Mothers of young adults with intellectual disability: multiple roles, ethnicity and well-being

Reducing Depressive Symptoms Among Latina Mothers of Autistic Children: A Randomized Controlled Trial

This study examines the intervention effect of a culturally tailored parent education program in reducing depressive symptoms among Latina mothers of autistic children. In this two-site randomized waitlist-control study (n = 109 mother-child dyads), a peer-to-peer mentoring (promotora) model was used to deliver an intervention that was designed to increase mothers' self-efficacy and use of evidence-based strategies. We assessed mothers' depressive symptom (CES-D) scores at three time points and used linear mixed models to determine whether their scores significantly changed from baseline to postintervention (Time 2) and at 4 months postintervention (Time 3). Results show that mothers in the intervention group reported a significant decrease in mean depressive symptom scores at Time 2 and that the effect was maintained at Time 3 with intermediate to medium effect sizes. There were no differences in results across sites. Findings suggest that Parents Taking Action, a culturally tailored intervention led by peer mentors, showed a significant effect both immediately after the intervention and 4 months postintervention in reducing depressive symptoms among Latina mothers of autistic children.

Cognitive facet and paradigm of the caregivers of children with developmental problems in Eastern India

Background

The role of caregivers in grooming the neuro-developmental outcome of high-risk newborns and developmental challenges in children needs to be explored.

Objectives

To find the knowledge and perception among parents regarding the neuro-developmental outcome of high-risk newborns, methods adopted to address these problems, and to identify areas on which awareness generation needs to focus.

Materials and Methods

A questionnaire-based awareness survey was conducted to understand the knowledge, attitude, and practices of families of children with developmental challenges.

Results

The study revealed that more than 70 percent of families lack information about child development, developmental challenges, and means to deal with them. They are unaware of the available health care services and other resources. One in three families has misconceptions on developmental disabilities; consider them as curse or jinx and consequently neglected. Female children with developmental problems are further ostracized due to gender inequity in families. About 10 percent of families have shown great openness toward acquiring new skills and knowledge for handling their children with developmental delays.

Conclusions

This study is based on the précis research findings of our grass-root level fieldwork conducted in remote rural Bengal areas. The observation will be of interest and learning materials for general primary care practitioners, family physicians, and stakeholders to initiate appropriate intervention strategies for properly rehabilitating children with developmental delay at grass-root levels of primary health care.

Children's and Parents' Factors That Affect Parenting Stress in Preschool Children With Developmental Disabilities or Typical Development

OBJECTIVE

This study compared parenting stress in preschool children with developmental disabilities (DD) or typical development (TD). We also investigated children's factors that affect parenting stress.

METHODS

A total of 196 preschool children participated in the study (aged 54.8±9.2 months). There were 79 children with DD (59 with autism spectrum disorder, 61 with intellectual disability, 12 with language disorder) and 117 with TD. The high parenting stress and the low parenting stress groups were divided based on the Total Stress of Korean Parenting Stress Index Fourth Edition (K-PSI-4) with an 85-percentile cutoff score. Pearson's correlation analysis was conducted to calculate the correlation between K-PSI-4 and the children's or parents' measures.

RESULTS

The difference in parenting stress between DD and TD was significant in the Total Stress of K-PSI-4 (p<0.001). The Total Stress scale of K-PSI-4 represented a modest to strong correlation with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Our results showed that caregivers of children with DD reported higher parenting stress than those with TD. Parenting stress was strongly associated with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Among the children's factors, especially social communication, attention problems, and aggressive behavior had association with caregivers' higher parenting stress.

CONCLUSION

These findings suggest the need for early intervention for parenting stress in caregivers by assessing child characteristics, including social cognition, awareness, communication, and inattention and hyperactivity, in the evaluation of children with DD.

Caregiver stress and cultural identity in families of preschoolers with developmental delay and behavioral problems

INTRODUCTION

Research on families of young children with developmental delay and disruptive behavior problems has failed to examine caregiver stress in the context of cultural factors.

METHODS

Families of 3-year-old children with developmental delay and behavior problems were recruited from Early Intervention sites. All caregivers in the current analysis (n = 147) were from immigrant and/or cultural minority backgrounds. Regarding income-to-needs, most families (57.8%) fell into the extreme poverty, poor, or low-income categories. Caregivers reported on their own experiences of acculturation and enculturation as well as their child's problems.

RESULTS

Path analyses revealed that higher caregiver acculturation was associated with less parenting-specific stress, and higher caregiver enculturation was associated with less caregiver general stress. Severity of child problems was associated with more parenting-specific stress and general stress. Exploratory analysis yielded significant differences in associations between acculturation, enculturation, and caregiver stress in Black/African American caregivers versus Hispanic White caregivers.

CONCLUSION

Findings suggest that among cultural minority caregivers of young children with developmental and behavioral problems, acculturation and enculturation may influence caregiver stress. While the cross-sectional nature of the study precludes causal conclusions, clinicians should consider how cultural factors can be harnessed to strengthen caregiver resiliency and improve engagement in parenting interventions.

Mental ill-health in mothers of people with intellectual disabilities compared with mothers of typically developing people: a systematic review and meta-analysis

BACKGROUND

Mothers of people with intellectual disabilities (IDs) face exceptional challenges and may be more prone to experiencing mental ill-health compared with mothers of typically developing people. These mental ill-health problems may differ at different stages of the caregiving trajectory. However, there is no evidence synthesis on this topic. We aimed to systematically review evidence in this area and identify gaps in the existing literature.

METHOD

Prospero registration: CRD42018088197. Medline, Embase, CINAHL and PsycINFO databases were searched. No time limits were applied. Studies were limited to English language. Inclusion criteria were studies of mothers of people with IDs that also included a comparison group of mothers of typically developing/developed children. Data were extracted from selected studies using a structured database. Study selection and quality appraisal were double rated. Where possible, meta-analyses were performed.

RESULTS

Of the retrieved articles, 32/3089 were included, of which 10 reported on anxiety, 21 on depression and 23 on other indicators of mental ill-health. Overall, previous studies reported that mothers of people with IDs experienced poorer mental health as compared with mothers of typically developing people. Meta-analyses revealed significant findings for anxiety, depression, parenting stress, emotional burden and common mental disorders, but not for somatic symptoms. However, there was a considerable heterogeneity; hence, interpretation of results should be cautious. Identified gaps included scarce research on mental ill-health of mothers of adults with IDs at different stages of the caregiving trajectory.

CONCLUSIONS

There is evidence of poorer mental ill-health in mothers of people with IDs compared with mothers of typically developing people, but lack of focus on different stages of the caregiving trajectory, methodological inconsistencies between studies and lack of robust studies pose limitations. This highlights the need both for improved support for mothers of people with IDs and for further methodologically robust research.

Mental health and well-being of fathers of children with intellectual disabilities: systematic review and meta-analysis

BACKGROUND

Caring for a child with intellectual disabilities can be a very rewarding but demanding experience. Research in this area has primarily focused on mothers, with relatively little attention given to the mental health of fathers.

AIMS

The purpose of this review was to summarise the evidence related to the mental health of fathers compared with mothers, and with fathers in the general population.

METHOD

A meta-analysis was undertaken of all studies published by 1 July 2018 in Medline, PsycINFO, CINAHL and EMBASE, using terms on intellectual disabilities, mental health and father carers. Papers were selected based on pre-defined inclusion and exclusion criteria.

RESULTS

Of 5544 results, 20 studies met the inclusion criteria and 12 had appropriate data for meta-analysis. For comparisons of fathers with mothers, mothers were significantly more likely to have poor general mental health and well-being (standardised mean difference (SMD) -0.38, 95% CI -0.56 to -0.20), as well as higher levels of depression (SMD, -0.46; 95% CI -0.68 to -0.24), stress (SMD, -0.32; 95% CI -0.46 to -0.19) and anxiety (SMD, -0.30; 95% CI -0.50 to -0.10).

CONCLUSIONS

There is a significant difference between the mental health of father and mother carers, with fathers less likely to exhibit poor mental health. However, this is based on a small number of studies. More data is needed to determine whether the general mental health and anxiety of father carers of a child with intellectual disabilities differs from fathers in the general population.

Coping, stress and negative psychological outcomes in parents of children admitted to a pediatric neurorehabilitation care unit

BACKGROUND

Parents' attitudes and psychological adjustment during their child's hospitalization in a pediatric neurorehabilitation care unit are key aspects for the child's adherence to care and the impact of the disease.

AIM

The aim of this study was to examine the relationship between parenting stress, coping style, and negative psychological outcomes in families of children admitted for the first time to a pediatric neurorehabilitation care unit.

DESIGN

This is an observational study.

SETTING

Pediatric neurorehabilitation care unit.

POPULATION

One hundred twenty-four parents of children diagnosed with neurodevelopmental or neurological conditions.

METHODS

Parents completed standardized questionnaires assessing parenting stress, coping style, anxiety and depressive symptoms.

RESULTS

We found that parents of children with neurodevelopmental conditions showed more emotion-focused coping strategies (P=0.016) and depressive symptoms (P=0.01) compared with parents of children with neurological conditions. Hierarchical regression analyses showed that emotion- and avoidance-oriented coping style and socioeconomic status are crucial factors in the adjustment process of parents of children with neurodevelopmental conditions. By contrast, parenting stress and child difficulties were the most significant predictors of negative psychological outcomes in parents with neurological conditions.

CONCLUSIONS

This study sought to develop more understanding of the relationship among parenting stress, coping, and anxiety or depressive symptoms in parent of children hospitalized in a pediatric neurorehabilitation care unit. We suggest that examining parents may increase our understanding of the interplay between child and parent functioning in families with children admitted for the first time to a pediatric neurorehabilitation care unit.

CLINICAL REHABILITATION IMPACT

Identify these predictors might help professionals to develop screening procedures to identify parent at high risk for anxiety or depression, and to conduct early interventions to reduce uncertainty and maladaptive coping strategies that may influences rehabilitation process.

Factors associated with stress in families of children with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD).

METHODS

Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression.

RESULTS

Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress.

CONCLUSION

The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.

The transition to adulthood of young adults with IDD: Parents' joint projects

INTRODUCTION

Parents have found the transition to adulthood for their sons or daughters with intellectual and/or developmental disabilities (IDD) particularly challenging. The literature has not examined how parents work together and with others in face of this transition nor has it highlighted parental goals in this process. This study used a perspective based on joint, goal-direct action to describe the projects that Canadian parents engaged in together and with others relative to this transition.

METHODS

Using the qualitative action-project method, joint projects between parents and with others were identified from their conversations and followed for 6 months.

FINDINGS

Three groups of projects were described: equipping the young adult for adult life, connecting for personal support and managing day-to-day while planning for the future.

CONCLUSIONS

Parents act together and with others relative to the transition to adulthood of their young adult children with IDD. These projects are complex and differ in goals, steps, resources and emotional regulation and motivation.

Physical and psychological health of family carers co-residing with an adult relative with an intellectual disability

BACKGROUND

Providing long-term care to an adult relative with intellectual disability can impact negatively on caregivers' health and well-being.

METHODS

Data were collected via online and postal questionnaires on 110 family carers' physical and psychological health, family stress and perceived positive gains from caring. Psychological adaptation and carers' satisfaction with available support were also examined.

RESULTS

Study participants reported more health problems than general populations. Higher support needs of care recipients were associated with increased family stress. Carers being female were associated with lower family stress. Older age and better socio-economic position were associated with better psychological outcomes. Other associations were consistent with psychological adaption and perceived helpfulness of support buffering negative outcomes and facilitating positive gains from caring.

CONCLUSIONS

Family carers of adults with intellectual disability appear to experience poorer health outcome than population norms. Adaption to the caregiving role may buffer negative outcomes. Further large scale, population-based, longitudinal research is needed.

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.

Subjective Psychological Well-Being in Families with Blind Children: How Can We Improve It?

The aim of this work was to examine family well-being in a sample of Spanish families with blind children. Sixty-one participants reported their perceived economic status, the level of job satisfaction, and state-anxiety symptoms. The participants of our study scored higher on state-anxiety and lower on material well-being than the normative sample, although these differences did not reach statistical significance. They also scored higher on job satisfaction and family satisfaction than the general population. A negative correlation was found between state-anxiety and material well-being (r = - 0.62, p = 0.001) and between state-anxiety and family satisfaction (r = - 0.57, p = 0.001). A positive correlation was found between material well-being and job satisfaction (r = 0.40, p = 0.001), and between material well-being and family satisfaction (r = 0.41, p = 0.001). Higher levels of material well-being, job satisfaction, and family satisfaction were associated with lower levels of anxiety in these families. However, no statistically significant correlation was found between family satisfaction and job satisfaction. Our results suggest that the family experience of having a disabled child is evolving, and this implies achieving greater job and family satisfaction than the normative samples, although anxiety scores continue to be higher and material well-being scores remain lower. On the whole, our results confirm that it is necessary to provide these families with more economic resources, which would have a positive impact on their subjective psychological well-being, decreasing their state-anxiety, and increasing their satisfaction with life.

A cross-sectional cohort study of a large, statewide Medicaid home and community-based services autism waiver program

State-specific 1915(c) Medicaid Home and Community-Based Services waiver programs have become central in the provision of services specifically tailored to children with autism spectrum disorders (ASD). Using propensity score matching, 130 families receiving waiver services for a child with ASD were matched with and compared to 130 families waiting on the registry (i.e., control group). Results indicate that participants in the waiver group reported more improvement in independent living skills and family quality of life over the last year compared to those on the registry. More frequent intensive individual support services and therapeutic integration were statistically predictive of improvement in a variety of domains. The results suggest that the waiver program may be promising for improving child and family functioning.

Predictors of caregiver depression and family functioning after perinatal stroke

BACKGROUND

Perinatal stroke is a leading cause of cerebral palsy and lifelong neurological morbidity. Studies on perinatal stroke outcomes are increasing, although examinations of its broader impact on parents and families have been limited. A recent study found that parents of children with moderate and severe outcomes have increased risk for psychosocial concerns, including depressive symptoms and poor family functioning. Other parents adapt remarkably well, but how this occurs is unknown. The primary aim of this study was to examine predictors of parent and family outcomes, namely caregiver depression and family functioning. The secondary aim was to explore potential mediators and moderators of the relationship between condition severity and parent and family outcomes.

METHODS

Parents were recruited from a large, population-based perinatal stroke research cohort, and they completed measures assessing their demographics, social supports, stress levels, marital quality, feelings of guilt and blame, psychological well-being, and family functioning. Bivariate analyses compared these variables. Predictor variables, mediators, and moderators were chosen according to the strength of their relationship with the outcome variables (i.e., caregiver depression and family functioning) and theory. Hierarchical regression, mediator, and moderator analyses were conducted accordingly.

RESULTS

A total of 103 parents participated in this study (76 mothers, 27 fathers; mean age of 39.2 years; mean child age of 7.46 years). Condition severity, anxiety, social support, and blame independently predicted caregiver depression while condition severity, stress levels, and marital quality independently predicted family functioning. Blame regarding the cause of their child's condition also mediated the relationship between condition severity and caregiver depression.

CONCLUSIONS

Adverse parental outcomes can be predicted in perinatal stroke populations. Moreover, anxiety and stress management techniques, marital support, and psychoeducation regarding the unpreventable nature of perinatal stroke may be utilized in the future to enhance family outcomes.

Improving health behaviours of Latina mothers of youths and adults with intellectual and developmental disabilities

BACKGROUND

Latina mothers who care for children with intellectual and developmental disabilities (IDD) over the lifespan struggle to take care of their own health needs in the context of their caregiving experience. Services are typically aimed at the persons with IDD and not their family caregivers. Yet, attending to family caregiver needs may contribute to better long-term care of persons with IDD who remain at home. To address this unmet need, we developed a culturally sensitive health education intervention for Latina mothers who care for youth and adults with IDD. The aim of the intervention is to improve maternal health-related self-efficacy and health behaviours, and to reduce stress.

METHOD

A randomised control design was employed to determine preliminary efficacy of the intervention. Paired sample t-tests were conducted to examine within-group changes from baseline to 3-month post-test. Repeated-measures analysis of covariance was used to examine the group-by-time interaction effects.

RESULTS

Intervention participants showed greater increases between pre- and post-test in health-related self-efficacy; self-care, nutrition and overall health behaviours. Both groups reported decreases in depressive symptoms and caregiver burden.

CONCLUSIONS

While additional research is needed to determine long-term effects and to replicate findings, our results suggest that this culturally sensitive health intervention is a promising way to increase health behaviours which may lead to overall good health for Latina mothers who care for children with IDD across the lifespan.

Spiritual Journey in Mothers' Lived Experiences of Caring for Children With Autism Spectrum Disorders

INTRODUCTION

Helping mothers who have children with autism spectrum disorders requires understanding of their lived experiences. This study aims to uncover the spiritual journey as a main theme in Iranian mothers' experiences.

METHOD

This hermeneutic phenomenological study is a part of a larger study undertaken for partial fulfillment of the requirement for PhD dissertation in nursing. The main study was performed on 18 cases of Iranian mothers, with experience of caring for a child with an autism spectrum during 2011-2012. They were selected based on purposeful sampling method. Semi -structured interviews for data collection were used. Data analyses were done with the interpretative method.

RESULTS

Spiritual journey is one of the main themes of the phenomenon under study in the original project. It consists of three sub -themes each of which supported by a number of common meaning. The sub-themes and their common meanings in parenthesis are (1) Descent: wondering between what is and what will be (having sorrowful tale, unanswered question, escaping from reality, losing hope) (2) Connecting to deity: reflection on the failure in her struggle (gratefulness, surrendering to god, having the divine test) (3) Ascent: helping her child is becoming all of the mother's life (to rescue, being hopeful, listening to her inner voice)

CONCLUSION

This research concluded that caring for the autistic children led mothers' lives to raise spirituality and enabled them to help their children and themselves, to grow and be refined in this process.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cultural and child-related predictors of distress among Latina caregivers of children with intellectual disabilities

The objective of this article is to examine associations among socioeconomic, cultural, and child factors and maternal distress among families of children with intellectual disabilities (ID). Latino and nonLatino White (NLW) mothers of children with and without ID (N  =  192) reported on familism, language acculturation, maternal distress, child adaptive functioning, and child behavior problems. Among mothers of children with ID, higher levels of child behavior problems mediated the association between Latina ethnicity and elevated maternal distress. Associations between child behavior problems and maternal distress in Latina mothers of children with ID were moderated by single-parent marital status, higher familism, and lower English usage. Thus, child and cultural factors contribute to elevated distress among Latina mothers of children with ID.

Support and self-efficacy among Latino and White parents of children with ID

Research indicates that mothers of children with ID who receive familial support experience less stress than those who receive less support. Less is known about the relation of support to mothers' evaluation of parenting self-efficacy, particularly in Latino families. We examined the relationship of different types of family support to life satisfaction and parenting self-efficacy (PSE), and explored whether income and ethnicity moderated these relationships. Interviews with 84 Latino and 37 White participants revealed that partner emotional support predicted life satisfaction and PSE in both ethnic groups, with a stronger relationship evident for the PSE of Latino mothers. Income was not a significant moderator. These findings provide guidance for more effective family interventions targeted toward Latinos.

Family routines within the ecological niche: an analysis of the psychological well-being of U.S. caregivers of children with disabilities

Using mixed methods, this study examined the relationship of caregivers of children with disabilities' psychological well-being (PWB) and their orchestration of daily routines within their ecological niche. Thirty-nine U.S. caregivers completed in-depth interviews, PWB Scales, and Family Time and Routines Index (FTRI). We used a multi-step analysis. Interview data was coded and vignettes created without knowledge of PWB and FTRI ratings. Next, the relationship of quantitative measures was analyzed. Four groups were created using FTRI-extent and PWB means: (1) low routine-low PWB, (2) low routine-high PWB, (3) high routine-low PWB, and (4) high routine-high PWB. We examined qualitative differences in key features between groups.

FINDINGS

Total PWB and FTRI scores were not significantly correlated, PWB Purpose in Life and FTRI-extent scores were moderately positively correlated, and PWB Environmental Mastery and FTRI-extent correlation approached significance. Qualitative findings describe caregivers' structuring of routines, intensity of oversight, support in routines, management of dinner, paid work, and needs for respite. The four groups differed in paid work, household support, degree the child could self-occupy, Environmental Mastery, and opportunities to recuperate. Caregivers with higher levels of well-being and more regular routines did paid work, had supportive spouses, had children who more often could follow routines, had higher Environmental Mastery, could orchestrate a family meal, and had breaks from care in either work or leisure. All Native American caregivers and Mexican American caregivers with spouses were in the high routine-high PWB group. Insight into this complex negotiation between family members within daily routines may provide practitioners a better understanding of how to work within family circles to foster therapeutic alliances, identify focused intervention targets, and promote positive family wide outcomes.

Longitudinal models of socio-economic status

Parenting research is frequently conducted without a thorough examination of socio-economic characteristics. In this study, longitudinal observations of positive parenting were conducted across six time points. Participants were 219 mothers of children with and without developmental delays. Mothers’ positive parenting increased during early and middle childhood in children with and without developmental delays. Mothers who reported more education had significantly higher levels of positive parenting when their children were 3 years old. Mothers who reported more family income grew at a significantly faster rate in positive parenting. There was preliminary support that mothers with more income were more likely to be members of a class that started off and remained at a higher level of positive parenting over time. Implications are discussed.

Resilience in families raising children with disabilities and behavior problems

The purpose of this study was to investigate the resilience displayed by families raising children with disabilities and behavior problems. The question is why do some families do well when others, exposed to similar stressors, struggle to keep their family life running? A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the Family Life Survey, which incorporated measures of child behavior problems, social-ecological resources and family-level 'outcomes'. Families raising children with disabilities and behavior problems 'do well' under conditions of high social support and low financial hardship. In contrast, families with low levels of social support and high levels of financial hardship typically struggle, even when the number or intensity of child behavior problems is low. The study findings are consistent with the view that 'resilience' has more to do with the availability and accessibility of culturally relevant resources than with intrinsic, individual or family factors. With respect to family-level outcomes, strengthening social relationships and ameliorating financial hardship may be more important than behavior modification.

Mothers of children with developmental disabilities: stress in early and middle childhood

Using a sample of 219 families of children with (n=94) and without (n=125) developmental disabilities, this study examined the longitudinal perspectives of maternal stress in early (ages 3-5) and middle childhood (ages 6-13) and its relationship to mothers' and children's characteristics. Multivariate latent curve models indicated that maternal stress remained high and stable with minimal individual variation in early childhood, but declined with significant individual variation in middle childhood. Maternal stress at the beginning of middle childhood was associated with earlier maternal stress, as well as children's behavioral problems and social skills. The trajectory of maternal stress across middle childhood was related to children's behavioral problems. Implications for interventions are discussed.

Factors Involved in Iranian Women Heads of Household's Health Promotion Activities: A Grounded Theory Study

We aimed to explore and describe the factors involved in Iranian women heads of household’s health promotion activities. Grounded theory was used as the method. Sixteen women heads of household were recruited. Data were generated by semi structured interviews. Our findings indicated that remainder of resources (money, time and energy) alongside perceived severity of health risk were two main factors whereas women’s personal and socio-economic characteristics were two contextual factors involved in these women's health promotion activities. To help these women improve their health status, we recommended that the government, non-governmental organizations and health care professionals provide them with required resources and increase their knowledge by holding training sessions.

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

The self-perceived physical health of mothers raising children with developmental delay (DD; N=116) or typical development (TD; N=129) was examined across child ages 3-9 years, revealing three main findings. First, mothers of children with DD experienced poorer self-rated physical health than mothers of children with TD at each age. Latent growth curve analyses indicated that mothers in the DD group experienced poorer health from age 3 but that the two groups showed similar growth across ages 3-9 years. Second, cross-lagged panel analyses supported a child-driven pathway in early childhood (ages 3-5) by which early mother-reported child behavior problems predicted poorer maternal health over time, while the reversed, health-driven path was not supported. Third, this cross-lagged path was significantly stronger in the DD group, indicating that behavior problems more strongly impact mothers' health when children have developmental delay than when children have typical development. The health disparity between mothers of children with DD vs. TD stabilized by child age 5 and persisted across early and middle childhood. Early interventions ought to focus on mothers' well-being, both psychological and physical, in addition to child functioning.

"Communities" in community engagement: lessons learned from autism research in South Korea and South Africa

Little research has been conducted on behavioral characteristics of children with autism spectrum disorder (ASD) from diverse cultures within the US, or from countries outside of the US or Europe, with little reliable information yet reported from developing countries. We describe the process used to engage diverse communities in ASD research in two community-based research projects-an epidemiologic investigation of 7- to 12-year olds in South Korea and the Early Autism Project, an ASD detection program for 18- to 36-month-old Zulu-speaking children in South Africa. Despite the differences in wealth between these communities, ASD is underdiagnosed in both settings, and generally not reported in clinical or educational records. Moreover, in both countries, there is low availability of services. In both cases, local knowledge helped researchers to address both ethnographic as well as practical problems. Researchers identified the ways in which these communities generate and negotiate the cultural meanings of developmental disorders. Researchers incorporated that knowledge, as they engaged communities in a research protocol, adapted and translated screening and diagnostic tools, and developed methods for screening, evaluating, and diagnosing children with ASD.

Trajectories of emotional well-being in mothers of adolescents and adults with autism

Raising an adolescent or adult child with a developmental disability confers exceptional caregiving challenges on parents. We examined trajectories of 2 indicators of emotional well-being (depressive symptoms and anxiety) in a sample of primarily Caucasian mothers (N = 379; M age = 51.22 years at Time 1) of adolescent and adult children with an autism spectrum disorder (ASD; M age = 21.91 years at Time 1, 73.2% male). We also investigated within-person associations of child context time-varying covariates (autism symptoms, behavior problems, residential status) and maternal context time-varying covariates (social support network size and stressful family events) with the trajectories of emotional well-being. Data were collected on 5 occasions across a 10-year period. Average patterns of stable (depressive symptoms) and improved (anxiety) emotional well-being were evident, and well-being trajectories were sensitive to fluctuations in both child and maternal context variables. On occasions when behavior problems were higher, depressive symptoms and anxiety were higher. On occasions after which the grown child moved out of the family home, anxiety was lower. Anxiety was higher on occasions when social support networks were smaller and when more stressful life events were experienced. These results have implications for midlife and aging families of children with an ASD and those who provide services to these families.

Barriers to maternal workforce participation and relationship between paid work and health

BACKGROUND

Families of children with disabilities experience extra financial strains, and mothers are frequently unable to participate in paid work because of caregiving obligations.

METHODS

A mailed survey and follow-up phone calls were used to gather data about mother's health, workforce participation and barriers to inclusion in the workplace (n = 152). Verbatim reports of issues that hindered workforce participation were analysed qualitatively to derive themes. Maternal health-related quality of life (HRQoL) was measured using the Short Form Health Survey Version 2 (SF-36v2). Norm-based conversions were used to compare HRQoL between working and non-working mothers and to compare to population norms.

RESULTS

Eighty-two per cent of mothers in the sample wanted and needed to work for pay but indicated over 300 issues that prevent their work participation. Data analysis revealed 26 common issues which prevent work participation. These issues fit into three main categories: mother-related reasons (28%), child-related reasons (29%) and service limitations (43%). Mothers who worked (n = 83) reported significantly better HRQoL than mothers who did not work (n = 69) on five of the eight SF-36v2 dimensions and overall mental health.

CONCLUSIONS

Compared to other working Australians, mothers in this study had higher education yet reported poorer health, lower family income and lower workforce participation. Respondents reported that service system limitations were the main barriers to participation in the paid workforce. Investigation of service changes such as increased respite care, availability of outside hours school care, improved professional competency and family-centred services is recommended in order to improve maternal participation in paid work.

The relationship between caregiver's strain and social support among mothers with intellectually disabled children

AIMS AND OBJECTIVES

To explore caregiver's strain, the relationship between social support and caregiver's strain and the predictors of caregiver's strain among mothers with school-aged intellectually disabled children in Taiwan.

BACKGROUND

Strain is a common condition among mothers who take care of intellectually disabled children; this correspondingly reduces their ability to care for children, thereby affecting the functioning of the entire family. Yet, there have been very few studies on caregivers of intellectually disabled children of school age.

DESIGN

Cross-section correlational design.

METHODS

Data collection consisted of face-to-face interviews combined with a structured questionnaire. Instruments employed were the Caregiver Strain Index, Social Support Scale and three open-ended questions. In total, 127 mothers completed the questionnaire.

RESULTS

Results showed that mothers with intellectually disabled children had a rather high level of strain and received inadequate social support. Social support and strain had a significant and negative correlation. Stepwise regression analysis revealed that mothers' health status, social support and amount of time spent as a caregiver, as well as the intellectually disabled children's dependent degree of daily living activity, were major predictors of caregiver's strain, which accounted for 38.4% of the total variance.

CONCLUSIONS

The results provide a guide for healthcare professionals in designing effective interventions and preventive care to reduce the level of strain in mothers with intellectually disabled children. This, in turn, could improve the quality of life of the mother and her family.

RELEVANCE TO CLINICAL PRACTICE

In Taiwan, care of intellectually disabled children is primarily provided by family members. Therefore, we should emphasise family-centred care to enable healthcare professionals to become more effective as case managers in local clinics, schools and communities.

Adolescer com deficiência mental: a ótica dos pais

Este trabalho tem como objetivo conhecer a representação da adolescência para os responsáveis por adolescentes com deficiência mental. Como metodologia, utilizamos a análise de narrativas de pais de adolescentes com deficiência mental. Baseamo-nos, principalmente, nas orientações de Thompson (1998) e Byron-Good (1996). Embora os pais reconhecessem nos filhos algumas características próprias da adolescência, nem sempre os consideravam como adolescentes, devido à pouca autonomia que possuíam. Muito freqüentemente, não propiciavam uma educação que contribuísse para uma maior autonomia dos filhos, ressentindo-se da falta de referências de como se comportar diante das mudanças de comportamento deles. Tendo em vista a constatação da importância da aquisição de uma maior autonomia para que os adolescentes tenham o reconhecimento deste período do desenvolvimento humano e possam vivenciá-lo da melhor forma possível, é neste sentido que algumas ações devem se desenvolver. Se forem apresentadas novas oportunidades de aprimoramento das competências e habilidades dos adolescentes com deficiência mental que ampliem seus " horizontes" , muitos poderão alcançar uma melhor autonomia que possibilite sua participação nas tomadas de decisão sobre seu destino e a vivência satisfatória de todas as etapas do seu ciclo de vida.

Socioeconomic and psychological variables as risk and protective factors for parental well-being in families of children with intellectual disabilities

BACKGROUND

The first aim of the present study was to estimate the extent to which differences in well-being in parents of children with and without intellectual disability (ID) in Sweden can be accounted for by differences in the presence of the risk factors: (1) child disability; (2) socioeconomic disadvantage; (3) household composition; and (4) parental characteristics. The second aim was concerned with individual variation in well-being within the group of parents of children with ID. The aim was to estimate if protective factors such as parental personality characteristics (sense of coherence), perceived positive impact of the child and satisfaction with participation in different arenas of life explained variation in well-being in mothers and fathers of children with ID over and above that explained by the risk factors.

METHOD

Parents of children with ID (62 mothers and 49 fathers) and control children (183 mothers and 141 fathers) completed postal surveys on well-being, socioeconomic situation, health, sense of coherence, satisfaction with participation in different arenas of life and the child's impact on the family.

RESULTS

The results showed that mothers of children with ID had lower levels of well-being than fathers and control parents, but the presence of a child with ID did not in itself predict poorer maternal well-being. Rather, differences in economic hardship and self-rated health were the strongest predictors for well-being. It was further found that 67.7% of the mothers of children with ID scored within the high well-being group. The predictive power of the model increased significantly for both fathers and mothers when protective factors were added to the model (42 and 78% explained variance compared with 25% with only risk factors).

CONCLUSIONS

Well-being of parents with a child with ID is dependent upon the interplay of risk and protective factors and research needs to address these variables simultaneously.

Children's delayed development and behavior problems: impact on mothers' perceived physical health across early childhood

Mothers of children with developmental delays may experience poorer psychological well-being than other mothers; however, little research has examined how delayed development in children might predict mothers' perceived physical well-being. Children with delayed development manifest heightened behavior problems, which may negatively affect maternal well-being. We examined the associations between developmental delay and behavior problems at child age 3 and mothers' self-perceived physical health at child ages 3, 4, and 5, in families of 218 children with and without developmental delays. The study sample comprised 218 families from central Pennsylvania and Southern California, USA who were recruited through community agencies that provide diagnostic and intervention services for individuals with development difficulties. We found that mothers of children with delayed development at age 3 reported poorer concurrent and later physical health than mothers of children with typical development. Broadening the analyses to include not only child development status (delayed development versus typical development) but also child behavior problems at age 3, only child behavior problems and the interaction of development status and behavior problems, but not development status itself, predicted maternal health. Early child behavior problems contributed to later maternal health above and beyond early maternal health, suggesting a possible causal association between child behavior problems and mothers' physical health. The relation between child behavior problems and maternal health was moderated by mothers' parenting stress and mediated by depressive symptoms. Mothers of children with both delayed development and high behavior problems are a particular risk group that may be especially in need of early intervention. Further research should examine the behavioral and biological pathways by which these child-related stressors influence mothers' physical health.

The impact of child disability type on the family

The purpose of this study is to better understand the differential impact of specific diagnoses on outcomes in families with children who have physical disabilities and to suggest ways in which clinicians across disciplines can use that knowledge to develop and implement more individualized, evidence-based programs. Descriptive statistics, correlation, and a univariate analysis of variance (ANOVA) were used to analyze data gathered from a sample of 205 parents or guardians of children with physical disabilities. Findings revealed a modest effect of diagnosis type on five family outcomes. These outcomes included: (1) how parents or guardians rated their child's current health compared to 1 year before the study, (2) the degree to which the child's physical health caused worry, (3) the degree to which the child's emotional well-being or behavior caused worry, (4) the degree to which the child's health or behavior limited types of family activities, and (5) the degree to which the child'shealth or behavior interrupted family activities. This article presents an interprofessional model of response.