Mothers with learning difficulties and their support networks

Exploring social networks, employment and self-determination outcomes of graduates from a postsecondary program for young adults with an intellectual disability

BACKGROUND: Data on graduates’ development and employment outcomes from postsecondary programs for young adults with an Intellectual Disability (ID) continue to increase and provide information on program efficacy and areas for growth. OBJECTIVE: This study explored the development of graduates’ social networks, employment outcomes, and self-determination a year after graduating from an inclusive postsecondary program. METHODS: The social networks, employment outcomes, and evidence of self-determination in a combined cohort of graduates (n = 6) were analyzed using social network analysis. RESULTS: All graduates except one were employed a year later. Half displayed smaller networks consisting of family members and new work ties. Only two graduates displayed large networks because of opportunities for socialization. In the absence of employment, students also fall back on familiar supports. Most parents were involved in graduates’ employment decisions, thereby curbing graduates’ expression of self-determination. CONCLUSIONS: Family supports are prominent in graduates’ networks and play a crucial role in employment choices. They act as constant protective and social-emotional supports ensuring graduates’ access to benefits and maintenance of well-being. Employment skills valued by employers and further opportunities to develop students’ social networks while in the PSE program needs to be a focus going forward.

A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada

BACKGROUND

Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD).

METHODS

Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis.

RESULTS

Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences.

CONCLUSIONS

Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.

Mellow Futures - An adapted parenting programme for mothers with learning difficulties in England and Scotland. Professionals' views on the outcomes

The Mellow Futures programme is a specially adapted parenting programme for mothers with learning difficulties that combines group work with home-based support. This paper reports on the findings of prospective and retrospective interviews with professionals who had referred mothers to the programme in England or Scotland between 2013 and 2015. The aim was to explore their perceptions of the programme as a whole, and its impact on the mothers they had referred to it. Mothers attending the Mellow Futures programme were invited to consent for a key professional to be contacted as part of the evaluation, generally those social workers who had referred the mothers to the programme. The 'referrers' were interviewed at the start and end of the programme. Thirty referrers contributed their views on the impact of the programme. Twenty-six were very positive about the impact of the Mellow Futures programme on the mothers: the programme was thought to have increased the mothers' confidence and self-esteem; supported them to work through issues; and helped them strengthen their relationship-building skills. Four referrers felt that the programme had not had any impact on the mothers they were supporting. The Mellow Futures programme focused on relationships, rather than parenting techniques, and three fundamentally important relationships in the mothers and babies' lives were targeted: the relationship/attachment between mother and baby; the supportive, ongoing relationships between the mothers in the group; and the mothers' more positive engagement with the professionals concerned with the welfare of their baby. The research confirms that, from the perspectives of referrers, linking group and home-based support can successfully help mothers with learning difficulties to care for their children.

"They don't think I can cope, because I have got a learning disability…": Experiences of stigma in the lives of parents with learning disabilities

BACKGROUND

Parents with learning disabilities report facing a widely held 'presumption of incompetence', placing them under pressure to prove their parenting competence. In collaboration with a learning disability theatre company, an inclusive research methodology explored experiences of parenting with learning disabilities, with a specific focus on the operation of stigma in parents' lives.

METHOD

Interviews with 17 mothers and 5 fathers who self-identified as having learning disabilities were co-facilitated by learning-disabled co-researchers, and analysed using thematic analysis, with input from people with learning disabilities.

RESULTS

Thematic analysis generated four key themes; (1) positions of powerlessness, (2) assumptions of incompetence, (3) challenging assumptions and proving competence and (4) claiming power.

CONCLUSION

Parents reported experiencing stigma and disempowerment within their networks, yet continued to embrace their valued parental identity and drew strength from involvement with self-advocacy organisations. The research informed arts-based performance pieces and resources aimed at training professionals and raising public awareness.

Parenting by mothers with intellectual disabilities in Poland: A photovoice study

BACKGROUND

The diverse nature of parenting among people with intellectual disabilities can be affected by many factors, including stereotypes, experiencing social isolation, living in poverty, suffering from chronic diseases and limited access to health care. Because of these factors, people with intellectual disabilities are not readily viewed as potential parents by society.

METHOD

The research was conducted using the photovoice method, which analyses photographs taken by participants-seven mothers with intellectual disabilities (aged 22-43).

RESULTS

Thematic analysis yielded six main areas: pregnancy and childbirth, household duties-everyday life, caring for children, the importance of motherhood for a woman, parenting problems and difficulties, and types and forms of assistance.

CONCLUSION

Raising a child has become a life goal for the interviewed women. However, there were also difficulties in their lives, which have not been solved by formal and informal support. Individual support for mothers should include tailor-made sexual education, access to gynaecological care or long-term family support.

Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis

CONTEXT

Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring.

OBJECTIVE

We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes.

DATA SOURCES

Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020.

STUDY SELECTION

Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English.

DATA EXTRACTION

We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses.

RESULTS

Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes.

LIMITATIONS

Most studies had moderate (n = 9) or weak quality (n = 17), with lack of control for confounding a common limitation.

CONCLUSIONS

In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.

Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study

Background: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. Materials and Methods: We conducted a population-based cross-sectional study of 15- to 44-year-old women with physical (n = 253,184), sensory (n = 93,170), intellectual/developmental (n = 8,986), and multiple disabilities (n = 29,868), and women without these disabilities (n = 2,307,822) using Ontario health administrative data (2017-2018). We described preconception health variables related to social determinants of health, physical health status, psychosocial well-being, history of assault, medication use, and continuity of primary care and compared women with and without disabilities in crude and age-standardized analyses, with standardized differences >0.10 indicating clinically meaningful results. Results: Women with physical, sensory, intellectual/developmental, and multiple disabilities had poorer preconception health than women without disabilities. Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. Conclusion: Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.

Social worker perception of grandparent involvement where a parent has an intellectual disability

BACKGROUND

Family members of parents with intellectual disabilities (ID) are viewed as their main source of support. However, the existence of family involvement itself does not guarantee that such support will be beneficial.

AIMS

This study draws on the perspectives of social workers to describe and evaluate involvement by Israeli family members (grandparents) in the lives of their adult children with ID (parents with ID) who themselves have become parents.

METHOD

A thematic analysis was conducted in 21 semi-structured interviews with social workers serving parents with ID through social service departments.

RESULTS

From the social workers' perspectives, grandparent attitudes regarding their adult children with ID procreating and parenting ranged from strong resistance to active encouragement. Two sub-themes of grandparent involvement were identified from the social workers' perspectives: the critical role of grandparent support, and the complex relationships between grandparents and the parents with ID. Two further and interrelated subthemes emerged on the role of social worker engagement with grandparents.

CONCLUSIONS

Professionals should be aware that grandparent involvement can either support or undermine the parenting function of parents with ID. Social service professionals need to promote family involvement that empowers parents with ID by supporting their needs and roles, but without supplanting their primary parenting activities.

The double-edged sword of vulnerability: Explaining the persistent challenges for practitioners in supporting parents with intellectual disabilities

BACKGROUND

Evidence suggests that parents with intellectual disabilities can be "good enough" parents with appropriate support that focuses on the whole family. This paper brings together theories of vulnerability with an ethics of care approach to reflect on challenges for practitioners in supporting parents, drawing upon data from a study carried out in Scotland.

METHOD

An online survey was administered to practitioners in three settings, and follow-up interviews were carried out with key informants.

RESULTS

Pockets of good practice existed but a number of barriers to supporting families remained. These related to a lack of accessible information, difficulties in identifying and engaging with families at an early stage and poor joint working across agencies.

CONCLUSION

The study concludes by arguing that practitioners' constructions of families as "vulnerable" reflects negatively on their perceived capacity to parent, creating further barriers in accessing appropriate support and reducing expectations of success.

Parents with intellectual disabilities and their perspective of peer support: "It depends on how they give it"

BACKGROUND

Parents with intellectual disabilities face particular challenges, such as lack of sufficient support with their parenting. Peers can be an important source of support for parents in the general population; however, there is a limited knowledge about peer support for parents with intellectual disabilities. The aim of this study was to explore experiences of parents with intellectual disabilities with social support with a focus on the role of peers.

METHOD

Twenty-six parents with intellectual disabilities in New South Wales, Australia, took part in a semi-structured interview.

RESULTS

The inductive content analysis of data revealed three main themes; this article reports on one of them-Developing interdependence.

CONCLUSIONS

The source of support was less important than the way support was offered. Parents valued support offered by someone who respected them as a person and parent, and was interested in what they wanted and needed.

Supporting children of parents with intellectual disability: A scoping review

BACKGROUND

Parents with intellectual disability live normal lives and have children, but many of them lose custody of their children. However, little is known about the support, if any, that these children receive. Here, the present authors review the literature on the help and support given to children of parents with intellectual disability.

METHOD

A scoping review of peer-reviewed and grey literature was conducted, covering 1997 to November 2017.

RESULTS

Thirteen publications were identified. The children benefited from help and support received through informal networks. They also benefited from formal support if it focused on the children's needs and interests.

CONCLUSIONS

The review shows that even though support from informal networks might be an influential factor in supporting children, there is a need for more research addressing the formal support these children receive and how they benefit from it.

Everyday life when growing up with a mother with an intellectual or developmental disability: Four retrospective life-stories

Background: The voices of those who have grown up in a family with maternal intellectual or developmental disability (IDD) are valuable for gaining an understanding of their situation, which is essential in order to be able to support these families and avoid potentially detrimental situations.Aim: The study aim was to describe the experience of having grown up in a family where the mother has an IDD, with a focus on everyday life and perceived health consequences in adult life.Method: A qualitative method with retrospective narrative interviews and narrative content analysis was chosen. In-depth interviews were performed with four women who had experiences of a childhood with maternal IDD.Findings: Four themes emerged: Living under adverse circumstances; Dealing with one's everyday life situation; Receiving insufficient support and wishing for more; and The echo from childhood into adult life. The findings revealed a distressing childhood, characterized by neglect, abuse, anxiety, and overburdening responsibilities, and also endeavors to keep the family situation a secret, while at the same time wanting the adult world to react.Discussion: The findings can hopefully stimulate occupational therapists and other professionals to more effectively identify the situation of these children and provide support to prevent adverse future health conditions and poor well-being.

"I Didn't Need People's Negative Thoughts": Women With Intellectual and Developmental Disabilities Reporting Attitudes Toward Their Pregnancy

Background

Since the illegalization of involuntary sterilization of persons with intellectual and developmental disabilities, there has been an increase in childbearing in this population. However, women with intellectual and developmental disabilities continue to experience prejudicial attitudes toward their pregnancies.

Objective

To analyze the experiences of women with intellectual and developmental disabilities regarding their perceptions of support persons’ attitudes toward their pregnancies.

Methods

Three case studies derived from grounded theory research exploring perinatal social support received by women with intellectual and developmental disabilities. Using inductive content analysis, we further analyzed the perceptions of women with intellectual and developmental disabilities regarding support persons’ attitudes toward their pregnancies. Findings: The nature of interactions with support persons and women’s characteristics, such as help-seeking behaviors, disability, mental illness, and age, influenced support persons’ attitudes toward childbearing. Women preferred support from caregivers perceived as nonjudgmental and tended to restrict contact with persons perceived as prejudicial. However, some attitudes improved following positive interactions with the women. The relationship between support persons’ attitudes and the women’s help-seeking behaviors is thus complex.

Conclusions

Education of families and medical and social services practitioners and opportunities for positive contact should be further explored. Caseworkers of women with intellectual and developmental disabilities may have invaluable roles in facilitating positive interactions between women with intellectual and developmental disabilities and caregivers.

Measuring emotional support in family networks: Adapting the Family Network Method for individuals with a mild intellectual disability

Background

Informal supportive networks of individuals with intellectual disability have become increasingly important. The aim of this paper is to describe how the Family Network Method – Intellectual Disability (FNM‐ID) offers a way to gather the perspective of people with mild intellectual disability on their family support.

Method

The FNM is designed to explore how individuals define their family contexts, and more specifically how they perceive existing supportive relationships in these contexts.

Results

By carefully piloting ways of questioning people with mild intellectual disability, systematic adaptations were made to the original FNM. Data obtained by the FNM‐ID can be analysed using social network analysis. Thereby, the FNM‐ID provides rich, theoretically significant information on emotional support in the family networks of individuals with mild intellectual disability.

Conclusions

The FNM‐ID is a useful and successfully adapted tool for other researchers and professionals to systematically explore the family support experiences of individuals with mild intellectual disability.

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.

The experience of adult children of mothers with intellectual disability: A qualitative retrospective study from Poland

BACKGROUND

Little is known about the experience of growing up with a mother with intellectual disability. The aim of this study was to explore this experience from the perspective of adult children.

METHOD

In-depth interviews with 23 adult children brought up by mothers with moderate-to-severe intellectual disability. The interview data were analysed using grounded theory methods.

RESULTS

The childhood experiences of the interviewees and the role their mothers played in their upbringing varied, depending in part on the involvement of extended family. It was the stigma of maternal intellectual disability, rather than their mother's functional limitations, that posed the greatest challenge.

CONCLUSION

Interviewees characterized their mothers and childhoods as different, yet ordinary. Understanding the social context, including but not limited to the availability of informal support, is critical to understanding the experience of children growing up with mothers with intellectual disability.

Behavioural and cognitive outcomes in young children of mothers with intellectual impairments

BACKGROUND

Despite an increase in international studies examining the experiences of parents with intellectual impairments and their children, few have utilised population-based data. This study investigated the behavioural and cognitive outcomes of 3-year-old US children of mothers with intellectual impairments compared with children of mothers without intellectual impairments.

METHODS

This study employed a secondary analysis of the Fragile Families Child and Wellbeing Study, a longitudinal birth cohort study in the US. Our analytic sample included mothers with intellectual impairments (n = 263) and a comparison group of mothers without intellectual impairments (n = 1298), as well as each sampled mother's focal child. When weighted, Fragile Families is representative of all births in US cities with populations over 200 000.

RESULTS

Children of mothers with intellectual impairments had poorer behavioural and cognitive outcomes in comparison to same-age children of mothers without intellectual impairments. Notably, however, children of mothers with intellectual impairments were not at increased risk of being aggressive unless their family income was below 200% of the federal poverty level. Further, families headed by mothers with intellectual impairments experienced multiple hardships related to socioeconomic factors, limited social supports and poor self-reported health.

CONCLUSION

Appropriate policies and programmes must be developed and implemented to effectively support these families, such as increased financial benefits.

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.

Ameliorating Psychosocial Risk Among Mothers with Intellectual Impairment

The purpose of this study was to pilot a flexible, group-based program designed to strengthen the social connections and enhance the psychological well-being of mothers with intellectual impairment. A multi-site, mixed-method, pretest-posttest design was employed. To obtain rich process and outcome data, the evaluation incorporated measures of psychosocial well-being, goal achievement scaling, and interviews with group facilitators and participants. A total of 18 mothers completed the program. Participation was associated with a meaningful reduction in psychological distress with effect sizes ranging from .57 for depression to .71 for anxiety. Participating in the group program gave the mothers something to look forward to each week, opportunities to learn from and support others, and the feeling of "being a part of society". Further research is needed to determine whether these promising results can be replicated, and to evaluate the long-term impact of the program on mothers and their children.

Caring for Blind Parents: Cost to the Education and Well-Being of Children in Tamale, Ghana

In this study we explored the experiences of the guide children (children who guide adults with visual impairment to beg for a living on the streets) in Tamale, Ghana, to unearth the impact of the guiding role on their educational participation and well-being. Data were gathered from 104 children and 57 adults using a set of questionnaires and interviews. The results showed that adults chose many of the children to take on the guide role and many of the children did not attend school. The implications for the children's well-being are discussed in relation to needs and rights.

Health of Young Children Whose Mothers Have Intellectual Disability

Understanding the needs and experiences of parents with intellectual disability (ID) and their children is critical to ensuring that policies can effectively support these families. This research analyzed data from the Fragile Families and Child Wellbeing Study to examine the health outcomes of U.S. children whose mothers have (n = 263) and do not have ID (n = 1,298). Compared to mothers without ID, mothers with ID experienced worse outcomes related to socioeconomic status, limited support networks, and poor self-reported health. However, after controlling for sociodemographic characteristics, mother's intellectual disability was not associated with a child having fair or poor health, asthma, or being overweight or obese.

Groups for Parents with Intellectual Disabilities: A Qualitative Analysis of Experiences

BACKGROUND

Parents with intellectual disabilities (IDs) are often socially isolated and need support.

MATERIALS AND METHODS

This qualitative study is based on participant observations of a group for parents with with intellectual disabilities. Data were categorized and interpreted in the framework of social capital and symbolic interactionism.

RESULTS

Being a part of the parent group provided parents with a social network, which had the potential to be supportive in everyday life. The social workers in the group were seen as allies, and parents appeared to trust them and felt they could seek advice and tell them about their personal problems. The parents sometimes asked for advice about how to handle contacts with other professionals in their everyday life. The parents valued the social contact with the other parents.

CONCLUSIONS

The group provided the parents with the opportunity to meet both other parents and two social workers. The group gave a greater number of social relations, adding to the parents' social capital and helping to reduce social isolation.

Social support received by women with intellectual and developmental disabilities during pregnancy and childbirth: An exploratory qualitative study

OBJECTIVE

this study aims to contribute to the development of a conceptual framework that will inform maternity care improvements for expectant mothers with intellectual and developmental disabilities (IDD) by exploring the structure, functions, and perceived quality of social support received by women with IDD during pregnancy and childbirth.

DESIGN/SETTING

using a grounded theory approach, we conducted an exploratory study set in Ontario, Canada in 2015.

PARTICIPANTS

the sample included four adult women with IDD who had given birth in the last five years.

MEASUREMENTS

data were collected using semi-structured interviews.

FINDINGS

the structure of social support received by women with IDD consisted of both formal and informal sources, but few or no friendships. Women with IDD reported high levels of informational and instrumental support and low levels of emotional support and social companionship. However, a high level of available support was not always perceived as beneficial. Emergent core categories suggest that social support is perceived as most effective when three conditions are met: (1) support is accessible, (2) support is provided by individuals expressing positive attitudes towards the pregnancy, and (3) autonomy is valued.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

our study confirms and identifies important gaps in the social support received by expectant mothers with IDD. Women with IDD currently lack accessible informational support, emotional support, and social companionship during pregnancy and childbirth. Additional findings regarding the structure and functions of social support are presented, and a preliminary conceptual framework of effective social support during pregnancy and childbirth, as perceived by women with IDD is also proposed. Findings suggest that increasing support accessibility should be a social and clinical priority; however, maternity care providers should be aware of stigmatizing attitudes and respect the autonomy of pregnant women with IDD as they prepare for motherhood.

Current evidence on antenatal care provision for women with intellectual disabilities: A systematic review

BACKGROUND

changing attitudes, alongside integration, more independent living and recognition of rights to family life have meant a steady rise in women with intellectual disabilities becoming pregnant. However, existing evidence shows that women with intellectual disabilities are less likely to seek or attend for regular antenatal care. This population experiences poorer maternal wellbeing and worse pregnancy outcomes compared to the general population, including preterm and low-birthweight babies.

PURPOSE

to identify and review the existing evidence on the provision of antenatal care among women with intellectual disabilities.

METHODS

a systematic search strategy was formulated using key Medical Sub-Headings terms and related text words for pregnancy, antenatal care and intellectual disability. Comprehensive searches dating back to 1980 using pre-determined criteria followed by a hand search of reference lists and citations were undertaken. Data were extracted using a data extraction form and methodological quality assessed using the framework developed by Caldwell et al. (2011). A three stage textual narrative synthesis was used to integrate the findings from the included studies.

RESULTS

searches identified 16 papers that met the inclusion criteria. A majority of the papers focused on women's experience of pregnancy and antenatal care with a paucity of papers identified on midwives knowledge and experience. The four broad themes of the analysis and synthesis performed included: In the Family Way ('I've a baby inside. I've got a life inside of me.׳); Knowledge and advocacy ('...everyone was looking at one another and no one was talking to me...'); Midwives educational needs ('...helpful to have guidance...') and Midwives Attitudes ('...women with [intellectual disabilities]...should not be pregnant').

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

significant gaps in the evidence base were apparent, however evidence was identified which showed that intellectually disabled pregnant women struggle to understand antenatal information communicated during pregnancy which was often text based. Maternity care providers need to make adjustments to their services so that antenatal communication, information and care is appropriate for this group of women. Midwives identified that they lacked knowledge in this area and wanted antenatal guidance on how to meet the care and communication needs of women with intellectual disabilities.

Strategies used by older women with intellectual disability to create and maintain their social networks: An exploratory qualitative study

Introduction

Social networks are important to health and wellbeing, and enhancing social networks are key occupations for older people. This is relevant for older people with intellectual disability, particularly older women, who face challenges in building social networks, and their social networks are vulnerable to loss as they age. This study aimed to investigate how older women with intellectual disability create and maintain their social networks.

Method

This exploratory qualitative study involved conducting in-depth interviews with five women with mild to moderate intellectual disability (as defined by their service organisation) aged over 50 years and living in the community, using the Support Interview Guide, that has previously been used with younger adults with intellectual disability. Participants could communicate in spoken English. Data were coded line by line and analysed using a thematic analysis.

Results

Participants created social networks independently and through others. Strategies used included communicating, sharing activities, celebrating special occasions, organising activities, supporting each other, having a routine, being out and about and using formal assistance. Barriers and facilitators were also identified.

Conclusion

As older women with intellectual disability age, occupational therapists and support organisations need to focus on assisting this group to build and maintain their social networks.

Parenting stress and child behaviour problems among parents with intellectual disabilities: the buffering role of resources

BACKGROUND

Parents with intellectual disabilities (ID) are at risk for high levels of parenting stress. The present study evaluated resources, including parental adaptive functioning, financial resources and access to a support network, as moderators of the association between child behaviour problems and parenting stress.

METHOD

A total of 134 parents with ID and their children (ages 1-7 years) were recruited from 10 Dutch care organisations. Questionnaires were administered to the parents to obtain information on parenting stress in the parent and child domain, financial resources and their support network. Teachers and care workers reported on child behaviour problems and parental adaptive functioning, respectively.

RESULTS

Parents experienced more stress with regard to their children than towards their own functioning and situation. Parenting stress was less in parents who were not experiencing financial hardship. Child behaviour problems were associated with high child-related parenting stress, not parent-related parenting stress. Large support networks decreased the association between child behaviour problems and child-related parenting stress. Financial resources did not significantly moderate the association.

CONCLUSIONS

Parenting stress among parents with ID is focused on problems with the child, especially when little social support is available.

Représentations sociales et parentalité : les points de vue des parents présentant une déficience ou une lenteur intellectuelle

Cet article présente les résultats d’une étude exploratoire québécoise portant sur les représentations sociales (RS) de la parentalité des personnes ayant une déficience ou une lenteur intellectuelle (DI/LI). Neuf parents ont participé à des entrevues individuelles semi-structurées. Pour les cinq répondants ayant conservé la garde de leurs enfants, la parentalité symbolise l’accès à un rôle hautement désiré dont l’exercice suscite fierté, valorisation, reconnaissance sociale et détermination. Pour ceux qui vivent leur parentalité à travers l’expérience du placement de leurs enfants, leur représentation est davantage teintée par des sentiments d’injustice, de souffrance et de disqualification. Ceux-ci émergent en effet de leurs échanges avec les intervenants en protection de la jeunesse et les membres de leur entourage. La réflexion proposée porte sur les facteurs pouvant freiner ou favoriser le développement d’une identité parentale positive et un réseau de soutien à la parentalité adéquat.

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.

How Do Women with an Intellectual Disability Experience the Support of a Doula During Their Pregnancy, Childbirth and After the Birth of Their Child?

BACKGROUND

With increasing numbers of people with an intellectual disability choosing to become parents, the right support is imperative for effective parenting (Macintyre & Stewart ). The aim of this study was to gain insight into the experiences of parents who received support from Doulas during pregnancy, birth and following the birth of their child. In addition, the experiences of the Doulas who provided the support were investigated.

MATERIALS AND METHODS

Four women with an intellectual disability who received Doula support were interviewed before and after the birth of their child. Three Doulas were interviewed after the birth about their experiences of supporting women with an intellectual disability.

RESULTS

Interview transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Themes were identified from each interview, before an overall analysis of themes from each support phase was undertaken.

CONCLUSIONS

Pre-natally, the Doula was considered helpful and a reliable source of information about pregnancy. Each mother perceived Doula support as a means of keeping her child in her care. Post-natally, mothers described a trusting relationship with their Doula, who enabled them to make informed choices. Doulas described how they adapted their work to meet the needs of parents with intellectual disability. Being involved in Child Protection procedures was perceived as stressful and challenging.

Prevalence and risk factors for postpartum depression symptoms among women with disabilities

The adverse consequences of postpartum depression on the health of the mother and her child are well documented. However, there is little information on postpartum depression among mothers with disabilities. This study examines the patterns of depression and depressive symptoms before, during and after pregnancy and the association between depression before and during pregnancy and postpartum depression symptomatology (PPD) among women with and without disabilities. Data from the 2009-2011 Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2013. Almost 30% (28.9%; 95% CI 22.8-35.8) of mothers with disabilities reported often or always feeling down, depressed or sad after childbirth compared to 10% of those without disabilities (95% CI 8.9-11.3). Compared to other women in the study, women with disabilities had a greater likelihood for PPD symptoms (RR 1.6, 95% CI 1.1-2.2) after accounting for sociodemographics, maternal characteristics related to PPD, and depression before and during pregnancy. Adjusting for other covariates, self-reported prenatal diagnosis of depression was not associated with symptoms of PPD and depression during pregnancy was marginally associated with PPD symptomatology for women with disabilities. Women with disabilities are at a greater risk of experiencing symptoms of postpartum depression than other women. Screening for PPD among new mothers with disabilities and timely referral of those with PPD diagnosis are vital to the health of mothers with disabilities and their children.

A register study of life events in young adults born to mothers with mild intellectual disability

BACKGROUND

Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up.

METHODS

The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study. However, of the remaining 28, it was not possible to establish contact with 21 who were instead searched for in various official registers.

RESULTS

Most (n = 18) individuals in the study group had been in contact with different authorities and clinics. Of the 21 individuals, 10 had contact with social services since childhood and 4 of these had been taken into care (foster family) and 6 had had contact families during childhood. One individual had been taken into a treatment centre and one grew up mainly with the father. Altogether 12 (57%) of 21 individuals did not grow up full-time with their biological mother. Twelve (57%) had major neurodevelopmental/neuropsychiatric conditions, including five with ID and seven with attention-deficit hyperactivity disorder (ADHD). Four individuals were registered within the Prison and Probation Service due to various types of crimes.

CONCLUSION

Individuals born to mothers with ID in our study group were at high risk of adverse experiences and negative outcomes, such as increased childhood mortality, a relatively large proportion of children taken into care, high rates of ID and ADHD in the children and of criminality in young adulthood. Taken together with the results obtained in an in-depth interview study of those in the originally targeted sample with whom it was possible to obtain contact, the present findings suggest that it will be important to provide early support and longitudinal developmental follow-up in groups of children growing up with a mother with ID. Children in this situation appear to be at a number of risks, probably related both to hereditary factors and to social disadvantage.

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.

Health disparities among childrearing women with disabilities

This study examines leading health indicators for childrearing women with disabilities, including health-related quality of life, chronic health conditions, adverse and preventive health behaviors, health care access, and social and emotional support. The study analyzes aggregated data from the Washington State Behavioral Risk Factor Surveillance System (n = 28,629). The weighted prevalence of key health indicators of childrearing women with disabilities (aged 18-59) are compared with childrearing women without disabilities. A series of adjusted logistic regression analyses are applied, controlling for confounding variables. When compared to childrearing women without disabilities, childrearing women with disabilities are less likely to have a partner or spouse, report lower income and education levels and are older. Childrearing women with disabilities, compared to childrearing women without disabilities, report significantly lower health-related quality of life including poor general health (adjusted odds ratio[AOR] = 6.85; p < .001), frequent mental distress (AOR = 4.02; p < .001), and frequent poor physical health (AOR = 9.34; p < .001); higher prevalence of chronic health conditions, including arthritis, cardiovascular diseases, diabetes, asthma, high blood pressure and cholesterol, and obesity (the range of AORs = 1.59 to 5.65; p < .001); higher prevalence of adverse health behaviors including smoking (AOR = 2.14; p < .001) and lack of exercise (AOR = 1.61; p < .001); more financial barriers to health care (AOR = 2.11; p < .001) and lack of social and emotional support (AOR = 2.05; p < .001) while controlling for age, education, income, and relationship status. Based on population level data, the study reveals that childrearing women with disabilities experience elevated risks of health disparities across many key health indicators, many of which are preventable and modifiable. These findings underscore the importance of identifying contributing factors and developing interventions to improve the health and quality of life of childrearing women with disabilities.

A systematic review of interventions to promote social support and parenting skills in parents with an intellectual disability

The family support needs of parents with an intellectual disability (ID) are relatively unknown. This paper reviewed two types of intervention for parents with ID: those designed to strengthen social relationships and those teaching parenting skills. A literature search was conducted using electronic databases and a limited number of evaluative studies were found. The evidence for interventions aimed at strengthening social relationships was inconclusive; although positive changes were observed, there were limitations in study design which restricted the generalizability of the results. The evidence for parental skills teaching suggested that behavioural based interventions are more effective than less intensive forms such as lesson booklets and the provision of normal services, although these studies also had limitations. There is a need for further large scale controlled studies in this area to provide clearer evidence and to explore additional factors relating to child, parent and family which may impact on outcomes.

Modifying the 'Positive Parenting Program' for parents with intellectual disabilities

BACKGROUND

Many parents with intellectual disabilities (ID) want and/or need professional guidance and support to learn skills and strategies to prevent and manage child behaviour problems. However, the available support is rarely suitable, and suitable support is rarely available. The aim of this study was to determine whether a popular mainstream parenting training programme, known as 'Group Triple P' (Positive Parenting Program), could be successfully modified for this parent group.

METHOD

A pilot study was undertaken to determine whether a modified version of Group Triple P would engage and retain parents with ID. A non-experimental, pre-test post-test study, involving a total of 30 parents with ID, was then undertaken to obtain preliminary efficacy data.

RESULTS

Parent engagement and participation levels were high. No parent 'dropped out' of the programme. After completing the modified Group Triple P programme, parents reported a decrease in psychological distress, maladaptive parenting and child conduct problems. Parents reported high levels of satisfaction with the information and support they received.

CONCLUSION

Research-informed adaptation of mainstream behavioural family interventions, such as Group Triple P, could make 'suitable support' more readily available, and more engaging for parents with ID.

Everyday life of young adults with intellectual disabilities: inclusionary and exclusionary processes among young adults of parents with intellectual disability

Ten young adults with an intellectual disability whose parents, too, have an intellectual disability were interviewed and completed questionnaires for this exploratory study aimed at charting their experiences of everyday life. Most of the participants reported high life satisfaction, especially with the domains of friends, leisure time, and family, and considered their families as a resource for their empowerment and development of resilience. The study participants' informal networks were composed of only a few individuals who, moreover, were mostly of dissimilar age and also included support professionals. The participants typically described themselves as excluded from others, an experience that was articulated most conspicuously in their narratives about the special schools they were attending.

Using a Digital Frame and Pictorial Information to Enhance the SafeCare® Parent-Infant Interactions Module With a Mother with Intellectual Disabilities: Results of a Pilot Study

Parents with intellectual disabilities (ID) are disproportionately represented in the child welfare system. Parents with ID can be better served by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, interactive, and self-instructional. SafeCare® is an evidence-based parenting program with flexibility to adapt its curricula while maintaining fidelity. This research presents the results of a pilot study that examined the effectiveness of an adaptation to the SafeCare® parent-infant interactions (PII) module for a mother with ID by using a digital picture frame with pictures of the mother and her infant engaged in skills that met the performance criteria for PII. A multiple-probe design across behaviors was used with the mother and her infant, showing a dramatic increase in PII skills that was maintained across 3 monthly follow-ups. Although further research is necessary, the preliminary data suggest the digital picture frame enhancement to the SafeCare® PII module may be a promising instructional tool for parents with ID.

Modeling contextual influences on parents with intellectual disability and their children

Many parents with intellectual disability experience living conditions associated with risk for children and parents. This study used structural equation modeling to test a theoretical model of the relationships among parent, child, family, and contextual variables in 120 Australian families where a parent had an intellectual disability. Findings revealed that parenting practices had a direct effect on children's well being, that social support was associated with children's well being through the mediator of parenting practices, and that access to social support had a direct influence on parenting practices. Implications of the findings for research, intervention, and policy are explored, with the goal of promoting optimal well being for children who are raised by parents with intellectual disability.

Disability and mammography screening: intangible barriers to participation

PURPOSE

The aim of this study was to investigate intangible or non-physical barriers to participation of women with disability in mammography screening.

METHOD

 Women with disability were recruited via specific advocacy and support organisations in New South Wales, Australia. Interviews were conducted which focused on issues relating to participants' experience with breast screening services.

RESULTS

 A total of 75 women with varying degrees of disability agreed to participate. Three key intangible barriers were identified related to the women's expectations to be informed, to be involved and to be treated with respect. Details of the content, type, timing of appropriately presented information as well as who should provide it were emphasised. Barriers to active involvement to manage their disability and take control over their experience were identified. The women also indicated the specific treatment they received from screening staff which negatively impacted on their experience.

CONCLUSIONS

 This study has provided important and clinically significant detail of intangible barriers to participation in screening mammography experienced by women with physical disability. These study outcomes suggest ways in which the satisfaction with the mammogram experience can be increased for these women and contribute to increased participation in mammography screening.

Predicting the unpredictable? Identifying high-risk versus low-risk parents with intellectual disabilities

OBJECTIVES

This study set out to identify risk factors affecting parents with intellectual disabilities (IDs) by determining: (i) whether perception of family support differs between parents with IDs, referring professionals, and a specialist parenting service; (ii) whether multivariate familial and demographic factors differentiates 'high-risk' from 'low-risk' parenting; and (iii) the impact of partner relationships on parental competency and risk status.

METHODS

Secondary data analysis was conducted on data gathered from 101 parents with IDs and 172 of their children, all of whom had been referred to a specialist parenting service over a 5 year period.

RESULTS

Cross-tabulations were applied to the data to examine causal processes and to improve general understanding of the risks associated with families. Contrary to popular expectations IQ levels of the main parent, relationship status, parental age, employment, amenities, valued support and parents' perception of need were not identified as contributory factors distinguishing 'high-risk' from 'low-risk' parents. Instead, 'high-risk' parenting associated more with parental reports of childhood trauma (emotional abuse and physical neglect in particular), parents' having additional special needs in addition to their IDs or parents who were raising a child with special needs. Other 'high-risk' factors identified related to the male partners of mothers with IDs, many of whom did not have IDs and/or whose histories included anti-social behaviors or criminality.

CONCLUSIONS

The study identified some high-risk variables among parents with IDs that can distinguish them from low-risk parents with IDs.

PRACTICE IMPLICATIONS

These findings generate challenges for agencies who attempt to capture the needs of parents with IDs and who endeavour to provide services to families deemed to be "at risk." These outcomes will be of special interest to the courts, especially when parents with IDs are involved in care proceedings.