Psychological variables as correlates of adjustment in mothers of children with intellectual disabilities: cross-sectional and longitudinal relationships

Background Existing research studies suggest that parenting a child with intellectual disabilities (ID) can be a stressful experience. However, there are few data addressing the question of how or why parents might experience considerable distress. In the present study, psychological variables (acceptance, mindfulness, avoidant coping) are explored that may explain some variance in maternal distress. Method Questionnaire data were gathered from mothers of children attending special schools at two time points, 18 months apart (n = 91 at Time 1; n = 57 at Time 2). In addition to measures of the child's functioning, the questionnaire pack included: a measure of acceptance of unwanted thoughts/feelings; a measure of attention to the present (mindfulness); a measure of active avoidance coping; measures of maternal anxiety, depression and stress; and a measure of mothers' positive perceptions of their child. Results In cross‐sectional analysis, acceptance was negatively associated with maternal anxiety, depression and stress, such that mothers who were generally more accepting reported fewer psychological adjustment problems. Longitudinal analysis showed that acceptance is bidirectionally related to anxiety and depression. Mindfulness was not significantly related to maternal distress, and avoidance coping was positively cross‐sectionally associated with depression only. There were no associations between psychological variables and maternal positive perceptions. Conclusions These data suggest that acceptance, in particular, may be a construct that explains some variance in maternal distress. Further research could focus on the utility of acceptance‐based interventions (e.g. Acceptance and Commitment Therapy) in the support of families with a child with ID.     

The role of coping strategies in predicting change in parenting efficacy and depressive symptoms among mothers of adolescents with developmental disabilities

Background Parents of children with developmental disabilities (DD) face greater caregiving demands than parents of children without DD. There is considerable variability in parents' adjustment to raising a child with DD, however. In line with a strengths‐based approach, this study explores coping strategies as potential mechanisms of resilience among mothers of adolescents with DD. This study examines the frequency with which mothers use various coping strategies and the extent to which those strategies moderate the relationship between adolescent behaviour problems and aspects of maternal well‐being. Both positive and negative dimensions of well‐being are explored, with maternal depressive symptoms and perceived parenting efficacy examined as outcomes cross‐sectionally and longitudinally. Methods The present study focuses on 92 mothers and their adolescents with DD. The adolescents had a wide range of diagnoses, all with continuing special needs. Data were collected from mothers through interviews and self‐administered questionnaires when their adolescents were aged 15 and aged 18. A structured assessment of the adolescent was completed during home visits at age 15. Results Mothers reported frequently using strategies of denial and planning but rarely using strategies of mental and behavioural disengagement to cope with recent stressful situations. Adolescent behaviour problems were found to contribute to greater symptoms of depression and lower feelings of parenting efficacy as well as increases in depressive symptoms over time. Mothers of sons, but not daughters, reported increases in parenting efficacy across their child's adolescent period. Above and beyond adolescent factors, several coping strategies emerged as significant predictors of mothers' symptoms of depression and perceived parenting efficacy. Moreover, use of Active Coping/Planning, Positive Reinterpretation/Growth, and Behavioural/Mental Disengagement as coping strategies moderated the impact of adolescent behaviour problems on maternal depressive symptoms. Conclusions This study extends previous findings by focusing on both positive and negative dimensions of parent well‐being during their child's adolescent period. Adolescence can be a stressful time for parents, with typical developmental tasks entailing additional strains for parents of adolescents with DD. The present findings point to several coping strategies that may reduce the impact of challenging behaviours during this period on mothers' symptoms of depression and feelings of parenting efficacy. Certain coping strategies were found to exert a greater impact on maternal well‐being for parents of adolescents with higher levels of behaviour problems, suggesting that interventions may benefit from an increased focus on this group of mothers with heightened caregiving demands.     

The effects of coping style,social support,and behavioral problems on the well-being of mothers of children with Autism Spectrum Disorders in Lebanon

The present study examined the effects of coping styles, social support, and child's behavioral symptoms on the well-being of 65 mothers of children with Autism Spectrum Disorders (ASD) in Lebanon. Comparisons to the well-being of 98 mothers of typically developing children were also drawn. Regression analyses showed that disengagement and distraction coping predicted poor well-being, whereas cognitive reframing showed a correlation with better well-being levels. A significant correlation was found between child's behavioral problems and maternal well-being. T-test analyses revealed that mothers of children with ASD differed in terms of coping styles used. Additionally, mothers of children with ASD showed lower levels of perceived social support. Well-being was significantly better for mothers of typically developing children. Study limitations and implications are discussed.     

Fathers' and mothers' perceptions of their child and maternal depressive symptoms

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/ emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8–9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.     

Paternal versus maternal coping styles with child diagnosis of developmental delay

Parents of children with disabilities vary in their reaction to their children's diagnosis. The current study focused on fathers in addition to mothers and examined their resolution and coping styles when having children diagnosed with developmental delay (DD). Sixty-five fathers and 71 mothers were interviewed using the reaction to the diagnosis interview (RDI; Pianta & Marvin, 1992a). Results indicated that the majority of parents were unresolved with their child's diagnosis, with no differences found between fathers’ and mothers’ rates of resolution. Furthermore, both parents of children that were diagnosed at a later age and parents that were less educated tended to be unresolved, as did fathers of a lower socioeconomic status. Older age of both children and mothers was related to maternal lack of resolution. Finally, an in-depth examination revealed significant differences in the manner in which fathers and mothers cope with their children's diagnosis: whereas mothers were more prone to using an emotional coping style, fathers tended to use a cognitive coping style. The clinical implications of paternal versus maternal coping styles are discussed.     

Parenting stress in mothers of children with an intellectual disability: the effects of parental cognitions in relation to child characteristics and family support

Background Recent theories of stress and coping in parents of children with intellectual disabilities (ID) emphasize the importance of cognitive appraisals in influencing parents’ levels of stress and their adaptations to difficulties presented by the children. This study investigated the relationships between parental cognitions, child characteristics, family support and parenting stress. The aspects of cognitions studied were: parenting self-esteem (including efficacy and satisfaction) and parental locus of control. Methods The group studied consisted of 46 mothers of children with ID. The Vineland Adaptive Behavior Scales and Maladaptive Behavior Domain were administered by interview. Mothers also completed four questionnaires: the Family Support Scale, the Parenting Sense of Competence Scale, a shortened form of the Parental Locus of Control Scale and the Parenting Stress Index (Short Form). Results Data were analysed using Pearson's correlation coefficients, partial correlations and a regression analysis. The results indicated that most of the variance in parenting stress was explained by parental locus of control, parenting satisfaction and child behaviour difficulties. Whilst there was also a strong correlation between family support and parenting stress, this was mediated by parental locus of control. Conclusions The results demonstrate the potential importance of parental cognitions in influencing parental stress levels. It is argued that these results have implications for clinical interventions for promoting parents’ coping strategies in managing children with ID and behavioural difficulties.     

Parenting stress in Chinese mothers of children with autism spectrum disorders

Objective

Elevated parenting stress has been observed among mothers of children with autism spectrum disorders (ASDs) in western countries, but little is known about mothers of Han Chinese children. The aim of the current study was to further the knowledge about stress experienced by Chinese mothers of children with ASD by examining maternal parenting stress in Heilongjiang province of China.

Methods

In this cross-sectional study, data about participants’ demographic characteristics, parenting stress, anxiety, depression, child’s behavioral problems, coping strategies, and social support were collected though a questionnaire survey. The participants included 150 families with ASD children, who were consecutively admitted to the clinics of the Children Development and Behavior Research Center in Harbin Medical University, Heilongjiang Disabled Persons Federation, and Mudanjiang Child Welfare Home.

Results

The participants reported elevated parenting stress. Mothers’ parenting stress was associated with levels of depression and anxiety, and child’s behavioral symptoms. Child’s behavioral symptoms, maternal anxiety, maternal depressive symptoms, and lack of governmental financial support were associated with overall parenting stress.

Conclusions

Government support may play an important role in reducing parenting stress in this population.     

Parenting stress,salivary biomarkers,and ambulatory blood pressure in mothers of children with Autism Spectrum Disorders

Parenting a child with an Autism Spectrum Disorder (ASD) is often associated with high levels of stress. This in turn can undermine the success of early intervention, and lead to poorer health outcomes for parents. The present study investigated the effects of parenting a child with an ASD on self-reported parenting stress, salivary biomarkers, and 24-h ambulatory blood pressure. Seventy-four mothers of 2–14 year olds with an ASD diagnosis completed a questionnaire booklet, which contained measures of parenting stress, and parent and child characteristics. Mothers wore an ambulatory blood pressure monitor, which collected systolic and diastolic blood pressure and heart rate over a 24-h period. Saliva samples were collected for the purpose of measuring cortisol and alpha-amylase levels. High levels of parenting stress and anxiety, and moderately high levels of depression were reported. Mothers were found to have low cortisol levels, suggesting dysregulation of the HPA-axis and cortisol profile. Hierarchical multiple regression analyses revealed that quantity of unmet service needs, sleep problems, socialisation deficits, adaptive behaviour, and the coping strategies of self-blame and behavioural disengagement predicted maternal outcomes. Findings are discussed in relation to their implications for supporting parents of children with ASD.     

Relationship between characteristic behaviors of children with AD/HD and mothers' parenting styles

Previous studies have revealed that mothers of children with attention-deficit/hyperactivity disorder (AD/HD) have an authoritarian parenting style. However, the psychological process of developing an authoritarian parenting style has yet to be clearly defined. To clarify this psychological process, the present study examined the hypothesis that the characteristic behaviors of children with AD/HD initially increase the mothers' parenting stress, which influences their parenting style. Thirty-six mothers of children with AD/HD (children's mean age: 8.1 years) and the same number of controls (children's mean age: 8.4 years) participated in the present study. The mothers' parenting stress was assessed using the Japanese Parenting Stress Index. Parenting styles were assessed using the TK-style scale for evaluating the relationships between parents and children. The results indicated that the mothers of children with AD/HD had significantly higher scores than controls for all parenting stress items and negative parenting style variables (dissatisfaction, reproach, strictness, interference, inconsistency and disagreement of 10 attitudes). Stepwise multiple regression analysis revealed that the characteristic behaviors of children with AD/HD were associated with the degree of attachment in mothers, which was related to the strict and reproachful parenting style in the AD/HD group. These results suggest that mothers of children with AD/HD are likely to have a strict and reproachful parenting style as a result of a lack of attachment with the child.     

Parenting stress and coping styles in mothers and fathers of pre‐school children with autism and Down syndrome

Background The study examined the profile of stress in mothers and fathers of preschool children with autism, Down syndrome and typically developing children. A further aim was to assess the association between parenting stress and coping style. Methods A total of 162 parents were examined using Holroyd's 66‐item short form of Questionnaire of Resources and Stress for Families with Chronically Ill or Handicapped Members and the Coping Inventory for Stressful Situations by Endler and Parker. Results and Conclusions The results indicated a higher level of stress in parents of children with autism. Additionally, an interaction effect was revealed between child diagnostic group and parent's gender for two scales of parenting stress: dependency and management and limits of family opportunities. Mothers of children with autism scored higher than fathers in parental stress; no such differences were found in the group of parents of children with Down syndrome and typically developing children. It was also found that parents of children with autism differed from parents of typically developing children in social diversion coping. Emotion‐oriented coping was the predictor for parental stress in the samples of parents of children with autism and Down syndrome, and task‐oriented coping was the predictor of parental stress in the sample of parents of typically developing children. The results strongly supported earlier findings on parenting stress in parents of children with autism. They also shed interesting light on the relationship between coping styles and parental stress.     

Dissecting maternal care: Patterns of maternal parenting in a prospective cohort study

Parental care has a strong impact on neurodevelopment and mental health in the offspring. Although numerous animal studies have revealed that the parental brain is a highly complex system involving many brain structures and neuroendocrine systems, human maternal parenting as a multidimensional construct with cognitive, emotional, and behavioural components has not been characterised comprehensively. This unique multi‐method analysis aimed to examine patterns of self‐reported and observed parenting from 6 to 60 months postpartum in a cohort of 496 mothers (mean maternal age = 32 years). Self‐report questionnaires assessed motivational components of mothering, parenting stress, parenting‐related mood, maternal investment, maternal parenting style, mother‐child relationship satisfaction, and mother‐child bonding at multiple time points. Observed parenting variables included the Ainsworth Sensitivity Scales at 6 and 18 months, the Behavioral Evaluation Strategies Taxonomies at 6 months, an Etch‐A‐Sketch cooperation task at 48 months, and the Parent‐Child Early Relationship Assessment at 60 months. To examine whether different latent constructs underlie these measures of maternal parenting, we conducted an exploratory factor analysis. Self‐report measures of parenting correlated only weakly with behavioural observations. Factor analysis on a subsample (n = 197) revealed four latent factors that each explained from 7% to 11% of the variance in the data (32% total variance explained). Based on the loadings of the instruments, the factors were interpreted as: Supportive Parenting, Self‐Enjoyment Parenting, Overwhelmed Parenting, and Affectionate Parenting. These factor scores showed specific associations with maternal education and depressive symptoms, as well as with child outcomes, including maternally reported internalising and externalising behavioural problems, school readiness, and child‐reported symptoms of mental health. These findings parallel the complexity of the parental brain, suggesting that maternal parenting consists of multiple components, each of which is associated with different maternal characteristics and child outcomes.     

Resilience and the course of daily parenting stress in families of young children with intellectual disabilities

Background Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses. Methods Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36–60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well‐being of each parent, marital adjustment and positive parent–child relationships. Results Mothers' daily parenting stress significantly increased over time, while fathers' daily parenting stress remained more constant. Decreases in mothers' daily parenting stress trajectory were associated with both mother and father's well‐being and perceived marital adjustment, as well as a positive father–child relationship. However, decreases in fathers' daily parenting stress trajectory were only affected by mother's well‐being and both parents' perceived marital adjustment. Conclusions Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high‐quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others' more resilient adaptations in ways that have not been previously considered.     

Applied behaviour analysis: does intervention intensity relate to family stressors and maternal well‐being?

Background Interventions based on applied behaviour analysis (ABA) are commonly recommended for children with an autism spectrum disorder (ASD); however, few studies address how this intervention model impacts families. The intense requirements that ABA programmes place on children and families are often cited as a critique of the programme, although little evidence is available to support this claim. Using Pearlin's (1999) stress process model, this study assessed: (1) whether mothers of children participating in a home‐based ABA programme reported elevated depressive symptoms; and (2) whether ABA intensity related to unmet family needs and maternal feelings of depression, personal strain and mastery. Method Forty‐one mothers of children diagnosed with an ASD participated in this study by completing questionnaires about their child's ASD behaviours, unmet family needs, and maternal feelings of depression, personal strain and mastery. Additionally, mothers provided information about their child's intervention programme and their own level of involvement in the programme. At the time of data collection, all families had been running a home‐based ABA programme for at least 6 months. Results Single‐sample t‐tests and multiple regression analyses were used to test the proposed hypotheses. Mothers of children participating in a home‐based ABA programme reported more depressive symptoms than mothers of children with other developmental disabilities. Comparisons revealed comparable depressive symptoms between the mothers of the present sample and those in other ASD samples. When considering weekly ABA intensity, mothers reported fewer depressive symptoms when their child was older and when their child participated in more ABA therapy hours. Conversely, mothers who were more involved in their child's ABA programme reported more personal strain. Conclusions The findings of this study supported the hypothesis that families participating in ABA experienced elevated depressive symptoms, much like any family raising a child with an ASD, suggesting a potential area for family‐level intervention. Additionally, ABA intensity related to maternal depression and personal strain, and therefore deserves continued attention. Future studies should attempt to replicate these findings with a larger and more representative sample and seek to identify mechanisms through which ABA intensity may influence maternal and family well‐being.     

Coping,distress, and well-being in mothers of children with autism

As is the case in stress research generally, studies examining the relationship between coping and mental health outcomes in parents of children with autism frequently classify parental coping methods as being either problem- or emotion-focused. We argue that this dichotomization of coping strategies oversimplifies the way parents respond to their child's autism. In the present study, the coping methods employed by 113 mothers of children with autism were investigated using the Brief COPE (Carver et al., 1989). Exploratory factor analysis of Brief COPE subscales identified four reliable coping dimensions: engagement coping, distraction coping, disengagement coping, and cognitive reframing coping. In addition, using multiple regression, we examined the relationship of coping strategies to negative and positive maternal outcomes (depression, anger, and well-being). In general, maternal use of avoidant coping (distraction and disengagement) was found to be associated with increased levels of maternal depression and anger, while use of cognitive reframing was associated with higher levels of maternal well-being. In several instances, child characteristics, particularly severity of child maladaptive behavior, moderated the effect of coping on maternal outcomes. Study findings are discussed in light of previous research in the area; in addition, study limitations and clinical implications are highlighted.     

A comparison of parenting stress between mothers of children with spina bifida and able-bodied controls

Objectives: To compare parenting stress between mothers of children with spina bifida (SB) and able bodied controls.

Methods: Sixty-six mothers of children with SB and controls (matched for age, sex and ethnicity) completed the Parenting Stress Index Short Form (PSI/SF) and General Health Questionnaire-12 (GHQ-12). Each child's adaptive skills was assessed using the Vineland Adaptive Behaviour Scales (VABS).

Results: Mothers of children with SB had significantly higher scores for GHQ-12 and the Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI) and Difficult Child (DC) sub-scales of the PSI/SF, even after adjusting for socioeconomic and caregiver status. Single parent status, having a child with SB and higher Life Stress scores were associated with higher PD and DC scores. Lower VABS scores were associated with higher P-CDI scores.

Conclusion: Factors such as recent life change events, single parent status and the child's adaptive skills modify the impact of spina bifida on parenting stress.     

Hope as a psychological resilience factor in mothers and fathers of children with intellectual disabilities

Background Positive psychology is an area gaining credence within the field of intellectual disability (ID). Hope is one facet of positive psychology that is relatively unstudied in parents of children with ID. In the present study, we explore hope and its relationships with parental well‐being in parents of school‐aged children with ID. Method A total of 138 mothers and 58 fathers of children with ID took part in a questionnaire‐based study. Parents reported on their feelings of hope and positive affect, other dimensions of psychological well‐being (anxiety, depression and stress), and on their child's behaviour. For this study, hope was measured as a goal driven behaviour comprising two components: agency (the perception that one can reach his/her goals) and pathways (the perception that one can find alternative routes to reach these goals should the need arise). Results For mothers, regression analyses revealed that lower levels of hope (agency and pathways) and more child behaviour problems predicted maternal depression. Positive affect was predicted by less problematic child behaviour and by higher levels of hope agency. For fathers, anxiety and depression were predicted by low hope agency and positive affect was predicted by high hope agency. Hope pathways was not a significant predictor of paternal well‐being. Hope agency and pathways interacted in the prediction of maternal depression such that mothers reporting high levels of both hope dimensions reported the lowest levels of depressive symptoms. Conclusions Hope is a construct that merits further investigation within families research, and is potentially a factor that could be utilised in intervention to help increase familial well‐being.     

Parenting stress in families with very low birth weight preterm infants in early infancy

Taking care of a premature infant adds an extra burden to already stressed parents. Previous studies have shown that parental stress occurs during the initial hospitalization. However, there is little information on parental stress over time, and the few existing results are conflicting. In addition, many studies have focused on maternal stress but there is little information about a father's long-term adaptation to stress. The purpose of this study was to examine the degree and type of parenting stress in the families of very low birth weight (VLBW) preterm infants over the first two years of life. We compared parenting stress in families with preterm infants with control families, while also comparing the stress in mothers to that in fathers. Furthermore, we explored the relationship between parenting stress in the preterm group with identified factors that included the infant's age, medical complications, and parents’ perceived feeding issues after they had been discharged from the hospital. This was an exploratory study with a cross sectional design. Participants included a total of 505 mothers from Tainan, Taiwan; 297 with preterm children (239 mothers, 58 fathers) and 208 with full-term children (181 mothers, 27 fathers). Assessments including the Parenting Stress Index, Neonatal Medical Index and Behavior-based Feeding Questionnaire were used to measure parental distress, infants’ medical complications and parents’ perceived feeding issues, respectively. Results of the study, though not statistically significant, indicated the presence of increased parenting stress in parents of preterm infants as compared to parents of full-term infants. 13.1% of mothers with preterm infants demonstrated total stress levels that warranted clinical intervention. We also found that mothers of preterm infants presented different parenting stress patterns than fathers of preterm infants. Fathers of preterm infants tended to have overall higher stress scores than mothers. On the other hand, mothers of preterm infants tended to report more health related difficulties, more depression, higher social isolation and role restriction, and less support from their spouses, than reported by fathers. Moreover, as time went on, parents with preterm infants continued to experience greater parenting stress than those with full-term infants. Understanding the experiences of parents with preterm children is important for health care providers while interviewing parents for information regarding their children and designing intervention programs to improve children's outcomes.     

Maternal depressive symptoms in pediatric major depressive disorder: relationship to acute treatment outcome

Objective:In the present study, we assess maternal depressive symptoms at the beginning and end of treatment to investigate the possible reciprocal relationship of maternal illness with the child's depressive illness and treatment.Method:We present data on 146 children and their mothers who were participating in a pediatric acute treatment study of fluoxetine. Patients were assessed with the Children's Depression Rating Scale-Revised at baseline and at each treatment visit. Mothers completed the Quick Inventory of Depressive Symptomatology-Self Report at baseline and end of acute treatment.Results:Thirty percent of mothers had moderate to severe levels of depressive symptoms at the child's baseline assessment. Overall, mothers reported improvement in maternal depressive symptoms at the end of their child's acute treatment, although maternal depression was not specifically targeted for intervention. Furthermore, mother's depressive symptoms appear to be associated with the child's depression severity both at the beginning and end of treatment. Mothers with higher levels of depressive symptoms had children with higher levels of depression severity at baseline and over the course of treatment. However, maternal depressive symptoms at baseline had no association with the rate of improvement of child depression severity.Conclusions:This study indicates a positive relationship between the depression severity of mothers and their children. These findings highlight potential areas of intervention in the acute treatment of childhood depression.     

The predictors of distress in parents of children with autism spectrum disorder

Abstract

Background It is well recognised that parents of children with autism spectrum disorder (ASD) often experience clinically significant levels of stress and depression. This study examined which ASD characteristic best predicted parental distress.

Method Parents of 109 children aged between 4 and 12 (M age = 7.89, SD = 2.43) completed self-report measures of anxiety, depression, stress, and parenting-specific stress. They also completed rating scales regarding their child's ASD characteristics.

Results This study found that the child's behavioural and emotional impairments predicted the parents’ overall levels of distress (i.e., stress/tension, anxiety, and depression), but not the stress associated with parenting. Instead, the child's social impairment severity was found to predict parenting-specific stress.

Conclusion This study highlights the pervasive influence of ASD symptomatology on the mental wellbeing of the parents and the importance of assisting parents to cope with the behavioural and social impairments of their child.