Challenges, Coping, and Resilience Among Immigrant Parents Caring for a Child With a Disability: An Integrative Review

Parenting stress in families of children with disabilities: Impact of type of disability and assessment of attending paediatricians

BACKGROUND

Parents of children with developmental disorders (DD) or disabilities report greater parenting stress than parents of typically developing children. To minimise this stress, stressful factors need to be known and stress needs to be recognised early. The present cross-sectional study aims to systematically assess and compare parenting stress in families of children with various types of disabilities. In addition, the assessment of parenting stress by attending paediatricians will be evaluated.

METHODS

We surveyed 611 parents about their parenting stress at the Children's Development Center (CDC). Three questionnaires, including the German versions of the Parenting Stress Index (PSI) and Impact on Family Scale (IOFS), were used to evaluate parenting stress. Furthermore, attending paediatricians assessed of the child's type of disability and their perception of parenting stress in a separate questionnaire.

RESULTS

Fifty-five percent of all parents reported stress at a clinically relevant level, 65% in the child domain and 39% in the parent domain of the PSI. Parenting stress differed significantly across diagnostic categories (p < 0.01) and was associated with childhood disability related issues of behaviour, sleep or feeding issues. Parenting stress was often underestimated by the paediatricians, especially when the children had disabilities perceived as less severe. In one-third of parents with clinically relevant total stress, paediatricians reported low stress levels. Parent-reported financial problems, social isolation, and partnership conflicts were not suspected by paediatricians in ≥85% of cases.

CONCLUSIONS

Clinically relevant parenting stress was found more often than in comparable studies. An assessment of parenting stress by paediatricians may be complicated by time constraints in medical appointments, the mainly child-centred consultation, or restricted expression of parents' stress. Paediatricians should move from a purely child-centred to a holistic, family-centred approach to treatment. Routine screening of parenting stress using standardised questionnaires could be helpful to identify affected families.

'From my world to yours…': exploring the availability of social networks among parents from culturally diverse backgrounds caring for children with developmental disabilities in Australia

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups.

Immediate Caregiving Environment of Young Children with Autism: Findings from the U.S. National Survey of Children's Health

Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that negatively affects children's learning, motor behavior, social communication, and interaction. It was estimated that, in 2020, 1 in 36 children aged 8 years in the United States had ASD. Caring for children with ASD might exert significant psychological and emotional distress on parents. Receiving parental emotional support and fostering positive parent-child interactions at home have been identified as beneficial for the immediate caregiving environment for children with ASD. The current secondary analysis of the 2019-2020 National Survey of Children's Health examined parent-child interactions and accessible sources of emotional support for parents caring for 3-5-year-old children diagnosed with ASD (N = 243). Children with the following characteristics had higher odds of having ASD: male gender; having no private insurance or uninsured; and having less than excellent general health. Among parents, higher odds of caring for children with ASD were associated with accessing emotional support from various sources, especially from healthcare professionals and peers, and spending more time telling stories and/or singing to their children. Given these significant health disparities, educational interventions and strategies are needed to foster a positive home caregiving environment for young children with ASD, including equitable access to parent resources.

"Do the Best You Can with Resources You Have to Offer": Community stakeholder views on supporting immigrant families

First and second-generation immigrant families of young children in the United States face potential challenges that may be mitigated with stakeholder support in their communities. We examined self-reported views and behaviors among professionals (n = 76) working with families in a mid-Atlantic urban community, and whether these views correlated with demographic factors. Over half of respondents were not able/willing to report the number of immigrant families served and over half believed immigrant parents are less likely to advocate for themselves or their child. Participants were fairly split in seeking advice from others and comfort in talking with immigrant families about their culture/needs. It is essential to assess stakeholders' views on perceived roles, roadblocks, and desired supports. This analysis informs efforts to work more collaboratively with community partners to improve outreach to immigrant families during those formative years in a child's development. Implications for research, practice, and policy are discussed.

Exploring the lived experiences of ethnic minority youth with disabilities: a systematic review and meta synthesis of qualitative data

PURPOSE

Racial and ethnic minority youth with disabilities often encounter more challenges and poorer health, social and vocational outcomes compared to white youth and yet, relatively little is known about their lived experiences. The purpose of this study was to explore the experiences of ethnic minority youth and young adults with disabilities.

METHODS

We conducted a systematic review of qualitative data with eight international databases assessed by four reviewers.

RESULTS

Twenty-one studies met the inclusion criteria, which involved 373 youth and young adults, across four countries over a 20-year period. We identified the following themes: (1) accessing and navigating services (i.e., environmental barriers; lack of supports, resources and information); (2) perceptions of disability (i.e., cultural adjustment and tensions between cultures; differing priorities for independence); (3) systemic factors (i.e., language and communication; stigma, discrimination and racism); (4) coping (i.e., reframing; and family involvement and support); and (5) intersectionality (i.e., disability, race and ethnicity, gender, and socio-economic status).

CONCLUSIONS

Our findings highlight how racial and ethnic minority youth with disabilities encounter many challenges in dealing with their condition and the urgent need for further research to develop a deeper understanding of their needs so that clinicians and service providers can enhance supports.IMPLICATIONS FOR REHABILITATIONRacial and ethnic minority youth with disabilities encounter different challenges than other youth, such as cultural adjustment, racism and culturally inappropriate services.Clinicians and service providers should be cognizant that ethnic minority youth may need different supports and resources as they grapple with tensions between cultures.Clinicians, educators and service providers should consider the complexity of how disability interacts with many other factors, such as race, ethnicity, gender and socio-economic status.

Multidisciplinary perspectives and practices of wheelchair prescription for children with neuromuscular conditions

PURPOSE

Clinical practice guidelines for paediatric neuromuscular disorders (NMDs) recommend timely provision of wheelchair equipment. The aim of this qualitative study was to understand healthcare professionals' clinical perspectives and practices when recommending wheelchair equipment for the first time, as well as perceived barriers and enablers to timely wheelchair provision.

METHODS

Twenty-one healthcare professionals (HCPs) from Australia and the United States participated in an interview (response rate: 88%, 16/21 women). Participants were from diverse disciplines, based in hospital or community health settings, and had at least one year of experience working in paediatric neuromuscular care.

RESULTS

Child fatigue, falls and engagement in age-appropriate activity were common reasons for HCP's wheelchair recommendation. HCPs were acutely aware of parents' experiences of grief and loss throughout the wheelchair prescription process, and over half acknowledged the lack of psychological care available to families affected by NMDs. Multi-disciplinary collaboration, psychologically-informed care, and shared decision-making with stakeholders were perceived enablers of wheelchair transition. Barriers included limited access to equipment, lengthy funding processes and lack of funding for home and vehicle modifications.

CONCLUSIONS

Integrated psychosocial care is needed to support families throughout their child's disease progression, including wheelchair transition. Implementation of readiness for change tools, and development of tailored informational resources is recommended. Improved access to equipment options and trials, and more efficient funding processes are highly likely to improve parental engagement throughout the wheelchair prescription process.Implications for rehabilitationHealthcare professionals express a strong demand for integrated psychosocial care within paediatric neuromuscular clinics to support families throughout transitions, including wheelchair introduction.Identifying parents' readiness for change can inform their information and support needs, strengthen their decision-making capacity and facilitate timely wheelchair introduction.Stronger collaboration between hospital- and community-based health professionals working in paediatric neuromuscular care is recommended to facilitate knowledge exchange and support families' transition to wheelchair use.Access to equipment options for extended loan or trial in the community can support timely wheelchair introduction.

'Somali parents feel like they're on the outer': Somali mothers' experiences of parent-teacher relationships for their autistic children

LAY ABSTRACT

Good relationships between parents and schools can improve autistic children's school success. There are many reasons why families from different cultural backgrounds find it harder to develop good relationships with schools, such as language barriers, discrimination and unfamiliarity with education systems. We know little about what 'good relationships' look like for these families. Here, we worked with a team of autistic and non-autistic researchers as well as an Advisory Group of Somali parents to conduct interviews with 15 Somali mothers of kindergarten and school-age autistic children. We asked mothers about their experiences of their child's education, communication with teachers and what a good relationship with schools would look like. We also asked how they felt the Somali community understood autism. We looked for common things that mothers said. We found that mothers were very proud of their children. They had high expectations, particularly about what children could do by themselves. Mothers found it frustrating that teachers had low expectations, that schools were not good at communicating with them and that autism-specific skills and experience were uncommon in schools. They also reported racist attitudes towards their children. Mothers experienced stigma and lacked resources, but support was gained from their daughters and their religion. Mothers themselves were proactively increasing community awareness and knowledge about autism in the hope that they and their autistic children would be valued and better supported. Our work has implications for how teachers and schools can work together with Somali parents to forge better futures for autistic children.

Rates and Correlates of Stigmatization Expressed by Parents of Young Children with Developmental Difficulties in a Middle-Income Country

OBJECTIVE

Information on stigmatization of young children with developmental difficulties (DDs) in low- and middle-income countries (LMICs), where most children reside, is crucial to combat stigma globally. We aimed to identify rates and correlates of stigmatization of young children with DDs in a middle-income country, Turkey.

METHOD

In this cross-sectional study, parents of children aged 0 to 42 months attending Ankara University School of Medicine, Department of Pediatrics, Developmental-Behavioral Pediatrics Division for their first visit were recruited consecutively. Parents responded to the written open-ended stigma questions of the Expanded Guide for Monitoring Child Development. Stepwise logistic regression analysis was used to determine factors associated with stigmatization.

RESULTS

The sample comprised 306 children (60.8% boys) with DDs (72.9% with chronic illness/disability and 27.1% with isolated language delay). Most of the mothers (61.1%) and fathers (60.7%) had less than high school education. Stigmatization was reported by 102 (33.3%) families. Child's sex, age, and health condition were not, but 5 of 9 environmental/contextual factors examined were statistically significantly associated with stigmatization. In the logistic regression model, not receiving support from relatives/friends (odds ratio [OR] = 4.97, 95% confidence interval [CI] = 2.16-11.48) and feelings of depression in the mother were independent factors associated with stigmatization (OR = 2.16, 95% CI = 1.04-4.50).

CONCLUSION

In a referred sample from Turkey and likely other LMICs, a large proportion of parents of young children with DDs report having experienced stigmatization at their first developmental assessment. Interventions that aim to address stigmatization in this early period must focus on support from family/friends and maternal mental health, which are independent strong correlates of stigma.

Perceived Experiences of Korean Immigrant Mothers Raising Children With Disabilities in the United States

INTRODUCTION

The challenges of acculturation that immigrant families experience could intensify if they have a child with a disability. This qualitative descriptive study aimed to describe the experiences of Korean mothers raising children with a disability in the United States.

METHODOLOGY

Semi-structured interviews were conducted based on the Resilience Model of Family Stress, Adjustment, and Adaptation. Directed content analysis was used.

RESULTS

Six Korean mothers participated in the interview and 16 codes were identified in relation to the five concepts of the Resilience Model, namely family demands, family resources, family appraisal, family problem-solving and coping, and family adaptation. Overall, mothers thought their families were well-functioning and viewed their quality of life positively within the context of immigration despite experiencing various family demands.

DISCUSSION

Findings of this study showed the resilience of Korean immigrant mothers and revealed the importance of understanding and considering unique cultural differences when providing care to this population.

Being more than a mother: A qualitative study of Asian immigrant mothers in Australia who have children with disabilities

INTRODUCTION

Studies on mothers of children with disabilities commonly report on their poor quality of life, high stress and mental health symptoms. However, the impact of caring for a child with disability on mother's everyday activities is less understood. The aim of this study is to explore the everyday activities of north-east and south-east Asian (NESEA) migrant mothers of children with disabilities, living in Australia.

METHODS

Informed by a grounded theory approach, this qualitative study used purposive snow-ball sampling to recruit NESEA mothers who had immigrated to Australia for at least two years and had at least one child with disabilities. Eleven mothers were interviewed. Grounded theory analysis was used to derive themes.

RESULTS

The overarching theme is 'Transforming'. Five subthemes emerged: 1) Journeying into the unknown; 2) Being the carer; 3) Being an immigrant; 4) Pillars of support; and 5) Empowered for everyday activities.

CONCLUSION

This study revealed the everyday activities and roles of NESEA immigrant mothers who have children with disabilities, their enablers and barriers in engaging in their valued activities and their positive transformation. Findings underpin the importance of facilitating mothers' participation in activities and roles that promote their well-being. Service providers and policy makers can create opportunities for immigrant mothers to participate in health promoting activities.

Brief Report: Impact of the COVID-19 Pandemic on Asian American Families with Children with Developmental Disabilities

Discrimination against Asians and Asian Americans increased during the COVID-19 pandemic. Yet, even prior to the pandemic, little research explored the experiences of Asian American families of children with autism and other developmental disabilities. This brief report summarizes the results of a survey conducted between May and July 2020, in the immediate aftermath of state and local lockdowns due to the pandemic. Twenty-five Asian American caregivers of children with autism and other developmental disabilities completed the survey and reported on the pandemic's impact on their household. Most of the caregivers were mothers, immigrants, Chinese, raising children with autism, and highly educated. Participants' primary concerns were the disruption of their children's educational and therapeutic services. We discuss research limitations and implications.

Attitudes promoting coping with death anxiety among parents of children with disabilities

We investigated death anxiety among parents of children with disabilities and its associations with coping attitudes and psycho-demographic factors. Surveys were administered to 382 parents of children who possess a severe disability and data were analyzed via descriptive and inferential statistics. Findings revealed that parents experienced high levels of death anxiety; the level of death anxiety changed according to some psycho-demographic factors, such as external support, type of disability, and death-related beliefs; and death anxiety was significantly explained by demographic variables, death-related thoughts, and experiences, and adaptive and maladaptive coping attitudes.

The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens

OBJECTIVE

The United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity.

METHODS

The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps.

RESULTS

The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks.

CONCLUSIONS

Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.

Psychological, sociocultural and economic coping strategies of mothers or female caregivers of children with a disability in Belu district, Indonesia

Caring for children with a disability can cause a range of psychological and socioeconomic challenges for parents and caregivers, such as anxiety, depression, inability to find affordable and appropriate childcare, loss of income and expenses related to disability specific treatment. As part of a study exploring the impacts of childhood disability on mothers or female caregivers and families, and the copy strategies they used, this paper describes strategies employed by mothers or female caregivers to cope with challenges associated with childhood disability within their family in Belu district, Indonesia. A qualitative approach using one-on-one in-depth interviews was used to collect data from participants (n = 22) who were recruited using a combination of purposive and snowball sampling techniques. Interviews were recorded, transcribed verbatim and imported to NVivo 12 for analysis. A qualitative framework analysis was used to guide data analysis. The conceptual framework of coping strategies guided the conceptualisation and discussion of the findings. The findings showed that active psychological coping strategies, including cognitive or acceptance strategies, knowledge of both health condition and socio-academic related development of children with a disability, and family relationship and support, were used by the participants to cope with psychological challenges facing them. Self-reliance and religious/spiritual coping strategies were also utilised. Sociocultural strategies, such as social withdrawal or disengagement, professional support and culture-based support, were used by the participants to cope with social impacts, stigma, and discrimination associated with childhood disability. Participants also reported using financial strategies such as selling of family assets to cope with the economic challenges. The findings indicate the need for programs and interventions that address the needs of mothers and female caregivers and their families, to assist with effectively managing the significant challenges they face when caring for a child with a disability. Further studies are needed, with a larger number of participants and the inclusion of fathers or male caregivers, in order to better understand the broader coping experience of childhood disability impacts within families.

Resilience in Multicultural Families of Children With Disabilities in Korea: A Path Analysis Using National Data

PURPOSE

The number of multicultural families has increased globally, and Korea has also witnessed a surge. Along with the various challenges experienced by these families, a child with a disability can pose additional challenges. In-depth knowledge about resilience factors among multicultural families of children with disabilities is important. The aim of this study was to examine relationships between family demands, family appraisals, family problem solving and coping, family resources, and family adaptation in multicultural families of children with disabilities in Korea as perceived by married immigrants.

DESIGN

This study was based on a secondary analysis of national survey data in 2015 and 2018 in Korea.

METHODS

A total of 256 multicultural families who have children with disabilities participated. Family demands were identified by examining marital conflict, cultural differences, marital status, and public assistance recipient households. Family appraisal was assessed by how the family perceived the married immigrant's culture. Family problem solving and coping were examined by how actively a married immigrant participated in social activities. Family resources were assessed by examining Korean language competency and the health status of immigrants. Family adaptation was identified by how immigrants perceived their life satisfaction. Path analysis was used to assess the factors.

FINDINGS

Family demands had a direct impact on family resources and family adaptation. Family appraisal had a direct impact on family adaptation. Family resources mediated the effect of family demands on family adaptation.

CONCLUSIONS

This study demonstrated that although a multicultural family of a child with a disability struggles with family demands, if the family receives positive resources from family members, they can adapt well. Current findings can be used to develop interventions that can foster greater resilience among families.

CLINICAL RELEVANCE

This study provides evidence that nurses can target modifiable family aspects, including immigrants' health and family perceptions of immigrants' cultures identified in this study to enhance the immigrant and family adaptation.

Family Variables and Quality of Life in Children with Down Syndrome: A Scoping Review

The purpose of this scoping review was to identify the family and child quality of life variables that have been studied in relation to one another in children with Down syndrome, the frequency with which different relationships have been studied, and the extent to which family variables were the focus of the research aims. A literature search was conducted to find studies published between January 2007 and June 2018. The initial search yielded 2314 studies; of these, 43 were selected for a final review. Researchers most often addressed family resources and family problem-solving and coping concerning child personal development and physical well-being. Little attention to child emotional well-being was observed, with none considering family appraisal of child emotional well-being. The relationship between family variables and child QoL rarely was the primary focus of the study. Methodologically, most reviewed studies used cross-sectional designs, were conducted in North America and based on maternal report. From future research considering the issues found in this review, healthcare providers can obtain an in-depth understanding of relationships between children and family variables.