Perkins, T.S., Holburn, S., Deaux, K., Flory, M.J. & Vietze, P.M.,

2002,

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

Methodology

This study investigates the emotional outcomes among children born to mothers with intellectual disabilities. Previous research has highlighted the increased vulnerability of the children of parents with learning disabilities to adjustment problems, rebellion, pseudo-retardation and adjustment difficulties in their children (O'Neil, 1985). Whilst resilience and protective factors have been identified which can ameliorate threats to the children's emotional development including: a) the dispositional attributes of children, b) the strength of affectional ties within the family and c), the availability of external support systems which provide positive affirmation, further research is needed in this area (Booth & Booth, 1997).

In this study, the authors use quantitative analysis to evaluate the interpersonal aspects of the mother-child relationship by assessing the strength of the child's attachment to their mother, general coping mechanisms and the quality of maternal caregiving. The results are fascinating and at the same time tantalising, as they generate more questions about the children's perceptions of their mother's learning disability and the impact on their self-worth and self-esteem.

Thirty-six children and adolescents of mothers with intellectual disabilities (age range 9 – 17 years) from various ethnic groups, were administered questionnaires to assess: (a) attachment style (using Hazan & Shaver's 1987 Attachment Scale); (b) caregiver style (using Hazan & Shaver's Parental Caregiving Style Questionnaire); (c) perception of maternal stigma (using a six-item questionnaire which was developed for this purpose by the authors); and (d) self-esteem (using Rosenberg's Self-Esteem Scale). The children were also asked to list the identities or roles that they play in life (from a List of Identities constructed by the authors). Interviews lasted approximately 45 min between the child and investigators. None of the children were receiving any type of remedial school service, or had a learning difficulty.

Critical appraisal

Few studies have examined emotional outcomes among children, and only one of these has focused on children of parents with learning disabilities (O'Neil, 1985). This interesting paper makes an important contribution to furthering our understanding about these particular families. It highlights the role of services in their support of mothers to enable them to adopt a warm caregiving style towards their children. Also, the research provides a model of multiple identities to explain the process by which children of parents with learning disabilities can learn to cope with threats to their self-esteem. However, there are methodological tensions which need to be highlighted:

First, the authors report that the avoidant attachment style and anxious/ ambivalent attachment style were significantly correlated with low levels of self esteem, even though the relationship between secure attachment and higher levels of self esteem was not substantiated. Perkins suggests that this may be due to methodological issues with the Hazen and Shaver (1987) attachment measure which they used. The Attachment Style Questionnaire (Hazen et al., 1987) was originally designed to look at romantic relationships and attachment styles, not the relationship of child to parent. Typically, it was used in the study of adolescents who are college age students and older. The authors acknowledge that methodological issues with the ASQ may have resulted in their original hypothesis being only partly supported.

Second, the reliability and validity of the findings may be compromised by weaknesses in sampling and some of the measures used. Children were recruited to the study using a key informant method through a range of agencies which identified families that met the eligibility criteria. Whilst it is difficult to implement controls into this type of sampling due to problems in identifying families headed by parents with learning disabilities, random sampling or a control group would have reduced sampling error.

Key findings

The data were analysed using Pearson's correlations and regression analyses to assess the direction and strength of relationships and the influence between subsets of variables.

• The prediction that a child's perception of stigma would reduce his/ her strength of attachment to the mother was supported by the data. Stigma was a significant predictor of secure attachment style, F (1,35) = 7.91, P = 0008, although the two remaining attachment styles were not significantly related to stigma.
• The prediction that maternal caregiving style would mediate the relationship between stigma and attachment was also significant. The authors reported that perception of stigma predicts warm caregiving style F (1,35) = 12.25, P< 0.001) and warm caregiving style predicts attachment F (1,35) = 20.98, P<0.001).
• The prediction that secure attachment style would be associated with higher self-esteem was not significant. However, children who had an avoidant attachment to the mother tended to have lower self-esteem (r = - 0.457, P = 0.003) and children who had more of an anxious/ambivalent attachment tended to have lower self-esteem (r = -0.41, P = 0.01).
• The prediction that the number of identities listed by the child would moderate the relationship between attachment style and self-esteem was not significant.

Social work practice implications

A particularly informative study in view of the lack of empirical research which exists on the importance of child attachment as an important predictor of key emotional outcomes involving children of parents with learning disabilities. The findings draw our attention to the importance of: a) enhancing maternal caregiver warmth at an early stage of parenting and b), helping children to break down the stigma they feel towards their parents when it is identified as a potential or emerging problem. Whilst there are some difficulties with the methodology and the measures used, this is a useful paper overall for social workers and other professionals involved in family assessments, support and the courts, especially when their involvement includes the needs of older children in families where there is a parent with a learning disability.

Policy implications

The model presented in this paper goes some way to support the hypothesis that the maternal caregiving style has a facilitative function in the parent-child relationship, which is consistent with the findings associated with attachment theory. However, in the absence of standardised tools for general use with the children and parents of these families, there can be no policy implications that arise directly from the findings. However, further research is needed to tap into parental attachment styles for this parent population. Also, there is a need to replicate the research with children who have special needs whose parents have learning disabilities. Longitudinal research is needed regarding measurement of attachment between a child/parent and perceived stigma over time.