Empowerment in parents of school-aged children with and without developmental disabilities

The relationship between the Family Empowerment Scale and Gross Motor Function Measure-66 in Young Children with cerebral palsy

BACKGROUND

Cerebral palsy (CP) is the most common cause of motor disability in children. A concept to consider in order to meet the needs of children with CP and their families is family empowerment. Family empowerment can be defined as the process by which families acquire the skills, knowledge and resources to allow them to gain control and improve the quality of their lives. The relationship between gross motor function and family empowerment may be important because children with CP vary so widely in their ability to perform motor skills, which may affect their family's levels of empowerment. The purpose of this research was to investigate the relationship between the Family Empowerment Scale (FES) and Gross Motor Function Measure-66 (GMFM-66) in children with CP who were under 3 years of age.

METHODS

Forty-one children with a mean age of 23.8 months participated in this study. The FES was completed by the participants' parents or regular caregivers and includes a total score and subscales of empowerment in the family, in service situations and in community/political environments. The GMFM-66 was administered by a physical therapist and consists of a total score of gross motor function (GMFM-66) and subscores for Dimension B (sitting), Dimension C (crawling and kneeling), Dimension D (standing) and Dimension E (walking, running and jumping).

RESULTS

Statistically significant positive correlations were found between the FES total and GMFM (total score and Dimensions B-E) with coefficients varying from 0.43-0.62. Significant relationships were also found between most subscales of the FES and the GMFM-66.

CONCLUSIONS

This study provides evidence of a relationship between family empowerment and gross motor function in young children with CP and suggests that caregivers of children with higher gross motor function report higher levels of self-efficacy.

Assessment of Sesame Street online autism resources: Impacts on parental implicit and explicit attitudes toward children with autism

The current study sought to characterize implicit bias toward children with autism and examine whether viewing educational materials about autism would change attitudes toward children with autism. A website developed by Sesame Street containing information about autism and resources for families was distributed to parents of children with autism (n = 473) and parents of children without autism (n = 707). Pre- and post-test measures of implicit bias toward children with autism; explicit attitudes and knowledge about autism; and parenting confidence, strain, and stigma were completed before and after the website was presented. Results indicated that parents of children with autism showed less implicit bias compared with those of non-autistic children during the pre-test, but the groups did not differ at the post-test. Parents without autistic children and those with more negative explicit attitudes showed a greater reduction in implicit bias from the pre- to the post-test. In addition, for parents of children with autism, a more positive change in explicit attitudes and increased knowledge from the pre- to the post-test was associated with more empowerment at the post-test. Together, our findings suggest that the online educational resources can reduce implicit bias against children with autism and help mitigate some of the psychological issues associated with parenting children with autism.

Empowerment in Polish fathers of children with autism and Down syndrome: the role of social support and coping with stress - a preliminary report

BACKGROUND

Although empowerment is an important factor in the adaptation of parents of children with intellectual and developmental disabilities, our understanding of empowerment in fathers or how it relates to coping with stress and subjective social support is limited. In Poland, families with children with intellectual and developmental disabilities experience many challenges because of insufficient support. Although parental contribution to developing different forms of services for people with disability is crucial, the potential of fathers is underestimated and poorly understood.

METHODS

The study enrolled 35 fathers of children with autism with intellectual disability, 37 fathers of children with Down syndrome and 40 fathers of typically developing children. They completed three questionnaires: Family Empowerment Scale, Ways of Coping Questionnaire and Social Support Questionnaire - Short Form.

RESULTS

Compared with other groups, family empowerment was lower in fathers of children with autism. No group differences were found for the service system and community dimensions of empowerment. In the fathers of children with autism, social support was not related to empowerment, but there was a negative correlation between emotional coping and service system. Satisfaction with social support in fathers of children with Down syndrome correlated positively with the community dimension of empowerment.

CONCLUSIONS

Results show that fathers of children with autism and intellectual disability require support in family empowerment and that the significance of emotion-focused and problem-focused coping and social support in the context of empowerment differs in fathers of children with autism and Down syndrome. These results should be considered preliminary because of the limited sample size.

Empowerment in families raising a child with cerebral palsy during early childhood: Associations with child, family and service characteristics

BACKGROUND

Insight into family empowerment is important in order to develop and offer services that support and strengthen parents caring for a child with disability. The aims of this study were to describe empowerment trajectories among parents caring for a young child with cerebral palsy (CP) and to explore associations between parental empowerment and characteristics of the child and family and the services they receive.

METHODS

58 children (median age at first assessment 28 months, range 12-57) and their parents were included in a longitudinal cohort study based on registry data from follow-up programs for children with CP in Norway. Parental empowerment trajectories were described by averaging scores in the three subscales of the Family Empowerment Scale (FES) (family, service situations and community) at enrollment and at semi-annual/annual assessments. A linear mixed model was used to explore associations.

RESULTS

Parental empowerment scores on the FES in family and service situations were high and stable during early childhood, while considerably lower in the community context. In service situations, perceived empowerment was significantly associated with both child, family and service characteristics, whereas empowerment in family situations was only associated with family characteristics. The service factor having a multidisciplinary support team was positively associated with perceived empowerment in both service situations and in the community.

CONCLUSION

Knowledge about parental empowerment in different contexts and associations with characteristics of the child and family and the services they receive can contribute to further reinforcing family empowerment and identifying parents in need of additional support.

Parental empowerment-Lesbian, gay, bisexual, trans or queer parents' perceptions of maternity and child healthcare

AIM

Describe empowerment in maternity and child healthcare from the perspective of self-identified lesbian, gay, bisexual, trans, or queer (LGBTQ) parents in Finland.

BACKGROUND

Parental empowerment is a core aspect of maternity and child healthcare. However, knowledge about LGBTQ parents' perceptions about empowerment is still lacking.

METHOD

Qualitative design, 22 parents participating. The interviews were conducted in between July and September 2016 and analysed using inductive content analysis.

FINDINGS

Three core categories emerged as follows: (a) recognition and acknowledgment, particularly being treated as a parent, irrespective of any biological or legal ties to a child; (b) cooperation and interaction, such as working together, respecting parents' autonomy, and supporting parents' full involvement; (c) equitable care, such as parents' trust in services, but also a health-care professional's knowledge of a family's special needs.

CONCLUSION

Empowerment was perceived as the parents' sense of being visible and recognized as a parent. This recognition requires education and structures that are inclusive of all families. In addition, the language used by professionals was a key indicator for promoting positive feelings of comfort and safety for all families.

LEARN2MOVE 0-2 years, a randomized early intervention trial for infants at very high risk of cerebral palsy: family outcome and infant's functional outcome

Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy.Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models.Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching."Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services.Implications for rehabilitationOne year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy.Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life.Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy.

Health Promotion Toolkit: An Approach for Empowering Families Caring For Children with Developmental Disabilities in Tabuk

AIM:

The study aimed to determine the effects of the health promotion toolkit on empowering families caring for children with developmental disability. It hypothesised that health promotion toolkit would effectively improve families’ empowerment and alleviate parental stress.

METHODS:

The research design was quasi-experimental. A convenience sample of 30 children with DD and their families enrolled at Shoaa ElAmal Center in Umluj participated. Tools were Health Promotion Assessment Sheet, Family Empowerment Scale, and the Parent Stress Index.

RESULTS:

The results documented significant lower levels of parental stress and higher levels of family empowerment among mothers at posttest than pretest. A significant negative correlation between family empowerment and parental stress was reported.

CONCLUSION:

Health promotion toolkit had a positive effect on empowering families as well as lowering parental stress. Recommendation Health promotion toolkit should be integrated as a monitoring method of health care needs of health promotional activities for children with developmental disabilities.

A model of well-being for children with neurodevelopmental disorders: Parental perceptions of functioning, services, and support

BACKGROUND

Both child function and supports and services have been found to impact the well-being of parents of children with neurodevelopmental disorders (NDD). The relationship between function and services and the well-being of children with NDD is less well-understood and is important to clarify in order to effect program and service change.

METHODS

The current project assessed whether child function as well as the adequacy of formal supports and services provided to children and their families were predictive of child well-being. Well-being was assessed using a measure of quality of life developed for use with children with NDD. Data from 234 parents were analysed using structural equation modelling.

RESULTS

Each predictor was found to load significantly on the overall outcome variable of well-being. Parent concerns about child function were significantly related to child well-being; parents who reported more concerns about their children's functioning reported lower levels of child well-being. Unmet needs for formal supports and services were also significantly related to child well-being; parents who reported that more of their children's and family's service needs were unmet reported lower child well-being. An indirect relationship was also found between child function and child well-being. When parents reported that their formal support needs were adequately met, their children's functional difficulties had a lower impact on parent perceptions of their children's overall well-being.

CONCLUSIONS

Taken together, the results of the current study enrich our understanding of well-being for children with NDD. Discussion focuses on the service implications for children with NDD and their families.

Linking implementation of evidence-based parenting programs to outcomes in early intervention

In the field of early intervention, only a few studies of parenting interventions include both participant and facilitator behaviors. Fidelity and supervision (facilitator characteristics) and dosage and satisfaction (participant characteristics) were tested on the outcome of improved parenting style in a sample of 36 parents of young children with disabilities. Results indicated that the facilitator behavior of fidelity was significantly and negatively related to the program outcome of parenting style; no effect was found for the facilitator behavior of supervision. For the participant behaviors, both dosage and satisfaction had non-significant relationships with the program outcome of parenting style at follow-up. The surprising negative relationship between content fidelity and parenting style was discussed.Two possible explanations were: (1) process or quality of intervention delivery is more influential than content fidelity, which considers only adherence to the intervention manual, and (2) the developmental stage of early intervention families calls for more focus on relationships between facilitators and parents and less on content of the specific intervention.

Family empowerment and quality of life of parents raising children with Developmental Disabilities in 78 Japanese families

OBJECTIVES

The families of these children experience distress both at the time of diagnosis and afterward. A top priority is to understand family empowerment, family function, and family members' quality of life (QoL) and to effectively support these families in Japan. The objective of this study was to assess the actual conditions of families living with children having DDs and to explore the factors associated with family empowerment and parents' QoL.

METHODS

We surveyed ninety-three parents (78 mothers, 15 fathers) from 78 families which lived with children with DDs in the capital region of Japan. We assessed two main outcomes using the Japanese versions of the following instruments: Family Empowerment Scale (FES), World Health Organization Quality of Life 26 (WHOQOL26), and other six outcomes. Correlation and multiple regression analyses were conducted.

RESULTS

No medication, cooperation with child rearing, assistance from a developmental support center, solved problems related to child rearing, and higher scores in Problem Solving contributed to higher FES scores. Higher WHOQOL26 scores were related to being a full-time housewife, higher self-esteem, no developmental support, a broad emotional support network, higher scores in Problem Solving and Role Function, and lower scores in Affective Reaction and General Function.

CONCLUSIONS

We revealed that family empowerment and QoL of parents rearing children with DDs in Japan were affected by various subscales of family function and other family attributes. Effective interventions for improving family empowerment and QoL should be researched in the future.

"Over time it just becomes easier…": parents of people with Angelman syndrome and Prader-Willi syndrome speak about their carer role

PURPOSE

This study investigated two of the stresses experienced by parents caring for offspring with Angelman syndrome (AS) and Prader-Willi syndrome (PWS) in Western Australia, and identified their coping strategies.

METHODS

Parents of 19 offspring with AS and PWS participated in the Family Stress and Coping Interview which provides a stress level score, and a discussion of stressors and coping methods associated with 24 life situations, two of which are reported. All text was examined using directed content analysis.

RESULTS

Family carers (14/19) reported high stress associated with the initial diagnosis of AS or PWS in their offspring; and finding time for themselves. Stressors identified included lack of quality information about the disorder, time constraints and physical and emotional tiredness. Parents adopted a variety of coping strategies, including learning about the disorder, accepting the situation, seeking instrumental and social supports and dealing with problems.

CONCLUSIONS

No specific coping strategy was associated with reduced stress. However, parents felt that accurate and timely information during the diagnostic period helped. Parents used family and community support although there were difficulties accessing respite care. It is advised that government agencies, service providers, family members and peer support associations should provide practical and emotional support to assist the parents of offspring with AS and PWS, and indeed any form of intellectual disability, across the lifespan. Implications for Rehabilitation Long-term caring for offspring with AS or PWS can involve considerable stress for parents. Stress has been associated with poorer health outcomes for parental carers. Parents need a variety of practical and emotional supports to cope with stress, including timely access to information.

Remembering parents in parent-mediated early intervention: An approach to examining impact on parents and families

The goal of this review is to advance the discussion regarding meaningful outcomes of early intervention for children with autism spectrum disorder. The rapid growth in the development and evaluation of early intervention approaches for autism spectrum disorder includes both therapist-driven and parent-mediated interventions. The majority of research on both approaches to early intervention focuses on promoting child outcomes (e.g. language acquisition) with less emphasis on family and parent outcomes (e.g. quality of life, self-efficacy). Given that parent buy-in is essential for parent-mediated interventions to be effective over time, increased attention to family outcomes that are of value to families and have the potential to be impacted positively by these interventions is needed to develop, disseminate, and sustain high-quality interventions in community settings. In this review, we draw from work on parent and family outcomes targeted in related fields (e.g. Part C early intervention, pediatric chronic illness, behavior management parent training) that we propose are particularly relevant for evaluating the impact of parent-mediated interventions in early intervention for autism spectrum disorder.

Associations between family characteristics and parental empowerment in the family, family service situations and the family service system

BACKGROUND

Parental empowerment signifies parents' sense of confidence in managing their children, interacting with services that their children use and improving child care services. High empowerment is associated with parents' resilience to demands and their confidence to make decisions and take actions that positively affect their families. Most families with children access various healthcare and education services. Professionals working in these services are therefore ideally placed to reinforce parental empowerment. However, little is known about the characteristics associated with parental empowerment within a generic sample of parents or in the context of basic child care services.

AIM

The aim of this study was to assess how family characteristics are associated with maternal and paternal empowerment in the family, in service situations and in the service system.

METHOD

Parental empowerment was measured among 955 parents (mothers = 571; fathers = 384) of children aged 0-9 years using the Generic Family Empowerment Scale. Family characteristics were assessed through questions on children, parents and the life situation. Associations between empowerment and family characteristics were evaluated using one-way analysis of variance and t-test. Parental empowerment was predicted by multiple linear regression analysis.

RESULTS

Parents' concerns related to their parenting, such as whether they possessed sufficient skills as a parent or losing their temper with children, as well as experiences of stress in everyday life, were negatively associated with all dimensions of maternal and paternal empowerment. Both determinants were more common and more significant in empowerment than child-related problems.

CONCLUSION

Promoting parental self-confidence and providing appropriate emotional and concrete support for everyday functioning may reinforce parental empowerment, thereby enhancing families' well-being and coping, as well as improving their access to required services and timely support. Finally, it may facilitate the provision of better services to all families.

Predictors of distress and well-being in parents of young children with developmental delays and disabilities: the importance of parent perceptions

BACKGROUND

Moving from family-centred to child-centred models of service delivery can be stressful for parents as their young children with developmental delays and disabilities transition into school. The purpose of this paper was to explore and compare predictors of both distress and well-being in parents during this transition period.

METHODS

A sample of 155 mothers of 113 boys and 42 girls participated in the study. The mean age of the children was 4.9 years and their diagnoses included autism spectrum disorder (52%); unspecified intellectual disability/developmental delay (26%); Down syndrome (12%); other genetic conditions (4%) and other diagnoses (6%). Participants completed surveys primarily online focusing on child characteristics, family resources, parent coping strategies, parental distress and positive gain.

RESULTS

Multiple regression analyses were conducted to determine predictors of parent reported distress and positive gain. Parent coping variables were the strongest predictors of both positive gain and parental distress, with reframing emerging as a predictor of positive gain and parent empowerment emerging as a predictor of both greater positive gain and lower parental distress.

CONCLUSIONS

The results of this study highlight not only the importance of including positive as well as negative outcomes in research with parents but also the importance of including parent characteristics such as coping strategies (e.g. reframing and empowerment/self-efficacy) as potential predictors of outcome in such studies.

Perceived self-efficacy in parents of adolescents and adults with autism spectrum disorder

Many parents of adolescents and adults with autism spectrum disorder experience difficulty accessing appropriate services for their children, and may report low levels of parent self-efficacy. In an effort to identify the factors that contribute to the difficulties these families face, this study examined the role of demographic, systemic, and clinical need variables as they relate to parents' experience of self-efficacy. Participants included 324 parents of individuals with autism spectrum disorder, 12-25 years of age. Results suggest that parent self-efficacy is related to a number of variables and not simply a child's clinical situation, including child age, parent immigrant status, barriers to service access, and caregiver burden. Given the crucial role that parents often play in the lives of individuals with autism spectrum disorder across the lifespan, it is important that service providers support the efforts of parents who provide and access care for their children.

Families supporting a child with intellectual or developmental disabilities: the current state of knowledge

This IASSIDD Position Paper provides a concise authoritative summary of (i) existing scientific knowledge regarding the situation, challenges and wellbeing of families that include a child with intellectual and/or developmental disabilities, and (ii) priorities for future research. IASSIDD (www.iassidd.org) is the leading global organisation for researchers and research centres that seek to improve the understanding of and improve the lives of people with intellectual or developmental disabilities, their families and those who support them. The paper and the recommendations it contains have been developed through an iterative process led by IASSIDD’s Families Special Interest Research Group (SIRG). During this process, all members of the Families SIRG and all members of IASSIDD’s ruling council have had the opportunity to comment on drafts of this paper. The final Position Paper was adopted by the Council of IASSIDD on 9 July 2012.

Caregivers' hair cortisol: a possible biomarker of chronic stress is associated with obesity measures among children with disabilities

BACKGROUND

The stress of caring for a loved one with chronic illness has been associated with childhood obesity. Hair cortisol has been proposed as a novel biomarker of chronic psychological stress. This study aimed to evaluate the associations between caregivers' chronic stress evaluated by hair cortisol concentrations (HCC) and obesity measures among children with disabilities such as autism.

METHODS

Eighty-five dyads of children with disabilities and their primary caregivers participated in the study between April and July 2013 in the Patagonia Region, Chile. Trained research staff conducted anthropometric measurements of children and caregivers. Cortisol concentrations, extracted from hair samples with methanol, were quantified using liquid chromatography tandem mass spectrometry. Pearson's correlation coefficients and linear regression models were used to examine the associations between caregiver HCC (log-transformed) and child obesity measures with adjustment for covariates.

RESULTS

Caregiver HCC were positively and significantly correlated with child weight (child age- and sex-adjusted r =0.23, P = 0.036), body mass index (BMI) (r = 0.23, P = 0.035), circumferences of neck (r = 0.30, P = 0.006), waist (r = 0.27, P = 0.014), and hip (r = 0.22, P = 0.044). After adjustment for children's age and sex, caregiver HCC were significantly related to child weight (kg) (beta = 4.47, standard error (SE) = 2.09), BMI (kg/m(2)) (beta = 1.52, SE = 0.71), neck circumference (cm) (beta = 1.20, SE = 0.43), waist circumference (cm) (beta = 3.75, SE = 1.50), and hip circumference (cm) (beta = 3.02, SE = 1.48). Caregiver HCC were also positively but not statistically significantly associated with child waist-to-hip ratio (beta = 0.01, SE = 0.01; P = 0.191) or body fat percentage (%) (beta = 2.11, SE = 1.28; P = 0.104). Further adjustment for other covariates including child disability diagnosis and caregiver age, sex, education, current smoking, perceived stress, and caregiver BMI did not change the results substantially.

CONCLUSIONS

Chronic stress of caregivers, evaluated by increased cortisol concentrations in hair, was positively associated with obesity measures among children with disabilities.

The validity and reliability of the Finnish Family Empowerment Scale (FES): a survey of parents with small children

BACKGROUND

The Family Empowerment Scale (FES) is a widely used instrument which measures the parents' own sense of their empowerment at the level of the family, service system and community. It was originally developed for parents of children with emotional disabilities.

AIM

The aims of this study were to evaluate the validity and reliability of the Finnish FES and to examine its responsiveness in measuring the empowerment of parents with small children.

METHODS AND PARTICIPANTS

The English FES was translated into Finnish using back translation and modified so as to be generic and convenient for all families. The construct, convergent, discriminant and concurrent validities, reliability and responsiveness of the Finnish FES were examined. Participants (n = 955) were the parents of children aged 0-9 years who had been selected using stratified random sampling.

RESULTS

Confirmatory factor analysis proved that the Finnish FES had three subscales based on the original FES. Convergent and discriminant validities confirmed and supported the same construct. The relationship between parents' participation and empowerment was tested for concurrent validity. As in previous FES studies, the participating parents were more empowered, which supported the concurrent validity. The reliability of the Finnish FES proved acceptable for both parents. The Finnish FES could also discriminate the responses of the parents. Participation in the activities organized by the family service system influenced parents' perceptions of empowerment more than did their background characteristics.

CONCLUSIONS

The Finnish FES is a valid and reliable instrument and it is suitable for measuring the empowerment of parents. However, it is necessary to consider how the FES would identify in the best way the parents who perhaps need some help.

Sleep quality, stress, caregiver burden, and quality of life in maternal caregivers of young children with bronchopulmonary dysplasia

Little is known about the influence of sleep quality, stress, and caregiver burden on quality of life in maternal caregivers of young children with bronchopulmonary dysplasia (BPD). In 61 maternal caregivers (mean age 29.59 years) of young children with BPD (mean age 13.93 months), caregivers reported sleeping a mean of 5.8 hours, and significant correlations were found between sleep quality and depressive symptoms and stress, as well as an inverse correlation with quality of life. Sleep quality was found to be the most significant predictor of quality of life in maternal caregivers.

Modeling family adaptation to fragile X syndrome

Using data from a survey of 1,099 families who have a child with Fragile X syndrome, we examined adaptation across 7 dimensions of family life: parenting knowledge, social support, social life, financial impact, well-being, quality of life, and overall impact. Results illustrate that although families report a high quality of life, they struggle with areas such as social support, social life, and parenting knowledge. Path analysis revealed that child and family factors play a role in adaptation, but family resources and social supports moderated their effect on quality of life, well-being, and overall impact. The interrelationship among multiple aspects of family life should be examined to improve family resiliency.

Coaching mothers of children with autism: a qualitative study for occupational therapy practice

ABSTRACT The purpose of this study was to understand the perceptions of mothers of children with autism spectrum disorder (ASD) who participated in 10 one-hour coaching sessions. Coaching occurred between an occupational therapist and mother and consisted of information sharing, action, and reflection. Researchers asked 10 mothers six open-ended questions with follow-up probes related to their experiences with coaching. Themes were identified, labeled, and categorized. Themes emerged related to relationships, analysis, reflection, mindfulness, and self-efficacy. Findings indicate that parents perceive the therapist-parent relationship, along with analysis and reflection, as core features that facilitate increased mindfulness and self-efficacy. The findings suggest that how an intervention is provided can lead to positive outcomes, including increased mindfulness and self-efficacy.

The experiences of parents who report youth bullying victimization to school officials

Current research offers a limited understanding of parental experiences when reporting bullying to school officials. This research examines the experiences of middle-school parents as they took steps to protect their bullied youth. The qualitative tradition of interpretive phenomenology was used to provide in-depth analysis of the phenomena. A criterion-based, purposeful sample of 11 parents was interviewed face-to-face with subsequent phone call follow-ups. Interviews were taped, transcribed, and coded. MAX qda software was used for data coding. In analyzing the interviews, paradigm cases, themes, and patterns were identified. Three parent stages were found: discovering, reporting, and living with the aftermath. In the discovery stage, parents reported using advice-giving in hopes of protecting their youth. As parents noticed negative psychosocial symptoms in their youth escalate, they shifted their focus to reporting the bullying to school officials. All but one parent experienced ongoing resistance from school officials in fully engaging the bullying problem. In the aftermath, 10 of the 11 parents were left with two choices: remove their youth from the school or let the victimization continue. One paradigm case illustrates how a school official met parental expectations of protection. This study highlights a parental sense of ambiguity of school officials' roles and procedures related to school reporting and intervention. The results of this study have implications in the development and use of school-wide bullying protocols and parental advocacy.

Predicting mental health among mothers of school-aged children with developmental disabilities: the relative contribution of child, maternal and environmental factors

AIM

Many mothers of children with developmental disabilities are known to experience high levels of stress, and compromised mental health. Research is crucial to better understand and assist mothers with compromised mental health, and ultimately better service families raising and supporting a child with a disability.

METHOD

Data were collected using cross sectional mail-out survey with follow up phone call. Instruments included the Short Form 36 version 2 (SF-36v2) and instruments that measured maternal, child and environmental factors. Descriptive statistics examined characteristics of participants. Correlation, t-tests, and multiple regression analyses were used to identify factors associated with mothers' mental health.

RESULTS

Mothers (N=152) cared for a school-aged child (aged 5-18 years) with high care needs and developmental disabilities including autism spectrum disorder (n=94); cerebral palsy (n=29); attention deficit hyperactivity disorder (n=19). Factors associated with maternal mental health included the child's psychosocial health (r=.36) and challenging behaviour (r=-.33); maternal empowerment (r=.40); maternal participation in health promoting activities (r=.43); and the child's unmet service needs (r=-.29). The strongest predictors of maternal mental health in this cross sectional study were maternal participation in healthy activity and empowerment, the child's emotional functioning and unmet service needs.

CONCLUSION

This study identified maternal factors as the most important influence on self reported mental health among this sample of mothers. Findings suggest that service changes that provide mothers with information about their own health and need for health enhancing activities, as well as education that empowers mothers to manage and master their child's disability and needs, may contribute to maternal mental health and well being.

Promoting patient empowerment in the healthcare system: highlighting the need for patient-centered drug policy

In recent years the term 'patient empowerment' has increasingly been used among healthcare policy makers; however, discussions have focused on narrow activities that as stand-alone activities would be unlikely to give patients power. This paper presents findings from a systematic review of the medical literature. After offering a new definition of patient empowerment, we review the literature behind the concept, aided by a conceptual model. The model is derived from our review of all papers published in medicine (Medline) between 1980 and 2005, and is focused around issues related to the antecedents, activities and outcomes of patient empowerment, especially as they relate to researchers who may need to formulate or evaluate public policies aimed at the issue. We strive to stimulate more discussion of the linkages between public policy and patient empowerment, identifying a need to take a holistic approach, especially when policies are aimed at empowering patients in the area of personal drug management.

Impact of a Contextual Intervention on Child Participation and Parent Competence Among Children With Autism Spectrum Disorders: A Pretest–Posttest Repeated-Measures Design

OBJECTIVE. We tested an occupational therapy contextual intervention for improving participation in children with autism spectrum disorders and for developing parental competence.

METHOD. Using a repeated-measures pretest–posttest design, we evaluated the effectiveness of a contextually relevant reflective guidance occupational therapy intervention involving three components: authentic activity settings, family’s daily routines, and the child’s sensory processing patterns (Sensory Profile). We used these components to coach 20 parents in strategies to support their child’s participation. Intervention sessions involved reflective discussion with parents to support them in identifying strategies to meet their goals and make joint plans for the coming week. We measured child participation (Canadian Occupational Performance Measure, Goal Attainment Scaling) and parent competence (Parenting Sense of Competence, Parenting Stress Index).

RESULTS. Results indicated that parents felt more competent and children significantly increased participation in everyday life, suggesting that this approach is an effective occupational therapy intervention.

Marriage and family therapists working with couples who have children with autism

Current research about families and couples who have children with autism is discussed using the Double ABCX model as a guide. A case study is presented along with recommendations for therapists who work with couples who have children with autism. Marriage and family therapists are encouraged to use the Double ABCX model as both an assessment tool as well as for intervention. More research and effective therapists in this area are needed in order to keep up with the rising rates of families that include children diagnosed with autism.

Autism in developing countries: lessons from iran

Most research into Autism Spectrum Disorders has been conducted in affluent English-speaking countries which have extensive professional support services. This paper describes a series of investigations that was undertaken in Iran, and these findings, together with reviews of research in other low-income countries, are used to identify key lessons in three areas of service provision of particular relevance to developing countries with scarce professional resources: first, the issues to be considered in establishing the prevalence of the condition nationally; second, identification of parental understanding of ASD and the impact it has on them as carers; third, the education and training that could be provided to families when professional supports are sparse. It is concluded that culturally sensitive, parental support strategies must be central to the planning and development of services. Moreover, future research should further elucidate the needs of families and evaluate the impact of culturally tailored interventions designed to promote the children's development and overall family quality of life.

The quantitative measurement of family quality of life: a review of available instruments

BACKGROUND

Family quality of life (FQOL) has emerged as an important outcome of service delivery for individuals with disabilities and their families. The purpose of this review was to explore the disparity of scale development approaches between families with children with disabilities and families from other populations and identify strengths to serve as a source of recommendations to improve the measurements of FQOL in the disability field.

METHOD

We conducted a keyword search of 25 databases. Sixteen measurement tools on FQOL, family well-being and family satisfaction currently used in the disability field, healthcare field and general family studies published in journals from 1980 to 2009 were included in the analysis.

RESULTS

Three themes emerged from the detailed analysis and comparisons of the instruments: (1) description of the primary purpose and theoretical basis; (2) identification of the tool's respondents, domains, response formats and scoring strategies to assess family systems; and (3) summarisation of available psychometric information.

CONCLUSIONS

As family researchers continue their mission to conceptualise and theorise about FQOL, they should also promote the refinement of FQOL measurements and consider the implications from family instruments used in the healthcare and general family fields from the following aspects: (1) domains of FQOL; (2) units of analysis; (3) response format; (4) scoring choice; and (5) psychometric evaluation.

Assessment of the quality of life in families with children who have intellectual and developmental disabilities in Slovenia

BACKGROUND

Research was conducted, within the framework of the International Family Quality of Life Project, on the quality of life of families with a member who has a disability. We concentrated on the nine specific domains that the family life measure used, and recorded data from five of its six measurement dimensions: Importance, Opportunities, Initiative, Attainment and Satisfaction.

METHOD

The sample consisted of 20 families from Slovenia with children who have intellectual or developmental disabilities. The data were collected using the Family Quality of Life Survey-2006.

RESULTS

Except for Community Interaction, the other domains (Health, Financial Well-Being, Family Relations, Support from Others, Support Services, Influence of Values, Careers, Leisure and Recreation) show statistically significant differences among the five dimensions measured. Importance was rated highest, and Attainment and Opportunities were rated lowest, while Initiative and Satisfaction were evaluated lower than Importance but higher than Attainment and Opportunities. Among the domains of family life, Family Relations was evaluated the highest from the perspective of all five dimensions.

CONCLUSIONS

The family members rated Importance high for all of the quality of family life domains, but it appears from the lower Opportunities scores that their opportunities are limited; this may result in fewer possibilities for attaining a better quality of life. The results of our research are useful to Slovene researchers who work in the areas of special pedagogy and rehabilitation, politicians, non-governmental organisations and social services. The quality of life of families with children with disabilities, their empowerment and their inclusion into community life should be significantly enhanced when consideration is given to all the family members' support and service needs.

Predictors of parenting self-efficacy in mothers and fathers of toddlers

BACKGROUND

Researchers interested in child developmental outcomes have highlighted the role that parenting self-efficacy (PSE) plays in psychosocial child adjustment. PSE is a cognitive construct that can be broadly defined as an individual's appraisal of his or her competence in the parental role. PSE has emerged in the literature as an important variable when exploring variance in parenting skills. Despite this, much remains to be learned about PSE. Little is known about the predictors of PSE, with much of the existing research conducted in a piecemeal fashion that lacks a solid theoretical framework. In addition, PSE in fathers has been understudied and relatively little is known about PSE in families with toddler age children. Informed by Belsky's process model of parenting, this study explored similarities and differences in PSE and the predictors of PSE for mothers and fathers of toddlers.

METHODS

A total of 62 cohabiting couples whose first-born child was 18-36 months old completed self-report measures of PSE, general self-efficacy, depression, marital satisfaction, parenting stress, child difficultness and family functioning.

RESULTS

For fathers, parenting stress and their relational functioning (i.e. marital satisfaction and family functioning) with their spouse predicted PSE scores. For mothers, general self-efficacy and relational functioning were predictive of PSE.

CONCLUSIONS AND LIMITATIONS

The results of this study support the use of Belsky's process model of parenting to study the predictors of PSE. Important differences were found in the prediction models for mothers and fathers. Future studies need to clarify the nature of parental self-efficacy beliefs in fathers and continue to use comprehensive theoretical models to identify potentially relevant covariates of PSE. Limitations of the current investigation include reliance on self-report measures and the homogeneity of the sample.

Enrichment, stress, and growth from parenting an individual with an autism spectrum disorder

BACKGROUND

Past researchers have focused primarily on the associated negative impact of caring for a child with special needs. In this study, caregivers report the enrichment and stress of caring for a child with an autism spectrum disorder.

METHOD

Eighty caregivers completed the Social Communication Questionnaire (SCQ), Effects of the Situation Questionnaire (ESQ), and Posttraumatic Growth Inventory (PTGI). Enrichment and stress scores were compared to symptom severity data and posttraumatic growth scores.

RESULTS

Consistent with prior research, caregivers reported greater levels of stress than enrichment. On just over half of the stress/enrichment variables, parental ratings of stress and enrichment were negatively correlated. Scores of total stress and enrichment were not correlated to the severity of the individual's symptoms or caregivers' growth scores.

CONCLUSIONS

These findings suggest that although stress is a major concern for caregivers, enrichment and growth may also occur in varying degrees.

Predictors of parenting stress among Vietnamese mothers of young children with and without cognitive delay

BACKGROUND

The study examined whether Vietnamese mothers of children with cognitive delay experienced more parenting stress compared to mothers of children without delay, and the factors that contribute to the parenting stress.

METHOD

The study sample included 225 mothers of children with and without cognitive delays from Hue City in Vietnam. The study protocol included mothers reporting on the scales of parenting stress and perceived social support, and on demographic questions.

RESULTS

Mothers of children with cognitive delay experienced more stress. They were poorer and less educated, and perceived less social support. More mothers of these children had health issues. Having a child with cognitive delay was the strongest predictor of stress after controlling other demographic and psychosocial variables.

CONCLUSION

Special education and early intervention services should be developed and available to educate the children with cognitive delay and support their mothers in Vietnam. Effective services also need to address their poverty and health care needs.

Creating supportive connections: a decade of research on support for families of children with disabilities

Raising a child with disabilities involves balancing a number of challenges, including seeking and gaining support. A synthesis of past research on support for families is needed to map directions for future research. This article reviews the past 10 years of empirical research on formal and informal support for families of children with disabilities. The review includes quantitative and qualitative studies representing several disciplines. Nine focus areas are identified: well-being, resources and socioeconomic factors, culture and minorities, intervention, extended families, siblings, professional support relationships, religion, and policy. Research is synthesized within each of the focus areas and suggestions are provided for future communication research. Dominant theories in existing studies are reviewed with directions for future theory-driven communication research.

Locus of control fails to mediate between stress and anxiety and depression in parents of children with a developmental disorder

Stress, anxiety and depression are raised amongst parents of children with a developmental disorder. However, the processes by which stress leads to depression and anxiety are poorly understood. In a cross-sectional survey, levels of parental stress, depression and anxiety were compared between parents of children with an autistic disorder, children with Down's syndrome and children with no disorder (N = 619) and the mediational role of locus of control was examined. Anxiety and depression were higher in parents of children with a disorder, and highest in parents of children with autism. Locus of control was more external in parents of children with autism. Locus of control failed to mediate the relationship between stress and both anxiety and depression in parents of children with a disorder. This suggests that help for parents of a child with a disorder may be effective if focused on the sources of stress rather than perceived control over events.

Factors linked to distress in mothers of children disclosing sexual abuse

The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.