McConnell, D., Llewellyn, G., Mayes, R., Russo, D. & Honey, A.,

2003,

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

Study aims

This study investigates the variation in developmental outcomes for children of parents with intellectual disability. The absence of longitudinal studies that have tracked the development and well-being of children in these families over time is well documented. This paper contributes another piece to the jigsaw in an attempt to further our understanding of children's vulnerability to developmental delay, and the maternal/ environmental factors when their parents have a learning disability. Within the current context of what is currently known about these families in the research literature, this study must rank as one of the pathfinders.

Methodology

This was a descriptive analysis of 45 parents with learning disabilities, all of whom were drawn from another study but were selected in the course of a randomised controlled trial (Llewellyn, McConnell & Honey, 2001). Parents were identified for inclusion in another Australian study, through government and non-government services in Sydney . Standardised assessments and structured interviews were used, both of which were conducted in parents' homes on a weekly basis over 3-4 weeks.

The development of 37 children was assessed (involving 20 females and 17 males, mean age 35.1 months) using the Developmental Profile II. This assessment covered five domains of the children's development (physical, self-help, social, academic and communication). An extensive structured interview took place with the mother. Information was gathered regarding: a), possible organic pathology from pregnancy and birth data, and the health/disability status of the youngest child, b) maternal data (age, ethnicity, marital status, history of abuse, etc.) and from standardised measures of IQ, literacy and health and c), family and environmental characteristics , captured in part by the HOME inventory which measures the quality of the home environment.

Critical appraisal

A thorough analysis of multiple factors was conducted by the authors in their quest to understand the influence on the well-being and development of children born to mothers who have learning disabilities. Their investigation explored the myth that children of mothers with learning disabilities will be vulnerable to, and predisposed to, developmental delay as a result of their mother's diagnosis. Overall, this was a well-conducted and robust study that significantly advances our understanding in this area. The findings are weakened, however, by the lack of analysis of the influence of fathers or partners in the parenting. Twenty children ( n = 20 ) had a father figure in their lives, compared to 17 of the children who lived in single mother household or with their mothers in their extended families. Also, the relatively small sample size and weaknesses inherent in a retrospective methodology applies in this instance. Nevertheless, this is an important paper that any professional working with families with learning disabilities needs to have on their essential reading list.

Key research findings

• The developmental status of the children varied markedly.
• Controlling for possible organic pathology, the development of these children did not vary significantly from age-norm expectations in four domains: physical, self, social and academic.
• Expressive and receptive language delays were observed across all of the children
• No statistically significant correlation was found between developmental status and characteristics of the mother or home environment
• The key to prevention may lie in the provision of suitable antenatal and maternity services to ensure the best possible birth outcomes.

Social work practice implications

Some interesting findings are reported in this paper, many of which have relevance to social work practice. The high prevalence rates of physical and sexual abuse and poor health reported by mothers will be of relevance to practitioners who are evaluating parental competency and endeavouring to provide support to these families. Also, the authors provide supporting evidence to challenge the myth that the home environment for many of these families is any less stimulating than for the general population. The vulnerability to developmental delay in children who have organic pathology, and in areas of communication is provided for the whole sample. Overall, the paper offers social workers a finer understanding of resilience and risk to the development and well-being of the children born to mothers with learning disabilities.

Implications for policy