Grandma's hands: parental perceptions of the importance of grandparents as secondary caregivers in families of children with disabilities

Grandparental support and maternal depression: Do grandparents' characteristics matter more for separating mothers?

Grandparental support may protect mothers from depression, particularly mothers who separate and enter single parenthood. Using longitudinal Finnish register data on 116,917 separating and 371,703 non-separating mothers with young children, we examined differences in mothers' antidepressant purchases by grandparental characteristics related to provision of support. Grandparents' younger age (<70 years), employment, and lack of severe health problems predicted a lower probability of maternal depression. Depression was also less common if grandparents lived close to the mother and if the maternal grandparents' union was intact. Differences in maternal depression by grandparental characteristics were larger among separating than among non-separating mothers, particularly during the years before separation. Overall, maternal grandmothers' characteristics appeared to matter most, while the role of paternal grandparents was smaller. The findings suggest that grandparental characteristics associated with increased potential for providing support and decreased need of receiving support predict a lower likelihood of maternal depression, particularly among separating mothers.

Perceived Impact, Needs, and Resources of Grandparents of Children and Adolescents on the Autism Spectrum: A Qualitative Study

Grandparents play different roles in families of children and adolescents on the autism spectrum. They are frequently engaged in caregiving tasks with the person on the autism spectrum, providing emotional and instrumental support to the family. However, despite their frequent involvement and the importance of their role in the family, there are few studies that address the experiences of these grandparents, particularly in the Spanish and southern Europe context. This study explores the impact and needs of having a grandchild on the autism spectrum and the resources that grandparents have and use to face the difficulties that arise. A semi-structured interview was carried out with 17 grandparents of children and adolescents on the autism spectrum. We conducted a coding reliability thematic analysis of the impact and used a quantitative content analysis of grandparents' needs and resources. Results indicated three main aspects related to the impact: personal growth, wanting to help and not being able to, and suffering at three levels: for themselves, their sons and daughters, and grandchildren. Grandparents perceived needs in four contexts: their own needs, the needs of the nuclear family, the needs of the person on the autism spectrum, and the needs of society. The most frequent needs were informational and management of behavioral difficulties. In the resources, the most frequently used strategies were religious beliefs and informal support seeking. It is essential to address the quality of parents-grandparents' relationships, and include grandparents in intervention programmes, as a way of addressing grandparents' needs.

Attitudes toward Grandparental Involvement in Hong Kong: A Trend Analysis

This article examines individuals' attitudes toward the involvement of grandparents in family issues in Hong Kong. While existing studies have largely focused on the nature and types of grandparents' involvement in childcare, it is worth conducting a quantitative investigation of the attitudes in the general population about grandparental involvement. Drawing on the 2011, 2013, 2015, and 2017 waves of the Family Surveys, the study examined the trend in attitudes toward grandparental involvement with 8932 HK residents. Multivariate linear regression analyses were performed to assess individual and family relationship factors associated with the attitudes toward grandparental involvement. Results show that although most people held positive attitudes toward grandparental involvement, there was a significant drop in the agreement with grandparental involvement in 2017 across all age groups. The findings imply that intergenerational support tends to be weakened in HK in recent years. Involving grandparents in family issues in HK was more likely to be need-driven rather than value-driven, as parent respondents had relatively more positive attitudes toward grandparental involvement compared with non-parents. Positive family and intergenerational relationships were significantly associated with the positive attitudes toward grandparental involvement. Policymakers and service providers should recognize the changes in people's attitudes toward family lives and provide appropriate support such as family counselling, (grand)parenting programs and childcare support to promote the wellbeing of families and older adults.

The effects of living and learning conditions on the health-related quality of life of children and adolescents during the COVID-19 lockdown in the French Grand Est region

INTRODUCTION

COVID-19 lockdown measures resulted in children and adolescents staying and learning at home. This study investigated health-related quality of life (HRQoL) and its associated factors among youth during the first lockdown.

METHODS

A cross-sectional study was conducted among 8- to 18-year-olds from the French Grand Est region. Sociodemographic data and information on living and learning conditions were collected using an online survey. HRQoL was assessed using the KIDSCREEN-27. Multiple regression analysis was performed to explore factors related to low HRQoL in each dimension.

RESULTS

In total, 471 children from 341 households were included. Difficulties isolating at home were associated with low HRQoL in the psychological well-being (OR = 2.2, 95% CI: 1.2-4.0) and parent relations and autonomy (OR = 2.1, 95% CI: 1.2-3.8) dimensions. Conflicts with dwelling occupants were related to increased ORs in the psychological well-being (OR = 2.9, 95% CI: 1.9-4.6), parent relations and autonomy (OR = 2.2, 95% CI: 1.4-3.4) and school environment (OR = 2.4, 95% CI: 1.5-3.7) dimensions. Living in an apartment (OR = 1.8, 95% CI: 1.1-3.1), never leaving home (OR = 2.6, 95% CI: 1.2-5.9), having indoor noise at home (OR = 2.3, 95% CI: 1.2-4.6), and having a parent with high anxiety (OR = 1.8, 95% CI: 1.1-3.1) were associated with low HRQoL in the social support and peers dimension. Children working less than 1 h/day on schoolwork had an increased OR of 3.5 (95% CI: 1.4-9.0) in the school environment dimension.

CONCLUSION

Living and learning conditions were associated with low HRQoL among children and adolescents during the COVID-19 lockdown. Prevention and intervention programs are needed to support youth by facilitating their interactions and improving their coping and to prepare for future waves.

Health-Related Quality of Life and Related Factors among Primary Caregivers of Children with Disabilities in Shanghai, China: A Cross-Sectional Study

Health-related quality of life (HRQOL) of caregivers of children with disabilities (CWD) is important for both children's rehabilitation and caregivers' life, but the corresponding attention is far from enough in mainland China. Thus, we investigated the HRQOL of 170 caregivers and related factors in Shanghai. The 12-item Short Form Health Survey (SF-12) was used to measure HRQOL. The potential factors were collected, including child characteristics, caregiver characteristics, and environmental factors. Univariate analysis and multiple linear regression were performed to identify the key factors that could be intervened. Compared with the general population, caregivers of CWD had a slightly higher score on the physical component summary (PCS, 52.57 ± 8.41), but the score of mental component summary (MCS, 31.58 ± 7.72) was extremely low. Caregiver's illness condition, family size, and household income were significant factors of physical HRQOL. Caregivers with illness and caregivers living in an extended family were associated with higher mental HRQOL. Whereas these two factors had opposite effects on physical HRQOL. This finding indicated poor mental HRQOL among caregivers of CWD in Shanghai and thus requiring urgent attention and intervention. Improving physical fitness, maintaining family integration, and providing financial support should be considered when developing intervention for this population.

Grandparent support of mothers caring for a child with a disability: Impacts for maternal mental health

BACKGROUND AND AIMS

Mothers who are primary carers of children with disabilities experience more mental health problems than mothers of typically developing children. We aimed to update and extend research into mothers' perceptions of grandparent support with care, and impacts for maternal psychological well-being, because although contemporary grandparents live longer they also work longer.

METHODS

Surveys were completed by 72 mothers of clients (aged ≤8 years) of an Australian non-government disability agency. Mothers reported levels of practical and emotional support, face-to-face contact, and affectional solidarity with maternal and paternal grandparents. The Kessler Psychological Distress Scale (K10) was the dependent variable.

RESULTS

Mothers indicated high to very high levels of psychological distress. As in previous comparable surveys, most support was offered by maternal grandmothers who had more contact and closest relationships with mothers. Maternal distress was related to maternal grandmothers' health and relationships with maternal grandfathers. Face-to-face contact and closeness of relationships were strongly linked to provision of support.

CONCLUSIONS AND IMPLICATIONS

Grandparents are important supports for mothers of children with disabilities: mothers lacking support from their own parents are particularly vulnerable. Clinicians should actively facilitate grandparent involvement, and promote extended family relationships.

Panamanian Grandmothers' Family Relationships and Adjustment to Having a Grandchild with a Disability

The purpose of this article was to explore the family relationships and role adjustment of grandmothers in the Republic of Panama who have a grandchild with special needs. Thirty Panamanian grandmothers of children with a disability were interviewed using a standardized format and non-directive probing. Categories of analysis were established only after the data was fully collected and reviewed. The results indicate that for most Panamanian grandmothers, their changes in family relationships are not dramatic when they have a grandchild with a disability; however, 25% clearly report a deteriorated relationship with their son-in-laws. They view their relationship with their grandchild with a disability to be one that provides a mixture of affection, love, acceptance and patience. In the area of role adjustment, they see a need to become more involved in areas that include assisting their grandchildren and/or her family with caregiving and household responsibilities, economic and medical support, or in areas related to school/academic, spiritual or recreational activities. With respect to emotional adjustment, Panamanian grandmothers of children with disabilities distinguish themselves from grandmothers in the United States, by experiencing reduced emotional stress and dwelling less on personal loss, grief, or role stigma. The implications are that there appear to be universal beliefs and adjustment factors that Panamanian grandmothers of grandchildren with disabilities experience. However, culture appears to have a genuine influence that results in subtle but unique differences from their U.S. counterparts.

Grandparent Education Through Simulation-Diabetes

Purpose

The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM.

Methods

Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention.

Findings

This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement.

Conclusions

The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.

Social work and adverse childhood experiences research: implications for practice and health policy

Medical research on "adverse childhood experiences" (ACEs) reveals a compelling relationship between the extent of childhood adversity, adult health risk behaviors, and principal causes of death in the United States. This article provides a selective review of the ACE Study and related social science research to describe how effective social work practice that prevents ACEs and mobilizes resilience and recovery from childhood adversity could support the achievement of national health policy goals. This article applies a biopsychosocial perspective, with an emphasis on mind-body coping processes to demonstrate that social work responses to adverse childhood experiences may contribute to improvement in overall health. Consistent with this framework, the article sets forth prevention and intervention response strategies with individuals, families, communities, and the larger society. Economic research on human capital development is reviewed that suggests significant cost savings may result from effective implementation of these strategies.

Children on the autism spectrum: grandmother involvement and family functioning

BACKGROUND

This study investigated associations between the presence of a child with autism or Asperger's disorder in the family, family functioning and grandmother experiences with the goal of better understanding grandparent involvement in the lives of grandchildren on the autism spectrum and their families.

METHODS

Mothers and grandmothers of children who were either typically developing or on the autism spectrum completed parallel forms of a grandparent involvement measure. Mothers reported on the functioning of the immediate family. Data were analysed via multilevel modelling with mother-grandmother dyads as the unit of observation.

RESULTS

Autism spectrum disorders in children were associated with more flexible family functioning, lower levels of family satisfaction, greater grandmother difficulties and more grandmother information needs.

CONCLUSIONS

Participation of grandparents in diagnostic and treatment meetings and increased communication among family members may facilitate grandparent support and involvement in families with a child on the autism spectrum.

Les grands-parents : une source de soutien pour les parents d’enfants ayant une déficience

Les parents d’enfants ayant une déficience sont confrontés à plusieurs sources de stress et font face à plus d’obligations. Cet article présente une recension des écrits de 1985 à 2009 sur le soutien des grands-parents à ces parents. Cette revue révèle que différents éléments influencent la qualité de ce soutien : l’âge des grands-parents, leur état de santé, la proximité géographique, la communication, la proximité affective, les relations intergénérationnelles, leur attitude et leur implication. Cette recension soulève aussi la nécessité de poursuivre les études sur l’aide à donner aux grands-parents afin de faciliter leur rôle dans l’adaptation de la famille.

Parenthood, Childlessness, and Well-Being: A Life Course Perspective

This article reviews recent research (1999 - 2009) on the effects of parenthood on wellbeing. We use a life course framework to consider how parenting and childlessness influence well-being throughout the adult life course. We place particular emphasis on social contexts and how the impact of parenthood on well-being depends on marital status, gender, race/ethnicity, and socioeconomic status. We also consider how recent demographic shifts lead to new family arrangements that have implications for parenthood and well-being. These include stepparenting, parenting of grandchildren, and childlessness across the life course.

Intergenerational family support following infant death

The death of a child is a traumatic, nonnormative family life event. Although parental bereavement has received substantial attention, little research has focused on extended family members affected by a child's death, and still less on how multiple family members perceive and respond to one another following the loss. Guided by a life course perspective, this article examines social support between grandparents and their adult children in the aftermath of infant death. Through structured, open-ended interviews, 21 grandparents and 19 parents from 10 families described how they provided support to and received support from their intergenerational partners. Data were analyzed using a grounded theory approach. Six categories of support were identified: being present, acknowledgment, performing immediate tasks, information, unskilled support, and no support. Most support was provided by grandparents to adult children rather than from adult children to grandparents. All families reported significant support from at least one grandparent and nearly all families described ambivalent relationships that complicated support. Gender, family lineage, and family history were major influences. Multiple family perspectives about a significant life event contribute to our understanding about the intersection between individual and family life.

Support behind the scenes: attitudes and practice of pediatricians and nurses with grandparents of sick children

A total of 93 nurses and 52 pediatricians completed a quantitative and qualitative questionnaire tapping their perceptions of the functional aspects of grandparents' support to parents, the benefits and costs of this support, and their professional interactions with grandparents during the child's sickness. Results show that although healthcare professionals acknowledge the significant and stable role that grandparents can play, they rarely translate this into actual practice. Also, despite their emphasis on the importance of emotional support, they believed the actual support provided by the grandparents to be mainly instrumental, followed by emotional and financial support, and information and advice. The findings present a challenge to professionals and policy makers to adopt an approach of family-centered care that includes the grandparents, an important family resource that has been largely ignored.

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.

Families' needs when a child is long-term ill: A literature review with reference to nursing research

This article reports a literature review which draws together findings targeting families' needs when a child is long-term ill. The databases PubMed and CINHAL were searched from 1999 to 2003 during February 2004. The search terms were child health care, family caregivers, and needs and combinations of these. The search was limited to articles published in English and the Scandinavian languages. The analysis entailed a series of comparisons across articles focusing on major areas of inquiry and patterns of results. Various levels of needs are described, based on individual, family and social needs.

A life enriching togetherness ? meanings of informal support when being a parent of a child with disability

The majority of children affected by disability are cared for at home by their parents. It is well documented in research literature that the parents are in need of professional support. In the striving to improve the professional caring, it is also important to deepen our understanding about the meaning of informal support from the perspective of parents' life world. The aim of this study was to illuminate the meanings of lived experience of informal support, when being a parent of a child affected by disability. Thirteen parents, eight mothers and five fathers within eight families, participated in narrative interviews, which were analysed by using a phenomenological-hermeneutic method. The meanings resulted in three themes: 'being gratified by experiences of the child as having a natural place in relation with others', 'being provided a room for sorrow and joy' and 'being enabled to live an eased and spontaneous daily life'. These themes emanated from the experiences of other persons' being and doing in relation to the parents, the child affected by disability and the siblings. According to our interpretation, informal support means a life enriching togetherness, the core of which is natural human caring. The findings also showed that parents highly valued professional support concerning informal supporters.

“We’re tired, not sad”: Benefits and burdens of mothering a child with a disability

Caregiver burden has received considerable emphasis in the literature on the social experience of mothering children with disabilities. Little attention has been paid, however, to either the nature of the burdens perceived or to maternal ability to see beyond the burdens to the benefits of their caregiving role. This study utilizes a mixed methods approach to examine these neglected aspects of the social experience of mothering children with disabilities. Findings of a survey of 81 mothers of children with disabilities in Florida, USA and follow-up interviews with 7 of these mothers indicate that: 1. For most of the mothers included in the study, "the burden of care" is a matter of socio-structural constraints (Objective Burden) rather than emotional distress (Subjective Burden); 2. Despite the socio-structural constraints associated with caring for a child with complex needs, most mothers perceive valuable benefits in having a child with a disability; and 3. Perceived Stigma has an important positive impact on both dimensions of burden and, through its impact on Subjective Burden, can decrease the perceived benefits of caring for a child with a disability.

Families in a state of flux: the experience of grandparents in autism spectrum disorder

BACKGROUND

The experience of being a grandparent of a grandchild with autism spectrum disorder (ASD) is a previously under-researched area. This study sets out to examine the grandparents' own perspective in an exploratory way using a qualitative approach to answer the question, 'What is the experience like?'

METHOD

A qualitative research project, using a purposive sampling technique and semi-structured interviews to examine the experiences of six grandparents of children with ASD diagnosed by a specialist team in a second opinion Tier 4 Child and Adolescent Mental Health Service.

RESULTS

The experiences of the grandparents were characterized by three Key Themes which emerged from the interviews: (1) The Parental Bond (protective bonding towards grandchild and adult child); (2) Striving for Answers (searching for meaning); (3) Keeping Intact (holding the family together).

CONCLUSION

The study suggests some interesting insights and confirms the need for more attention to this area. A key question raised by the study is how a child-focused multidisciplinary team can embrace its role in delivering a family-centred service. The clinical implications of this project have led to a change of practice in the specialist team. Further research would be appropriate to investigate the therapeutic effectiveness and cost effectiveness of involving grandparents as part of the assessment process.

The impact of stigma on maternal attitudes toward placement of children with disabilities in residential care facilities

This study examines willingness to consider placement of children with disabilities in residential care facilities among 81 mothers of children with disabilities. Perceived stigma is added to the Andersen and Newman model of health service utilization in order to evaluate its impact on placement attitudes controlling for predisposing, enabling and need characteristics and health beliefs. Findings of regression analyses suggest that older, single mothers of more severely disabled children are more likely than other mothers to consider residential placement and that adequate finances and residential stability may reduce this willingness. When these variables are controlled, the expectation that people with disabilities will be stigmatized by others in the community increases willingness to consider placement and does so by increasing the degree of caregiver burden experienced. Results also suggest, however, that among mothers of young children, specific aspects of perceived stigma have direct affects on willingness to consider placement even when perceived burden is controlled.

"What do you mean 'what's wrong with her?'": stigma and the lives of families of children with disabilities

This study extends the application of modified labeling theory to the experience of courtesy stigma in families of children with disabilities. The study utilizes a mixed methods approach that integrates quantitative analysis of survey data, qualitative analysis of interactive interviews and personal narrative. A survey of 81 mothers of children with disabilities in Florida, USA, is used to test hypotheses related to the impact of perceived stigma on emotional and social outcomes for mothers and children. The author's experience as the mother of a child with cerebral palsy and interactive interviews with seven other mothers with similar experiences are used to contextualize, humanize and help interpret the quantitative findings. Results indicate that controlling for the effects of salient maternal and child characteristics and the daily hassles of caring for a child with a disability (objective burden), maternal perceptions that individuals with disabilities are devalued and discriminated against (stigmatized) by others increases maternal distress (subjective burden). Findings also indicate that children of mothers who perceive high levels of stigma interact less frequently with age peers in the informal settings of homes and neighborhoods.