Maternal and paternal stress in families with school-aged children with disabilities

This study examined stress factors in families with a school-aged child with a disability. Path analyses revealed that children's demandingness and neediness for care was related more to maternal stress and that child's acceptability was related more to paternal stress. Professionals who serve families with children with disabilities may need to devise more specialized support programs to help fathers become emotionally close to their atypical children and may need to provide more respite services for mothers. To assist parents of school-aged children with disabilities, support services may also need to extend beyond the usual early childhood period.     

Who Gets Care? Mental Health Service Use Following a School-Based Suicide Prevention Program

OBJECTIVE: To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. METHOD: In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. RESULTS: More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. CONCLUSIONS: Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.     

Prevalence and Characteristics of School Services for High School Students with Attention-Deficit/Hyperactivity Disorder

This study examines the prevalence and characteristics of services reported by school staff for 543 high school students participating in the 8-year follow-up of the multi-site Multimodal Treatment study of ADHD (MTA). Overall, 51.6 % of students with a history of attention-deficit/hyperactivity disorder (ADHD) were receiving services through an individualized educational plan (IEP) or a 504 plan, a rate higher than expected for this age group. Less than 5 % of these had 504 plans; 35.5 % attended special education classes. Very few services (except tutoring) were provided outside of an IEP or 504 plan. Almost all students with services received some type of academic intervention, whereas only half received any behavioral support or learning strategy. Less than one-fourth of interventions appear to be evidence based. Students receiving services showed greater academic and behavioral needs than those not receiving services. Services varied based upon type of school, with the greatest number of interventions provided to students attending schools that only serve those with disabilities. Original MTA treatment randomization was unrelated to services, but cumulative stimulant medication and greater severity predicted more service receipt. Results highlight a need for accommodations with greater evidence of efficacy and for increased services for students who develop academic difficulties in high school.     

The impact of dietary and tooth-brushing habits to dental caries of special school children with disability

The daily oral activities may severely influence oral health of children with disabilities. In this survey, we analyzed the impact of dietary and tooth-brushing habits to dental caries in special school children with disabilities. This cross-sectional survey investigated 535 special school children with disabilities aged 6–12 years, 60.93% males, 39.07% females from 10 special schools in Taiwan. Oral examinations were carried out by dentists with a Kappa score of their inter-examiner agreement exceeding 0.8. Data on demographics, diet, and tooth-brushing habits of children with disabilities were collected using a standardized questionnaire completed by parents/caregivers. More than three quarters of the participants were combined with severe or profound disability. Children with profound severity in disability had a higher percentage (67.37%) in teeth-brushing by parents/caregivers compared to those children with mild/moderate severity in disability which had a higher percentage (81.60%) in teeth-brushing by themselves. Children whose teeth were brushed by parents/caregivers had a better dental health, and lower caries prevalence. The main risk factors related to decayed teeth of children with disabilities are frequency of sweets intake, ability to brush teeth and with plaque or not. The dental health education, prevention program and periodical oral check-up to children with disabilities and their parents/caregivers should be reinforced. Brushing skill should be taught to children according to their type, severity and individual characteristics of disability.     

Parental perceptions of services to children with intellectual disability

This study reports the views of 123 parents of children with intellectual disability concerning the way they were told about their child's disability, the services recommended at that time and subsequently, the usefulness of services and the empathy of the providers. Results suggest a lag between the time at which some parents suspect that their child has a disability, and the time this suspicion is confirmed. Most parents indicated that they received factual information when first told of their child's disability. There were no significant differences between parental perceptions of the information given at disclosure of disability between the 1970s and the 1980s. The services most frequently recommended initially to parents were medical specialists, followed by early intervention and therapy services. Services which became significantly more likely to be recommended over the last two decades were physiotherapy and early intervention. The most useful services were ranked as the special school, pediatrician, early intervention program, regular preschool and other parents. The majority of children with moderate to severe disability were being educated in a special school or a special unit/class in a regular school. Approximately 25 per cent of parents commented on deficiencies in the co-ordination of services and in parental access to services.     

A review of special education law

Children with disabilities require special education and related services that are as diverse as the individual children themselves. Special education is not necessarily a special classroom but a well thought-out program of collaborative interventions leading to educational goals set forth by a multidisciplinary team. Effective special education is guided by both state and federal laws that protect the rights of the child and encourage certain universal core principles. Special-needs children are entitled to a free and appropriate education with related services in the least restrictive environment. Pediatricians and pediatric subspecialists are in a unique position to develop a medical home for the disabled child, and in doing so must be well-versed in both case law and federal legislation as it applies to special education, in an effort to be a child's best advocate. A chronological review of case law and federal legislation, including the Individuals with Disabilities Education Act, No Child Left Behind Act, and recent amendments, are discussed, and their relevance to physician practice is detailed.     

Effectiveness of the Parent Connectors Program: Results from a Randomized Controlled Trial

Parent education and support has been identified as a potential resource to help improve outcomes for youth who have emotional disturbances (ED). The current study builds on promising results from Parent Connectors (PCs) (Kutash et al. in Adm Policy Ment Health Ment Health Serv Res 38:412–427, 2011), a peer-to-peer program aimed at increasing the engagement of families in the education and treatment of their children who have ED. A total of 128 parents of students identified as having ED and enrolled in special education programs in 23 middle schools or special centers were randomly assigned to a treatment (had a PC) or comparison group. For parents who had a PC, results indicated positive program effects including increased perceived benefit of engagement, more engagement in their child’s services, and a more positive response to social norms. Students received more mental health services, were enrolled more days in school, and were suspended fewer times and for fewer days. The moderating effects of parent strain and child emotional functioning were examined, and implications for practice are discussed.     

Child mental health consultation with families of medically compromised infants

Prematurity and birth defects present parents with a crisis for which they have usually had little preparation and no prior education. Both types of early medical complications may represent a state of suspended animation for most parents. Even large premature infants with good prognoses induce anxiety and symbolize potential death and disability, and children with birth defects may portend years of medical procedures and long-term disability. The fear of serious neurologic impairment or mental retardation presents parents with a long period of ambiguity and chronic anxiety. During this period, they must be helpless observers rather than active participants. Recent research has indicated that the active involvement of parents in the care of their premature infants can be helpful in alleviating the guilt and anxiety related to loss and impairment. Similarly, early physical contact between parents and their severely malformed infant is equally critical. Even if the ultimate complexities of early attachment have yet to be delineated fully, this is a worthwhile practice and useful approach in the nursery. Child mental health professionals have important roles to fulfill in helping staff members deal with increased parental participation and directly managing family members with intense distress related to their infants' fragility. The role of the mental health professional in such consultation may cover five related tasks: 1. Understanding the nature of the biologic issues facing the child and integrating that understanding with an evaluation of the child's neurobehavioral profile. 2. Understanding the family's relationship with the child and their overall level of functioning during an acutely stressful time. 3. Developing an appreciation of the place of the child in his or her family and how the parents understand the nature of the medical problems. 4. Forming a collaborative relationship with the pediatricians and other subspecialists who care for the child so that behavioral and psychological interventions are integrated with the child's biomedical care. 5. Fostering a brief, or sometimes long-term, therapeutic relationship with the family or facilitating the family's finding such a relationship with another clinician. There will never be enough child and adolescent psychiatrists and psychologists to treat all families of medically compromised infants. Knowledge of normative responses has advanced to the point at which basic skills can be used by and transmitted to others who can provide basic services. There is much to be learned about the short- and long-term sequelae of such stressful situations on individuals and family systems with preexisting psychopathology. For such families, child mental health professionals are uniquely suited to play a further role in research and treatment.     

Help-seeking process of parents for psychopathology in youth with moderate to borderline intellectual disabilities

OBJECTIVE: To study the help-seeking process of parents for emotional or behavioral problems in their child with borderline to moderate intellectual disabilities. METHOD: In 2003, in a special education-based sample of 522 youths (ages 10-18 years, response = 77.9%), we studied the parents' perception of their child's problems, their subsequent felt need for professional help, actual help-seeking, and the factors possibly related to taking these steps. RESULTS: Even when parents indicated their child's emotional or behavioral functioning as "neither good nor bad," in about 70%, these problems were present according to standardized measures. Of the 213 parents (40.8%) who perceived problems, 70.6% felt a need, and 55.2% of these parents subsequently sought professional help. Parents more often sought help when their child had problems of anxiety and depression, experienced negative life events, and when parents perceived child psychopathology before the past year. Reported barriers to seeking help predominantly related to parents' evaluation of the severity of these problems and wanting to solve the problems themselves. CONCLUSIONS: Clinicians and other service providers should address parents' concerns regarding their child's emotional/behavioral functioning and treatment seeking. Also, they should provide information on treatment options and on signs and potential negative prospects of their child's problems.     

Parental Perspectives on Inclusion: Effects of Autism and Down Syndrome

This study examined the effects of the child's diagnosis (autism vs. Down syndrome), age, and current educational placement on parental perceptions toward inclusion for their child with disabilities. Parents of children with autism and with Down syndrome completed surveys regarding their opinions on their child's current educational placement, their desire for changing the current placement, and their views on inclusive education. Results indicated that diagnosis, age, and current placement influenced parental opinion on the ideal educational placement for their child. Parents of children with Down syndrome were significantly more likely to endorse inclusion (full-time placement in general education) as the ideal educational program for their child whereas parents of children with autism were more likely to endorse mainstreaming (consistent part-time placement with general education students). Parents of younger children and parents whose children were already placed in general education programs were more positive towards inclusion than parents of older children or students currently in special education. Findings are discussed in terms of child characteristics and prevailing educational practices.     

Validity and reliability of the Japanese version of the family needs survey

Early intervention and disability services in Japan historically have focused on supporting the individual with a disability, with only secondary attention to family needs and priorities. Since the Basic Law for Persons with Disabilities was codified in 2011, the Japanese government has been responsible for supporting families with members who have disabilities. To assess the needs of these families, we evaluated the reliability and validity of the Family Needs Survey (FNS), initially developed in 1988 (Bailey & Simeonsson), to determine its usefulness for programs providing services for Japanese families who have a child with a disability. The FNS is a practical tool to assess family needs and is already used across many different cultures and populations. To evaluate the reliability and validity of the FNS, we conducted an anonymous survey with a self-administered questionnaire at 6 treatment and education institutions, 3 medical institutions mainly for children with disabilities, and 39 special needs schools in the Osaka area. We analyzed 1171 parents’ survey responses: 452 fathers and 719 mothers of children with disabilities aged 0–15 years old who answered all items on the Japanese version of the FNS. Another survey was administered to 130 specialists who work with children with disabilities to assess the content validity of the Japanese version of the FNS. We verified the factor structure, content validity, and reliability of the Japanese version of the FNS as an assessment tool with 34 items among four factors that were based on the same items in the original FNS. The assessment could be used for families with school-age children as well as younger children, in contrast to the original version, which is not appropriate for school-age children. We also confirmed that it could be used without regard to type or degree of disability.     

A National Sample of Preschoolers with Autism Spectrum Disorders: Special Education Services and Parent Satisfaction

The Pre-Elementary Education Longitudinal Study (PEELS) examines the preschool and early elementary school experiences of a nationally representative sample of 3,104 children ages 3-5 with disabilities from 2004 through 2009. This paper describes the special education and related services received by a subsample of 186 preschoolers with autism spectrum disorders (ASD) in 2003-2004 and parental satisfaction with those services. Past research and patterns of litigation suggest that parents of children with ASD are not wholly satisfied with the special education and related services their children receive. In the current study, the authors found many similarities between children with ASD and children with other disabilities in the type of services received under IDEA and in parent satisfaction with these services. Still, some significant differences emerged in the number of services received, the amount of time children with ASD spent in special education settings, and parent satisfaction with the amount of time children spent with typically developing peers. Implications about the importance of parent satisfaction and social validity measures are discussed.     

Alienated advocacy: perspectives of Latina mothers of young adults with developmental disabilities on service systems

Although collaborative partnership between parents and professionals is a cornerstone of the special education and service systems, this relationship exists more as an ideal, especially when low-income, culturally diverse families are involved. Through three focus groups, we examined the beliefs of 16 low-income Latina mothers of young adults with developmental disabilities about their relationships with the educational and service delivery systems. Primary concerns identified were (a) poor communication, (b) low effort in providing services, (c) negative attitudes of professionals toward the client-children, (d) negative treatment of parents by professionals, and (e) the mother's role as central to the well-being of her child. Mothers tended to adopt a posture of alienated advocacy in relation to their child's educational and service needs.     

Racial/Ethnic Disparities in Parent Perception of Child Need for Mental Health Care Following School Disciplinary Events

Disciplinary problems at school potentially affect parent perception of child need for mental health care. This article explores effects of a child's first school suspension or expulsion on parent perception of child need for services in three racial-ethnic subgroups. Subjects were mothers participating in a national longitudinal study and their children. First-time school suspension or expulsion positively affected service use and parent-reported service need among white non-Hispanic children, but had little or no effect for African American and Hispanic children. These results suggest that information on child behavior provided to parents by teachers and school administrators can influence parent perception of child service need, but that racial-ethnic differences may exist in parent interpretation of and response to this information. Culturally appropriate approaches to relaying information to parents about child service need may help reduce these differences.     

Have there been changes in children's psychiatric symptoms and mental health service use? A 10-year comparison from Finland

OBJECTIVE: To study the differences in children's psychiatric symptoms and child mental health service use at two time points: 1989 and 1999. METHOD: Two cross-sectional representative samples of 8- to 9-year-old children from southern Finland were compared. The 1989 sample consisted of 985 children, of whom 95% participated, and the 1999 sample consisted of 962 children, of whom 86% participated. Information was gathered from parents and teachers using Rutter's questionnaires and other related determinants of service use and from children using the Child Depression Inventory. The sampling, procedure, and methods were similar at both time points. RESULTS: The overall rate of children's problems assessed by parents and teachers had not increased during the period 1989 to 1999. Boys had fewer psychiatric symptoms in 1999 than in 1989, whereas no clear change had occurred in girls' symptoms, except that, according to parents, girls in 1999 had more hyperactive symptoms. However, children themselves reported more depressive symptoms in the 1999 than in the 1989 sample. In 1989, 2.3% and in 1999, 5.3% of children had used child mental health services. The increase in service use among girls was fourfold. Parental evaluations of child psychopathology and teacher evaluations whether the child was psychologically healthy were the strongest determinants for referral at both time points. Parents preferred to seek help for their children's problems from teachers, school nurses, and school psychologists rather than from specialized child psychiatric services. CONCLUSIONS: There has been an increase in mental health service use especially among girls as well as a convergence of symptom levels by gender. It is important to develop child psychiatric services that are as close to the child's living environment as possible to further reduce the threshold for seeking help and to promote early detection and intervention.     

A school-based program of mental health services

The Brookdale School Program provides mental health consultation and direct services to more than 450 children in a Brooklyn school district through an unusual network involving the local hospital's psychiatry department, the community mental health center, and the school. In the Brookdale program hospital-based psychiatrists and school-based social workers, nurses, and psychologists work with teachers, administrators, and parents to provide insight into the emotional and learning difficulties of some children and to set treatment goals. Two case examples are presented.     

School-based mental health services in Baltimore: association with school climate and special education referrals

This study investigated the association between school-based mental health services and two proposed but untested outcomes of these services: (a) school climate and (b) patterns of referrals to special education. Results from a climate survey found that teachers and staff in eight elementary schools with expanded school mental health (ESMH) services gave higher ratings on the survey's mental health climate subscale than respondents from schools in a matched comparison group. No differences were found for the General Climate subscale of the survey. Results also indicated that teachers in ESMH schools referred fewer students to the special education eligibility process because of emotional and behavioral issues and that fewer students in ESMH schools were found eligible for special education for emotional and behavioral disabilities. Results of this study provide beginning evidence for the positive impact of ESMH programs on these two schoolwide indicators of functioning.