Levels of Psychological Distress Experienced by Family Carers of Children and Adolescents with Intellectual Disabilities in an Urban Conurbation

Exploring the experiences of ableism among Asian children and youth with disabilities and their families: a systematic review of qualitative studies

PURPOSE

Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families.

METHODS

We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus.

RESULTS

Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs).

CONCLUSIONS

Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies.

"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.

'We have been in lockdown since he was born': a mixed methods exploration of the experiences of families caring for children with intellectual disability during the COVID-19 pandemic in the UK

OBJECTIVES

This study aimed to explore the experiences of parents caring for children with intellectual and developmental disabilities (IDD) during the UK national lockdown in spring 2020, resulting from the COVID-19 pandemic.

DESIGN

Participants were identified using opportunity sampling from the IMAGINE-ID national (UK) cohort and completed an online survey followed by a semistructured interview. Interviews were analysed using thematic analysis.

SETTING

Interviews were conducted over the telephone in July 2020 as the first UK lockdown was ending.

PARTICIPANTS

23 mothers of children with intellectual and developmental disabilities aged 5-15 years were recruited.

RESULTS

Themes reported by parents included: managing pre-existing challenges during a time of extreme change, having mixed emotions about the benefits and difficulties that arose during the lockdown and the need for appropriate, individualised support.

CONCLUSIONS

Our findings confirm observations previously found in UK parents of children with IDD and provide new insights on the use of technology during the pandemic for schooling and healthcare, as well as the need for regular check-ins.

Residential placement and quality of life for adults with severe autism spectrum disorders and severe-to-profound intellectual disabilities

Purpose

The purpose of this paper is to evaluate the relationship between some main characteristics of different living arrangements and the quality of life (QoL) of their users with severe intellectual disability and low-functioning autism spectrum disorders.

Design/methodology/approach

Study participants were assessed for ASD severity through the Childhood Autism Rating Scale or the Vineland Adaptive Behavior Scales (VABS): for behavioral problems with the aberrant behavior checklist (ABC); for perception of efficacy and satisfaction with care, through an adapted Visual Analogue Scale; and for QoL with the QoL inventory in residential environments (validated in French as Inventaire de la Qualité de Vie en Milieu Résidentiel). Because the goal was to define a “residential profile (RP),” the authors evaluated each participating residence with the Working Methods Scale and the questionnaire on residential parameters.

Findings

The RP allowed for the classification of the residences into three clusters. The authors found no clear relationship between QoL and the RP clusters, but the authors found the RP clusters to be significantly correlated with ABC factors F1 (irritability, agitation, crying) and F2 (lethargy, social withdrawal), and VABS scores for living, socialization, and motor skills.

Originality/value

RPs were more strongly correlated with ABC items and the ability to cope with everyday life than with QoL. The authors hypothesize that RP is correlated with both aberrant behavior and the autonomy of residents and that QoL remains relatively stable. Therefore, RP is correlated with the status of the residents; however, this appears not to be correlated with their QoL.

Perceptions of learning disability nurses and support staff towards people with a diagnosis of schizophrenia

WHAT IS KNOWN ABOUT THE SUBJECT?: People with learning disability are more likely than the general population to develop schizophrenia. Personal recovery philosophies are based on positive attitudes and an optimism that recognizes and values people and their strengths and capacity to achieve goals. Little is known from previous studies about the illness perceptions of learning disability practitioners who work with people that experience both a learning disability and schizophrenia. The illness beliefs of learning disability practitioners about schizophrenia may mediate the potential for social exclusion and limit recovery outcomes. WHAT THIS STUDY/PAPER ADDS TO EXISTING KNOWLEDGE?: The findings show that the illness beliefs of learning disability practitioners and support workers regarding schizophrenia are pessimistic in terms of the consequences for people with schizophrenia and learning disability and their relatives as well as the chronic course of the illness. WHAT ARE THE IMPLICATIONS FOR CLINICAL PRACTICE?: This study identifies the nature of LD practitioner perceptions about schizophrenia and provides guidance about how personal recovery philosophies can be applied to the management of LD and schizophrenia. The beliefs of learning disability practitioners and support workers regarding schizophrenia need to be reframed to support better recovery outcomes and social inclusion for this group. The findings from this study can inform the development of training in bio-psycho-social models of schizophrenia, recovery approaches, family/carer interventions, clinical supervision, mentorship and reflection on clinical practice, which could be potentially useful strategies to help facilitate a reframing of beliefs.

ABSTRACT

Background and purpose of study The prevalence of schizophrenia in people with learning disability is 3-4%. This is the first study to investigate the illness perceptions of learning disability (LD) practitioners towards people with schizophrenia. Methods Learning disability practitioners (n = 210) that work with people with LD and schizophrenia completed a modified version of the Illness Perception Questionnaire Schizophrenia Carers Version (IPQ-SCV). Descriptive and correlational analyses were conducted for all of the IPQ-SCV subscales. Results A significant positive correlation was found between consequences relative and consequences patient (0.495, P < 0.001), and a negative correlation was found between timeline episodic and timeline chronic (-0.243, P < 0.001) subscales. Discussion Consistent with previous evidence found regarding negative staff attitudes to schizophrenia recovery outcomes, course and chronicity, the current investigation has extended and confirmed these observations to staff working with individuals with comorbid schizophrenia and learning disability. Implications for practice This study identifies the nature of LD practitioner perceptions about schizophrenia and contributes to the development of the recovery philosophy in relation to the management of LD and schizophrenia. The findings inform the design of training modules in bio-psycho-social models of schizophrenia, recovery approaches, family intervention, clinical supervision and reflection. These can help LD practitioners to reframe their schizophrenia/LD illness beliefs.

The impact of caring for an adult with intellectual disability and psychiatric comorbidity on carer stress and psychological distress

BACKGROUND

Given that carers of individuals with intellectual disability (ID) and carers of individuals with psychiatric disorders experience elevated levels of stress and psychological distress, carers of individuals with both ID and a comorbid psychiatric disorder are potentially at even greater risk for psychological difficulties. The aim of the present study was to investigate the psychological well-being of carers of adults with a dual diagnosis compared with carers of adults with intellectual disability alone.

METHOD

Four-hundred and forty-two questionnaires were sent to four community services and seventy-five family carers of adults with intellectual disability responded. Psychological well-being of carers was assessed using the Questionnaire on Resources and Stress - Friedrich edition (QRS-F) and the General Health Questionnaire (GHQ). Comorbid psychopathology for their family member with ID was assessed using the Reiss Screen for Maladaptive Behaviour (RSMB).

RESULTS

Twenty-four percent of the individuals with ID were reported to have comorbid psychopathology. Between-group analyses compared carers of people with ID and comorbid psychopathology to carers of people with ID alone. Regression analyses examined the relationship between psychopathology and other care-related variables to carer stress and psychological distress. Carers of people with ID and comorbid psychopathology were found to have significantly higher levels of stress and psychological distress than carers of people with ID alone. Autism was found to be the only significant predictor of both stress and psychological distress among measures of psychopathology.

CONCLUSIONS

Additional comorbid psychopathology in individuals with intellectual disability has a significant impact on their carers' psychological well-being.

Self-injurious, aggressive and destructive behaviour in children with severe intellectual disability: Prevalence, service need and service receipt in the UK

Children with severe intellectual disabilities are at increased risk of presenting with self-injurious, aggressive and destructive behaviour. Severity of these behaviours is an important predictor of psychological and behavioural service use by people with intellectual disabilities. However, studies suggest that the needs of children with intellectual disabilities and their families are not being met. The aims of the present study were to: (1) describe the self-injurious, aggressive and destructive behaviours and subsequent support needs of children with severe intellectual disabilities attending special schools in one major city within the UK, (2) compare teacher and primary carer ratings of behaviour and service need and (3) explore the extent to which the needs of children with intellectual disabilities are being met in terms of contact with relevant specialist services. Questionnaires were completed by teachers and primary family carers of children with a severe intellectual disability. Results indicated that at least 5.3% and 4.1% of children showed at least one behaviour at a clinically significant frequency and management difficulty respectively. Primary carers identified more children with significant behaviour difficulties and support needs than teachers. The odds for children presenting with high levels of the behaviours of interest for having a service need for behavioural intervention were at least 13 times those for children not showing the behaviours, yet only doubled for contact with a specialist relevant health-care professional. These results quantify the magnitude of the substantial gap between level of need and relevant support received.

The clinical profile of mentally retarded children in India and prevalence of depression in mothers of the mentally retarded

BACKGROUND

Mental retardation (MR) has a varied phenomenology in different parts of the world. While studying MR, psychological issues of caretakers are equally relevant. A study to investigate the phenomenology of MR in Indian children and the prevalence of depression in their mothers was planned in a teaching institute in Madhya Pradesh with an attached tertiary care hospital.

OBJECTIVES

The objective of the following study is to study the clinical profile of mentally retarded children in the study sample, prevalence of depression in the mothers and investigate various factors affecting it.

STUDY DESIGN

A cross-sectional study.

MATERIALS AND METHODS

A total of 60 patients diagnosed as MR were included in the study. Objective data was collected in a special proforma and mothers of these individuals were subjected to evaluation with Beck's Anxiety Inventory and the 17 item Hamilton Rating Scale for Depression.

RESULTS

The mean age of patients in the sample was 11.6 years, had received an average of 2.42 years of schooling, mean age at diagnosis of MR was 6.5 years and their mean IQ was 53. Out of the total 60 patients, 88% of the patients had significant co-morbidities. The prevalence of depression in mothers was 85% and it was more in mothers of, the ones with significant co-morbidities (OR = 2.67), severer forms of retardation and with higher levels of anxiety in the mother.

CONCLUSIONS

Prevalence of depression in mothers of mentally retarded children in India seems to be much greater than those reported from studies around the world. Medical services offered to the mentally retarded should move from an individual level to the family level, especially toward the mothers, who are the main caretakers. Counseling services, treatment if required and regular screening of mothers of the mentally retarded should be included in the protocol for management of mental retardation.

Types of disability in children and maternal depressive symptoms: Is there any relationship?

Objective:

To investigate the level of depressive symptoms in mothers of children with intellectual developmental disabilities (IDD) and the variations of these symptoms between mothers of children with different categories of IDD.

Methods:

This descriptive, cross-sectional study was conducted among 162 mothers of children with IDD in Tehran, Iran. The Beck Depression Inventory-II (BDI-II) and a demographic questionnaire were used to gather the required data.

Results:

Mothers of children with IDD experienced depressive symptoms of varying degrees of severity. BDI-II scores of the mothers who had children with IDD were high (18.15 ± 10.62) but depressive symptoms were not significantly associated with the children's type of disability.

Conclusion:

Mothers of children with IDD, in general, reported a mild level of depressive symptoms. As a result, one can suggest that they should be provided with regular psychological support.

Family carers' perspectives on post-school transition of young people with intellectual disabilities with special reference to ethnicity

BACKGROUND

School leavers with intellectual disabilities (ID) often face difficulties in making a smooth transition from school to college, employment or more broadly to adult life. The transition phase is traumatic for the young person with ID and their families as it often results in the loss of friendships, relationships and social networks.

METHOD

The aim of this study was to explore the family carers' views and experiences on transition from school to college or to adult life with special reference to ethnicity. Forty-three families (consisting of 16 White British, 24 Pakistani, 2 Bangladeshi and one Black African) were interviewed twice using a semi-structured interview schedule. The carers were interviewed twice, Time 1 (T1) and Time 2 (T2), T2 being a year later to observe any changes during transition.

RESULTS

The findings indicate that although transition planning occurred it was relatively later in the young person's school life. Parents were often confused about the process and had limited information about future options for their son or daughter. All family carers regardless of ethnicity, reported lack of information about services and expressed a sense of being excluded. South Asian families experienced more problems related to language, information about services, culture and religion.

CONCLUSIONS

The majority of families lacked knowledge and awareness of formal services and the transition process. Socio-economic status, high levels of unemployment and caring for a child with a disability accounted for similar family experiences, regardless of ethnic background. The three key areas relevant for ethnicity are interdependence, religion and assumptions by service providers.

Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison

Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families.

Health status, social support, and quality of life among family carers of adults with profound intellectual and multiple disabilities (PIMD) in Taiwan

BACKGROUND

Primary family carers of adults with profound intellectual and multiple disabilities (PIMD) experience a range of considerable demands.

METHOD

A census survey was conducted in a city of Taiwan; 796 family carers of adults (aged 18 or older) diagnosed with intellectual disability and/or with multiple disabilities living with the family completed interviews.

RESULTS

Adults with PIMD made up 9.5% of this group (n = 76). Nonparametric analyses showed that health status, formal social support, and quality of life (QoL; physical domain score) of carers of adults with PIMD were significantly lower than their counterparts (i.e., carers of adults with less severe disability), and that these variables were significantly associated with carer educational level, employment status, family income, and social networks.

CONCLUSIONS

Interventions need to include the creation of a supportive environment for adults with PIMD and their lifelong family carers, particularly those who are more socially disadvantaged.

Depressive symptoms in older female carers of adults with intellectual disabilities

BACKGROUND

This survey study aims to examine the prevalence and factors associated with depressive symptoms among primary older female family carers of adults with intellectual disabilities (ID).

METHOD

In total, 350 female family carers aged 55 and older took part and completed the interview in their homes. The survey package contained standardised scales to assess carer self-reported depressive symptoms, social support, caregiving burden and disease and health, as well as adult and carer sociodemographic information. Multiple linear regressions were used to identify the factors associated with high depressive symptoms in carers.

RESULTS

Between 64% and 72% of these carers were classified as having high depressive symptoms. The factors associated with carer self-reported depressive symptoms were carer physical health, social support and caregiving burden; overall, the carer self-reported physical health was a stronger factor associated with depressive symptoms than their physical disease status. The level of the adult with ID's behavioural functioning and the carer age, marital status, employment status, education level and the family income level were not significantly associated with carer depressive symptoms.

CONCLUSIONS

The factors identified in this study as correlating with self-reported depressive symptoms suggest that researchers and mental health professionals should collaborate to help improve the physical health and social support networks of the most vulnerable older female family carers. This should reduce depressive symptoms directly among this high-risk group.

Health status and coping strategies among older parent-carers of adults with intellectual disabilities in an Australian sample

BACKGROUND

Older parent-carers in Australia are the subject of increasing policy and practice attention due to concerns about their ongoing ability to care in the light of their own ageing and the ageing of their adult son or daughter. This paper examines health status and the coping strategies of a group of older Australian parents caring for an adult son or daughter with intellectual disabilities.

METHOD

Health status using the SF-12 (Ware, Snow, Kosinski, & Gandek, 1993), caring stress using the CADI (Nolan, Grant, & Keady, 1998), and coping strategies using the CAMI (Nolan et al., 1998) were assessed in 64 older parent-carers of adults with intellectual disabilities.

RESULTS

The self-reported health status of this sample of older parent-carers did not differ significantly from Australian population norms, with one exception. That is, the younger parent-carers in the sample (55-64 years) reported significantly poorer mental health. Better health was associated with having a partner, a larger and close support network of family, friends and neighbours, and a lower care-load. Overall, the study participants identified both satisfaction as well as stress associated with caring, a finding that runs counter to the common perception that being a carer is overwhelmingly burdensome. Common sources of stress were feeling helpless or not in control, and poor professional support. Analysis of older parent-carers coping strategies suggests that self-reliance, whether by choice or necessity, was the norm.

CONCLUSIONS

The health status of older parent-carers may present less cause for concern than anecdotal reports suggest. That said, the strong self-reliance particularly of the older carers presents a challenge to service providers seeking to engage those whose situation appears to warrant support from the service system.

Resilience and the course of daily parenting stress in families of young children with intellectual disabilities

BACKGROUND

Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses.

METHODS

Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36-60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well-being of each parent, marital adjustment and positive parent-child relationships.

RESULTS

Mothers' daily parenting stress significantly increased over time, while fathers' daily parenting stress remained more constant. Decreases in mothers' daily parenting stress trajectory were associated with both mother and father's well-being and perceived marital adjustment, as well as a positive father-child relationship. However, decreases in fathers' daily parenting stress trajectory were only affected by mother's well-being and both parents' perceived marital adjustment.

CONCLUSIONS

Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high-quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others' more resilient adaptations in ways that have not been previously considered.

Quality of life in caregivers of children and adolescents with intellectual disabilities: use of WHOQOL-BREF survey

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71+/-2.35, psychological well-being (PW) was 12.21+/-2.55, social relationship (SR) was 12.99+/-2.43 and environment (EN) was 12.32+/-2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities.

A qualidade de vida de pessoas com deficiência mental leve

Não é prática comum dar voz a pessoas com deficiência, mesmo quando se trata da investigação de sua própria qualidade de vida. Assim, este estudo teve por objetivo conhecer a opinião de 15 adultos com deficiência mental leve em relação a sua qualidade de vida e a opinião de seus cuidadores também a esse respeito, por meio de um instrumento que avalia a qualidade de vida (WHOQOL-Bref). Os dados foram analisados estatisticamente e comparados. Os resultados mostram que a diferença entre as avaliações foi pequena nas questões referentes à satisfação com os domínios físico, psicológico, das relações sociais e do meio ambiente. A avaliação feita pelas pessoas com deficiência foi apenas ligeiramente superior àquela feita por seus cuidadores. Não houve diferença estatisticamente significativa entre as avaliações, do que se conclui que as pessoas com deficiência mental são capazes de falar de suas próprias vidas de maneira positiva e bastante realista.

Families and intellectual disability

PURPOSE OF REVIEW

This review includes recent research pertaining to family functioning when there is a child or adult offspring with intellectual disability. The purpose was to broaden the examination of families research from an adjustment/coping perspective to consideration of more contextual factors (environment, culture, service delivery).

RECENT FINDINGS

Studies continue to focus on parental well being, with parents of children with intellectual disability still showing evidence of stress and depression. Increasing evidence is accruing, however, that child behavior problems or specific syndrome more directly relate to poorer parental well being. On the other hand, parenting behaviors also contribute to child behaviors, with studies highlighting the importance of parenting context and dynamics. Interventions focus on child behaviors as well as on stress reduction for parents. Finally, the continued involvement of parents across the lifespan of their young adult with intellectual disability is apparent from studies of quality of life and living arrangements.

SUMMARY

The well being of family members continues to be an area of interest, with special emphasis on siblings and cultural context. Methodological rigor in families research also continues to increase, with diverse methodologies represented. There is still a need, however, for the development of theoretical models within which to frame future research on topics such as siblings, as well as both negative and positive impact on families.