486 parents of children with disability in China to understand the role of social support between parenting stress and parents' resilience. The results indicated that the resilience of Chinese parents of children with disabilities was at a high level. Additionally, parenting stress, social support and resilience were significantly associated, and the mediating effect of social support between parenting stress and parents' resilience were proved by mediation analyses. The findings suggested that reducing parental stress and improving social support may predict (or be associated with) improved parent resilience. The authors discussed the implications for the improvement the resilience of Chinese parents of children with disabilities.

Development of the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP): A New Measure of Child and Parenting Behavior for Use with Young Autistic Children

Co-occurring emotional and behavioral problems (EBPs) frequently exist in young autistic children. There is evidence based on parental report that parenting interventions reduce child EBPs. More objective measures of child EBPs should supplement parent reported outcomes in trials. We describe the development of a new measure of child and parenting behavior, the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP). Participants were 83 parents/carers and their 4-8-year-old autistic children. The measure demonstrated good variance and potential sensitivity to change. Child and parenting behavior were reliably coded among verbal and minimally verbal children. Associations between reports from other informants and observed behavior showed the measure had sufficient convergent validity. The measure has promise to contribute to research and clinical practice in autism mental health beyond objective measurement in trials.

Parent-Reported Contribution of Family Variables to the Quality of Life in Children with Down Syndrome: Report from an International Study

PURPOSE

The intent of this study was to determine parents' views of the contribution of family variables to the quality of life (QoL) of children with Down Syndrome (DS). Based on prior research, we hypothesized that parents would report that family variables reflecting positive aspects of family functioning contributed to better QoL; and family variables reflecting the negative aspects of family functioning contributed to poorer QoL.

DESIGN AND METHODS

A cross-sectional study was carried out. Invitation letters were sent to DS support groups. Upon agreement, the parents of the children were sent a link to an online survey that included a consent form, demographic questionnaire, and child and family measures.

RESULTS

Results demonstrated the contribution of family demands to children's interpersonal relations. Family appraisals concerning the child and the family's ability predicted the children's physical and material well-being, personal development, self-determination, social inclusion, interpersonal relations, and rights. Family problem-solving served as a prominent predictor for children's physical and emotional well-being, personal development, interpersonal relations, and rights. Also, family resources predicted various aspects of children's QoL including physical, emotional, and material well-being, self-determination, social inclusion, interpersonal relations, and rights.

CONCLUSION

Results confirmed the significant relationship between family and children's QoL variables. Family appraisal and family problem-solving were especially identified as significant predictors of children's QoL that can be targeted for family interventions, since the family variables are modifiable aspects of family life.

PRACTICE IMPLICATIONS

Nurses can use current findings to develop interventions to enhance QoL of children with DS and families.

Coping strategies adopted by Iranian families of children with Down syndrome: A qualitative study

Down syndrome (DS) is the leading cause of intellectual disability. Previous quantitative studies have examined the effects of DS on families of children with DS. This study explored the coping strategies adopted by the families of children with DS. This was a qualitative content analysis study, in which the participants were selected using purposive sampling from the families of children with DS. Semi-structured interviews were performed and collected data were analyzed. A total of 20 family members (10 mothers, 6 fathers, 2 brothers, and 2 sisters) were interviewed. Six categories were extracted in this study, namely "searching for information," "paying attention to children's healthcare needs," "concentration on spirituality," "teaching socially appropriate behavioral skills," "efforts to increase self-reliance in children," and "development of family support circle." The participating families were able to use positive adaptive mechanisms and cope well with the problems associated with having a child with DS. However, they still needed more support from healthcare providers and support organizations. Receiving more support from healthcare providers, such as nurses, can help them in better management of their children.

Awakening cortisol indicators, advanced glycation end products, stress perception, depression and anxiety in parents of children with chronic conditions

This cross-sectional study aims to investigate awakening cortisol indicators and to explore their association with stress perception, advanced glycation end products (AGEs), depression and anxiety in parents of children with chronic conditions. We included five parental groups according to children's diagnoses: Down syndrome (DS; N = 31), autistic spectrum disorder (ASD; N = 29), cerebral palsy (CP; N = 15), diabetes mellitus type 1 (DMT1; N = 38), and a control group of heathy children (CG; N = 33). Salivary cortisol and AGEs were measured, alongside with psychological indices. Partial correlation and multiple linear regression were used in the analysis to identify parental characteristics associated with total awakening cortisol output (area under the curve with respect to the ground, AUC_G), cortisol awakening response (area under the curve with respect to the increase, AUC_I), perceived stress, and health outcomes (AGEs, depression and anxiety). There was no difference between groups for AUC_G, while DS and DMT1 groups showed reduced AUC_I (β = -0.241, p = 0.040; β = -0.249, p = 0.028, respectively), and ASD parents had a borderline insignificant result (β = -0.205, p = 0.081). Non-smokers had higher AUC_G, and parental sedentary activity and sleep duration were associated with AUC_I. AUC_G was positively associated with AGEs (β = 0.218, p = 0.013), anxiety (β = 0.207, p = 0.004), and with depression (β = 0.156, p = 0.034), unlike the AUC_I. DS parental group showed lower general stress perception (β = -0.260, p = 0.005). Parents of children with DMT1 had more pronounced depressive symptoms (β = 0.183, p = 0.039), while CP parents had a borderline insignificant result for depression (β = 0.143, p = 0.058). Based on these results, parents of children with chronic conditions have altered awaking cortisol response and are under increased risk of adverse health consequences.

Parents' Experiences with Implementing Therapy Home Programs for Children with Down Syndrome: A Scoping Review

This scoping review explores parents' experiences with implementing therapy home programs to determine the factors that influence compliance with incorporating therapy activities into their daily routines. Articles that described the experience of parents of children with Down syndrome with implementing an occupational therapy home program were included in this study. Peer-reviewed articles published within the past fifteen years (January 2003 - January 2018) were also included. Six articles met inclusion criteria. Three themes emerged: (1) emphasis on contextualization, (2) the parent-therapist relationship, and (3) emotional burden of parents. The findings suggest that practitioners develop interventions that are enfolded into the family's daily routine as well as considering the parents' emotional resources and learning style when designing therapy activities.

A comparative study of socioeconomic status, perceived social support and psychological distress of mothers of children with and without disabilities

Background/Aims

Quality of life has been defined as a measure of a person's physical wellbeing, psychological state, and social relationships. However, comparisons of psychological distress, socioeconomic status, and social support between mothers of children with and without disabilities have been limited, particularly in Saudi Arabia. The aim of this study is to comparatively evaluate the socioeconomic status, perceived social support, and psychological distress of mothers of children with and without disabilities.

Methods

The Socio-Demographic Information Form, the Multidimensional Scale of Perceived Social Support, and the Depression Anxiety Stress Scales were completed by 200 mothers of children with cerebral palsy or Down's syndrome and 100 mothers of children without disabilities.

Results

Welch's test indicated significant differences between the two groups on the total Depression Anxiety Stress Scales and all its subscales (<0.01) and the Multidimensional Scale of Perceived Social Support Friends subscale (0.02).

Conclusions

Mothers of children with disabilities perceived high levels of overall social support, which might have reduced their psychological distress. It is recommended for rehabilitation centres to organise support groups for family members. It will also be beneficial for families of children with disabilities, if heath sector policy makers can review and develop effective socioeconomic policies to improve their standards of living.

Social support and post-crisis growth among mothers of children with autism spectrum disorder and mothers of children with down syndrome

BACKGROUND

Raising a child with special needs challenges mothers in complicated ways, yet, alongside these difficulties, there is evidence for maternal post-crisis growth. Social support is one element that may contribute to growth.

AIMS

This study explores the relationship between social support and post-crisis growth, examines type of disability as a mediating variable between support and growth, and, looks at the relations between subtypes of support and growth.

METHODS & PROCEDURES

Participants included 99 mothers of children with Autism Spectrum Disorder (ASD) and 119 mothers of children with Down Syndrome (DS). Mothers completed three self-report questionnaires: demographic, Multidimensional Scale of Perceived Social Support, and the Stress-Related Growth Scale.

RESULTS

Social support was found to predict maternal post-crisis growth with type of disability serving as a mediating variable between them, such that social support contributes to post-crisis growth only among mothers of children with ASD. In addition, results revealed various correlations between types of support and types of growth.

CONCLUSIONS & IMPLICATIONS

The findings indicate that compared to DS, characteristics of ASD may contribute to less maternal post-crisis growth, and that social support serves as an important predictor for growth in this group. Finding ways to increase social support for mothers of children with ASD thus gains additional importance.

Developmental trajectories of children with Down syndrome by socio-economic status: the case of Latin America

BACKGROUND

Several studies show that socio-economic status (SES) is related to the developmental trajectories of children with typical development (TD). However, few studies have analysed this relationship regarding children with neurodevelopmental disorders such as Down syndrome (DS). In this paper, we analyse the impact of SES in the neurodevelopmental trajectories of children with DS in comparison with children with TD.

METHOD

Cognitive, language, motor and socio-emotional development were assessed in 31 children with DS between the ages of 15 and 80 months from high to low SES backgrounds. Data from this group were compared with data from a sample of 72 children with TD randomly selected from the Longitudinal Survey of Early Childhood. We analyse and compare these two groups using the developmental trajectories method RESULTS: The results show delayed onsets for the four abilities measured in children with DS compared with children with TD from high to low SES. In the comparison of the developmental trajectories, we found that the differences between the neurodevelopmental trajectories in DS and TD vary according to SES. High SES show differences only in language development, while low SES show significant differences in cognitive, language and socio-emotional development.

CONCLUSIONS

The results indicate that SES is a factor that could impact the developmental trajectories of children with DS. Although the differences between children with DS and with TD are similar at the beginning regardless of SES, the developmental trajectories are slower in children with DS of low SES than in children of high SES. We argue that the differences are related to the complex interaction of several biological and cultural factors associated with SES. Some specific hypotheses about nutrition, health care access, quality of education and parenting practices are presented, but more research in this area is needed to fully understand these results.