Feldman, M.A., Varghese, J., Ramsay J. & Rajska, D.,

2002,

Reviewed by Dr Susan McGaw,
Cornwall Partnership (NHS) Trust .

Methodology

Factors that impact, contribute and exacerbate stress in parents with intellectual disabilities were examined, with particular attention given to the relationship between parenting stress, social support and mother-child interactions. This controlled study recruited two groups of parents using non-randomised selection. Thirty mothers with intellectual disabilities comprised the full group, all of whom were resident in the area of Ontario , Canada . All the parents were recipients of social services support on the basis of their intellectual disability. They parented a total of 62 children (average age 8 years), many of whom had special educational needs. Eighteen parents comprised a sub-group, all of whom were assessed using parent-child observations in their homes (the mean age of their children was 3.4 years). There were no differences identified across the demographic variables (apart from child age) between the full group and sub-group.

There are many studies available regarding parental stress, social support and parent-child interactions involving parents with intellectual disabilities, though the link between the three has not been specifically or fully investigated. The Parenting Stress Index (PSI) was used to measure parenting stress, and two reliable and robust measures of social support were used (the Telleen Parenting Social Support Index – TPSSI, and the Interpersonal Support Evaluation List - ISEL), both of which were modified for use with parents with intellectual disabilities. An observational checklist previously developed by the author, was used to record positive interactions between mother and child of the 18 mothers and their children comprising the sub-group. Interviews were conducted in the homes of all parents.

This study set out to provide new data regarding this contingency with the authors hypothesizing that:

• maternal stress levels would be elevated
• mothers would report a high need for social support
• support size and satisfaction would be negatively correlated with stress
• perceived support needs would be positively correlated with stress
• support size and satisfaction would be positively correlated with positive mother-child interactions
• support need would be negatively correlated with positive-child interactions
• parenting stress would be negatively correlated with positive mother-child interactions

Critical appraisal

A sound and robust study which was executed by the authors with precision. Clarity is brought to the multiplicity of factors impacting the parenting of these vulnerable families with reference made to the ecological model as a guide for professionals to identify with. There are a few areas of weakness within the sampling methodology, for example, the severity of intellectual disability was unknown, a factor which could render the study difficult to replicate and weaken the integrity of its findings. Also, it is unclear how parents were selected and whether safeguards were in place to ensure against recruitment of a skewed population. Other limitations acknowledged by the authors relate to the use of the TPSSI, ISEL and PSI, none of which have been standardised for use with persons with intellectual disabilities.

Key findings

• mothers with intellectual disabilities are likely to be highly stressed and socially isolated;
• social support and stress were negatively correlated, suggesting that the former may buffer the adverse effects of the latter;
• further studies with larger samples should examine the interaction of a variety of child, parent and family variables on parenting practices, parent-child relationships and child outcomes;
• further research should evaluate the effects of appropriate, tailor-made social supports and investigate whether this would decrease stress and increase child-care skills, positive parent-child interactions, child development and family preservation;
• more research is needed to evaluate the effects of combining competency-building family social support programmes with state-of-the-art education specifically designed for parents with intellectual disabilities.

Practice implications

Social workers should be better informed by the data emerging from this study. The impact of social support on the stress levels of mothers who have intellectual disabilities and the impact on the parent-child interaction are relevant to many families in need'. These findings probably confirm what many social workers know, but until now, have not been able to substantiate.

Policy implications