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

Childhood Disability and Serious School Discipline Among Urban Youth

PURPOSE

To examine associations between childhood disability, its various types (physical, cognitive, emotional), and serious school discipline (suspensions/expulsions) in adolescence.

METHODS

We conducted analyses of secondary data from the Future of Families & Child Wellbeing Study, a population-based urban birth cohort followed across six waves in 20 large US cities, to investigate associations between childhood disability and serious school discipline in adolescence. Disability status included disabling physical, cognitive, and emotional conditions reported by the child's mother between ages 1-9. Serious school discipline was measured at youth aged 15 as suspensions or expulsions in the past two years based on reports by the mother and the youth. Associations were examined using logistic regression models adjusting for confounding factors, presented as average marginal effects.

RESULTS

Of the 2,504 adolescents in the analysis sample, one-third (33%) were identified as having a measurable disability and these youth were more likely to have experienced receiving serious school discipline, based on mother and youth reports. Adolescents with cognitive or emotional conditions had a significantly higher likelihood of receiving serious school discipline compared to those that did not have those conditions, while those with physical disability did not.

CONCLUSIONS

In this study of US urban youth, teens with cognitive or emotional conditions had a higher likelihood of experiencing serious school discipline, while youth with physical disability did not, suggesting that youth with less visible disability conditions are more likely to be penalized at school. These findings point to the urgent need for improved interventions for these youth.

A non-randomized controlled study to assess the impact of the "Appui Parental", an early and intensive support programme for vulnerable families: Study protocol

INTRODUCTION

Early home visit programmes have been developed to help parents build an adequate relationship with their baby and to prevent child developmental delays and affective disorders. The "Appui Parental" programme is an intervention carried out by nursery nurses to provide intensive parental support to vulnerable families. Before extending this programme, it seemed necessary to evaluate its impact objectively.

OBJECTIVES

The main aim is to determine the impact of the "Appui Parental" programme on the change in the child's symptoms. The secondary objectives are to evaluate its effects on mother-child interactions, self-assessed parental competence, perception of social support, primary caregiver's anxiety-depression symptoms, alliance with the nursery nurse, frequency of out-of-home placements, and nursery nurses' stress.

METHOD

This non-randomized prospective multicentre study would include 44 families who receive the "Appui Parental" intervention for a one to 20-month-old child (intervention group) and 44 families with the same vulnerability criteria who receive care as usual by the maternal and child protection services (control group). The child, parents, mother-child interaction, nursery nurse-mother alliance, and nursery nurse's stress will be assessed at month one and month 18 after inclusion. Comparisons between groups will be performed.

CONCLUSION

This study should provide the public authorities with objective data on this programme's impact and allow them to pursue its generalization. For professionals, the study should confirm the interest in close early parental support through home visits or should lead to rethinking some aspects of the programme.

Child protection involvement of children of mothers with intellectual disability

BACKGROUND

Children born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research.

OBJECTIVES

To investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data.

PARTICIPANTS AND SETTING

A cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia.

METHODS

Cox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated.

RESULTS

Children born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70-5.12)) and placement in out-of-home care (HR: 6.21 (4.73-8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk.

CONCLUSIONS

Intellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs.

Disproportionate Representation of Children of Color and Parents with Disabilities in the Child Welfare System: The Intersection of Race/Ethnicity, Immigration Status, and Disability

CASE

An almost 5-year-old girl is referred to a developmental-behavioral clinician for developmental evaluation because of language and learning concerns. Her developmental screening in the primary pediatrics office showed scores concerning for delays in communication, social-emotional, gross, and fine motor domains. Her mother has concerns about her language. Her mother's primary language is Spanish, but the patient and her siblings speak primarily English. She speaks in short phrases and sentences with grammatical errors. Her mother understands approximately 75% of what she says, and strangers understand approximately 50%. She uses gestures and facial expression, is social and friendly, demonstrates pretend play, and plays well with her siblings and other children her age. She has occasional meltdowns, but there are no other major behavioral concerns. She feeds herself with utensils and is able to dress herself. She toilet trained recently, at about age 4.5 years.She did not receive early intervention before age 3 years and had no previous evaluations. She did not attend preschool or child care. Her mother reported that they were referred to the school district twice, but she had trouble requesting the evaluation.She lives with her parents and 2 brothers. The patient's parents immigrated to the United States from Mexico 7 years ago. They are both farm workers, and extended family members are in Mexico. On reviewing family history, the clinician learns that the patient's mother had trouble learning and attended school until she was 12 years old. She did not receive extra help at school. The child's mother said that she forgets things and "has trouble with reading and writing fast." The patient's 10-year-old brother has an individualized education plan and is in a substantially separate classroom. He has inclusion activities of recess, art, and music. He receives speech-language therapy and academic support for reading and writing. The patient's mother becomes tearful and shares that Child Protective Services was notified because of her inability to request the school evaluation, but a case was not opened.Developmental evaluation reveals expressive language at a 33-month-old level and receptive language at a 39-month-old level. Cognitive testing shows extremely low verbal comprehension, borderline visual spatial skills, and fluid reasoning in the low average range. Working memory and processing speed fall in the borderline range. The clinician learns at a follow-up visit that the patient's mother was evaluated by state disability services and has mild intellectual disability.What is your next step in management? What feedback or resources would you provide to the pediatric clinician and family?

"Someone will come in and say I'm doing it wrong." The perspectives of fathers with learning disabilities in England

When people with learning disabilities have children and become parents, they sometimes need good support to help them.Research about parents with learning disabilities and the support they get is usually about mothers and not fathers. There is not very much written about dads with learning disabilities.This paper is about interviews with eight dads with learning disabilities who told us about what it was like to be a dad and about the kind of support they had got.We think more support needs to be given to parents with learning disabilities and that dads should be included in this.

ABSTRACT

Background: This article reports on the perspectives of fathers with a learning disability in England about being fathers and the support they have received. Although there is an established literature that considers parenting with a learning disability, few studies have focused on the perspectives of fathers.Method: We adopted a qualitative approach for this study, using semi-structured interviews with eight fathers with learning disabilities, recruited through learning disability organisations and social media. The data were analysed using thematic analysis.Results: Being a father was important to participants and the findings are presented in three themes: descriptions of fatherhood; challenges of fatherhood; and support with fatherhood.Conclusion: We discuss how fathers' perspectives on fatherhood relate to wider transformations of fatherhood in society, the impact of these on fathering with a learning disability and the implications for services.

A Case Report of Failure to Thrive Caused by Parental Intellectual Disability: The Invisible Population

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

Evaluating the effects of multisystemic therapy for adolescents with intellectual disabilities and antisocial or delinquent behaviour and their parents

BACKGROUND

An adaptation of multisystemic therapy (MST) was piloted to find out whether it would yield better outcomes than standard MST in families where the adolescent not only shows antisocial or delinquent behaviour, but also has an intellectual disability.

METHOD

To establish the comparative effectiveness of MST-ID (n = 55) versus standard MST (n = 73), treatment outcomes were compared at the end of treatment and at 6-month follow-up. Pre-treatment differences were controlled for using the propensity score method.

RESULTS

Multisystemic therapy-ID resulted in reduced police contact and reduced rule breaking behaviour that lasted up to 6 months post-treatment. Compared to standard MST, MST-ID more frequently resulted in improvements in parenting skills, family relations, social support, involvement with pro-social peers and sustained positive behavioural changes. At follow-up, more adolescents who had received MST-ID were still living at home.

CONCLUSIONS

These results support further development of and research into the MST-ID adaptation.