Child behaviour problems mediate the association between coping and perceived stress in caregivers of children with autism

Coping and child behaviour problems (CBP) predict psychological distress in caregivers of children with autism. Whether CBP mediate the relationship between coping and caregivers’ psychological functioning has yet to be determined. This was the aim of the current study. A sample of 56 caregivers of children with autism completed an electronic survey assessing perceived stress, disengaged and problem focused coping, and CBP. Disengaged and problem focused coping predicted both CBP and perceived stress, albeit in different directions. CBP was also predictive of perceived stress. Data revealed an indirect effect of both disengaged and problem focused coping on perceived stress through CBP. In conclusion, caregivers who use more disengaged coping might be less effective at managing the problematic behaviours of the child with autism, thus resulting in poorer psychological functioning. Conversely, caregivers who use more problem focused strategies might, due to fewer CBP, be relatively protected against the psychological sequelae associated with the caregiving experience. Whether interventions that enhance problem focused coping have adaptive effects for caregivers’ psychological functioning, and whether these effects are mediated by fewer CBP might be the focus of subsequent research.     

Consistent stress profiles in mothers of children with autism

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.Orchard Mental Health CenterThis research was supported by U.S. Department of Education, NIDRR Cooperative Agreement No. G0087C0234 (Koegel and Dunlap), by U.S. Public Health Service Research Grants MH28210 (Koegel) and MH39434 (Schreibman) from the National Institute of Mental Health, by Grant No. G008530082 from the U.S. Department of Education, Handicapped Children's Early Education Program (Dunlap), and by Fogarty Senior International Fellowship 1 FOB TWO 1374-01 (Schreibman) from the Fogarty International Center of the National Institutes of Health. The authors acknowledge the contributions of Prof. Dr. med. Hedwig Amorosa, and Dorle Staniczek, Soz. Pad. of the Max Planck Institute for Psychiatry, Munich, West Germany, and express particular appreciation to Prof. Dr. med. D. Ploog, Director of the Institute.     

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.     

Behavior problems of children with autism, parental self-efficacy, and mental health

Self-efficacy has been identified in the general parenting literature as an important variable affecting parent outcomes. In the present study, 26 mothers and 20 fathers of children with autism reported on their self-efficacy, anxiety, and depression. Teachers rated the behavior problems of the children. Regression analyses showed that self-efficacy mediated the effect of child behavior problems on mothers' anxiety and depression, but there was no evidence that it functioned as a mediator for fathers. However, there was evidence that self-efficacy moderated the effect of child behavior problems on fathers' anxiety. No evidence for the moderating effect of self-efficacy was apparent for mothers. Methodological issues and the theoretical and practical implications of these results are discussed.     

Child welfare involvement of mothers with mental health issues

Many mothers with mental health issues are caught up in the child protection system and face the prospect of having their children removed from their care. The aim of this study was to determine prevalence and outcomes for mothers with mental health issues and their children in child maltreatment cases opened for investigation in Canada. The method was secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) core data. This CIS-2003 contains process and outcome data on a nationally representative sample of 11,652 child maltreatment investigations. Maternal mental health issues were noted in 2,272 (19.7%) cases opened for investigation. The most common child protection concerns were neglect, emotional maltreatment and exposure to domestic violence. A significant association was found between maternal mental health issues and child maltreatment investigation outcomes, with many potentially confounding variables held constant. Broad spectrum, multi-disciplinary services are needed to support mothers with mental health issues. Effective mental health care is vital but insufficient. Addressing trauma, strengthening social relationships and alleviating poverty are also key. Systemic advocacy is needed to ensure that mothers with mental health issues can access broad spectrum supports.     

Behavioural and emotional problems in children of alcoholic mothers and fathers

 The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism. Accepted: 29 November 1999     

Predictors of stress in mothers and fathers of children with fragile X syndrome

This study examined parental and family stress and functioning where there is a child with fragile X syndrome. Mothers and fathers in 40 families were asked about their child with fragile X syndrome, family supports, their psychological stress, the marital relationship, and their family stress. Results indicate parents were well adjusted in terms of their levels of psychological stress and in their marital relationships, however, parents reported high levels of family stress. Mothers and fathers were found to experience similar levels of stress and to report similar levels of satisfaction with supports. Stress was predicted by different variables in mothers and fathers, suggesting that different processes underlie their experiences. The strongest predictor of maternal stress was the level of marital satisfaction while the strongest predictor of paternal stress was the level of the child's adaptive skills.     

Parenting stress of mothers and fathers of young children with cognitive delays in Vietnam

Background This research examined the effects of child and family variables on stress experienced by mothers and fathers of young children with cognitive delays in Vietnam. Methods The mothers (n = 106) and fathers (n = 93) whose children (age range = 3–6 years) were identified as having cognitive delays participated in the interview survey. The survey consisted of a set of the standardized questionnaires that were translated into Vietnamese and assessed for the content validity in the Vietnamese context. Results Mothers experienced more stress than fathers. Path analyses were conducted for mothers and fathers separately. Mothers with female children, those with children of lower intellectual functioning, and those whose husbands had health conditions experienced more stress than the other mothers. Fathers with lower economic status and a smaller social support network were more stressed than the other fathers. Both mothers and fathers were more stressed when they experienced stronger stigma, although the effects were not significant when other variables were considered together in path analyses. Conclusions The findings revealed traditional gender roles. Mothers were more affected by the child’s characteristics and the spouse’s functioning; they anticipated future problems related to the child’s functioning more than fathers did. Fathers were more affected by concerns about the family’s connection to the wider world such as economic issues and the social support network. Longitudinal studies of how social support and stigma affect families would be valuable.     

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.     

Depression in mothers and fathers of children with intellectual disability

Parental depression was assessed using the Beck Depression Inventory (BDI) in 216 families with children with autism and/or intellectual disability (ID), and in 214 control families. Mothers with children with autism had higher depression scores (mean = 11.8) than mothers of children with ID without autism (mean = 9.2), who in turn, had higher depression scores than fathers of children with autism (mean = 6.2), fathers of children with ID without autism (mean = 5.0), and control mothers (mean = 5.0) and fathers (mean = 4.1). Forty‐five per cent of mothers with children with ID without autism and 50% of mothers with children with autism had elevated depression scores (BDI > 9), compared to 15–21% in the other groups. Single mothers of children with disabilities were found to be more vulnerable to severe depression than mothers living with a partner.     

Self-reported depressive symptoms and parental stress in mothers and fathers who bring their infants to an infant mental health clinic

Background: The parental functioning and its influence upon infant mental health development have been extensively studied but there are few clinical studies investigating less severe psychiatric problems among mothers and fathers in the same family. Aim: This study focuses on the emotional well-being of mothers and fathers who bring their infants to an Infant Mental Health Clinic. Methods: The studied sample is comprised of 63 families with 0–47-month-old infants where the mothers completed the Center for Epidemiological Study—Depression Scale (CES-D), including 43 families in which the CES-D was completed by both parents. In 44 families, the mothers also filled in the Swedish Parental Stress Questionnaire (SPSQ), including 32 where the SPSQ was completed by both parents. The children were independently classified with the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0–3). Results: Altogether, 54% of the mothers and 11% of the fathers reported depressive symptoms above the CES-D clinical cut-off. Self-rated depressive symptoms and parental stress were strongly related. The mothers' self-rated depressive symptoms were associated with the severity of their infant's problems, but the association was not specific to the DC 0–3 Axis I classification. The mothers' stress level was marginally related to DC 0–3 Axis II relationship classification. Conclusion: The results indicate that the inclusion of systematic parental self-ratings in infant mental health assessments could add clinical information facilitating the planning of family oriented interventions.     

Child mental health problems in the Gaza Strip

This study describes the mental health characteristics of 150 children of 6-13 years of age, who had been referred to different types of services in the Gaza Strip: a community mental health center, five primary health centers and a pediatric hospital. There was a high rate of somatising disorders among children referred to the mental health center (42%). Parent-reported rates of significant mental health problems were high for all groups, i.e., 70% in the mental health center group, 30% in the pediatric group, and 18% among children referred to primary health centers.     

Child mental health problems in Arab children: application of the strengths and difficulties questionnaire

AIM: This study aimed at establishing the mental health profile among 322 Arab children living in the Gaza strip. METHOD: Children were selected in four age bands, i.e. 3, 6, 11 and 16 years of age. The relevant forms of the Strengths and Difficulties Questionnaire (SDQ) was completed by parents, teachers and 16-year-olds. RESULTS: Factor analyses of the parent-related questionnaires identified similar general factors as in the UK-based studies of validating the SDQ. Certain items did not load as highly on the general factors, i.e. distractability, feeling scared, feeling unhappy, stealing, and being picked or bullied. Emotional problems items were rated differently in the pre-school group (aches, nervousness-clinging, worries) than in previous studies. Using previous optimal cut-off scores, parent SDQs revealed higher rates of children with emotional and conduct problems falling above the 90th centile established in the UK sample, but lower rates according to self-report SDQs by 16-year-olds. CONCLUSIONS: Western categories of mental health problems did not clearly emerge from the factor analysis. The main difference from western epidemiological studies appeared to operate in parents' perceptions of emotional problems in pre-school children. The SDQ is very promising as a screening measure or rating scale in different cultural populations. However, future research should identify and establish indigenously meaningful constructs within this population and culture, and subsequently revise measures of child mental health problems.     

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.     

Quality of life and mental health of parents of children with mental health problems

Mental health of parents and their quality of life is likely to be affected when a child in the family has a psychiatric disorder. The purpose of this study is to assess quality of life and mental health of parents of referred children waiting for service at the only child psychiatric service in Iceland, with reassessment at least 3 months after first attendance to the service. In order to do so, 208 parents of 123 children waiting for psychiatric care were sent the Icelandic Quality of Life (IQL), the General Health Questionnaire (GHQ-30) and the CAGE screen for alcoholism. For reassessment, responders in the first phase were assessed again with the IQL and GHQ-30, at least 3 months after initiation of child psychiatric interventions. A total of 120 of the 208 parents (58%) responded in the first phase of the study, 49 fathers and 71 mothers. The mean (+/- s, standard deviation) standardized IQL T-score was for the fathers 51+/- 7.5 but significantly lower for the mothers or 45 +/-11.5 (P = 0.001) compared to normal sample of same-age women (T-scores of 50 are normal). Nearly 55% of women compared with 26% of men were psychiatric cases, scoring 5 or higher on the GHQ. According to a CAGE score of 2 and above 16% of fathers and 14% of mother abused alcohol. No significant change occurred in parents GHQ-30 or IQL before and after initiation of treatment. We conclude that mothers of children with mental disorders have poor quality of life, and high prevalence of mental disorders; hence child psychiatry clinics need to ensure that mothers receive appropriate care along with the child.     

When mothers have serious mental health problems: parenting as a proximal mediator

Maternal mental health (MMH) problems are associated with lack of confidence in one's parenting, overly lax or too harsh discipline, and child academic underperformance. We asked if parenting mediates the effect of MMH problems on academic outcomes even among mothers with serious mental illness (n=164). Structural equation analyses show a significant association between MMH problems and permissive (lack of parenting confidence, lack of follow through) parenting and verbal hostility as well as worse academic outcomes (school recorded grades, teacher reported behaviour). Permissive parenting completely mediated the direct effect of MMH on academic outcomes. Further analyses showed that the mediation effect was attributed to a single component of permissive parenting-lack of parenting confidence.     

Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders

This study examined sleep problems and their correlates and comorbid psychopathology in children with autism spectrum disorders (ASDs). Participants consisted of 166 ASD children and 111 unaffected siblings aged 4–15 years. Parents completed a self-administered child sleep questionnaire. Of the children with ASDs, 47.0% (78/166) had at least one sleep problem. Children with ASDs were more likely to have bedtime resistance (OR 2.72, 95% CI 1.02–7.21), insomnia (OR 4.07, 95% CI 1.60–10.35), and daytime sleepiness (OR 7.62, 95% CI 1.17–49.38) compared to their unaffected siblings. Among children with ASDs, multivariate logistic regression analyses indicated that communication abnormalities and repetitive stereotyped behaviors were associated with increased risk of sleep problems. ASD children with sleep problems were more likely to have withdrawal problems, somatizing problems, aggressive behaviors, internalizing problems, externalizing problems, and total behavioral problems compared to those without sleep problems. Sleep problems are prevalent in children with ASDs and are associated with both internalizing and externalizing problems. Clinicians should pay close attention to sleep problems when assessing and treating autistic behaviors.