Perceived Stigma Among Serbian Parents of Children with Autism Spectrum Disorder and Children with Physical Disabilities: Validation of a New Instrument

Participation and Well-Being of Chinese Mothers Who Have Children With Disabilities

IMPORTANCE

High stress and compromised mental health are well-documented among mothers of children with disabilities, but less is known about the factors that influence their participation and well-being, especially among Chinese mothers. Identifying these factors could lead to strategies to mitigate potential risks to maternal well-being.

OBJECTIVE

To explore the relationships among participation in health-promoting activities, perceived stigma, perceived support, and well-being of ethnic Chinese mothers who have children with disabilities.

DESIGN

Cross-sectional survey.

SETTING

Community.

PARTICIPANTS

Ethnic Chinese mothers (N = 261) with children with disabilities of any age residing in Australia, Singapore, or Taiwan.

OUTCOMES AND MEASURES

Health Promoting Activities Scale, Personal Wellbeing Index, Warwick-Edinburgh Mental Wellbeing Scale; Kessler Psychological Distress Scale, Parental Perceptions of Public Attitudes Scale, and Multidimensional Scale of Perceived Social Support.

RESULTS

Moderate to strong correlations were found between mental well-being and all measures. The frequency of participation in health-promoting activities was a predictor of mental well-being (β = .21, p = .001). Perceived support was the strongest predictor of participation in health-promoting activities (β = .25, p = .005), mental well-being (β = .39, p < .001), and personal well-being (β = .45, p < .001). Perceived stigma predicted psychological distress (β = .32, p < .001) and mental well-being (β = -0.29, p < .001).

CONCLUSIONS AND RELEVANCE

Perceived support and stigma affected mothers' participation in health-promoting activities and well-being. Therapists can facilitate mothers' engagement in health-promoting activities and develop strategies to address stigma and enhance support. Plain-Language Summary: This research highlights factors that affect the well-being of ethnic Chinese mothers who have children with disabilities and provides cultural insights for occupational therapists who work with Chinese families. The article also encourages pediatric occupational therapists to address the occupational needs and well-being of mothers in parallel with therapy for their children. We discuss occupation-focused strategies, family-centered perspectives, and health promotion approaches in relation to improving the participation and well-being of ethnic Chinese mothers in their cultural context.

Preliminary Validation of Measures of Experienced, Perceived, and Internalized Stigma Among Adults Who Are d/Deaf or Hard of Hearing in the United States and Ghana

OBJECTIVES

In this article, we examine the psychometric performance of 3 scales measuring experienced, perceived, and internalized d/Deaf or hard of hearing (d/DHH) stigma among adult (18 and older) populations of individuals who are d/DHH, including those who have been d/DHH since before they developed language (lifelong) and those who became d/DHH after they developed language (acquired) in the United States and Ghana.

DESIGN

The preliminary validation study took place in the Greater Accra and Eastern regions of Ghana and across the United States. In the United States, all data were collected online via self-administered surveys in English. In Ghana, trained interviewers who are d/DHH and fluent in Ghanaian Sign Language conducted interviews with participants who are lifelong d/DHH using a video survey. Ghanaian participants with acquired d/DHH status were surveyed by trained hearing interviewers. We calculated polychoric correlation matrices between the measures to remove redundant and unrelated items and used exploratory factor analysis to create the final scales. We also tested the association between the factor scores and a simple summing method for calculating the scale.

RESULTS

The study sample included people who have been d/DHH since before they developed language (Ghana: n = 171, United States n = 100) and people who became d/DHH after they developed language (Ghana: n = 174, United States: n = 219). The final experienced, perceived, and internalized scales included six, seven, and five items, respectively. All three scales performed well as unidimensional measures across all four samples. Across the four samples, the experienced, perceived, and internalized stigma scales yielded ordinal αs ranging from 0.725 to 0.947, 0.856 to 0.935, and 0.856 to 0.935, respectively. It would be acceptable to operationalize all stigma scales as sum-of-item scores.

CONCLUSIONS

The scales performed well and appear to provide a valid means of measuring different types of stigma among diverse groups of people who are d/DHH. Future work should refine and validate these scales in additional contexts.

Stumbling Block in Providing Physical Activity Support Among Parents of Children with Autism Spectrum Disorder: A Moderated Mediation Analysis

Physical activity (PA) benefits children with autism spectrum disorder (ASD). Evidence suggests that some barriers impede parents from providing PA support for their children with ASD. Parental perceived stigma is one of these barriers. However, few studies have explored how parental perceived stigma influences parental PA support. This study aimed to investigate the relationship between parental perceived stigma and parental PA support, the mediating role of parental self-efficacy, and the moderating effect of having other typically developing children or not. A total of 274 participants were recruited to participate in the study. The results showed that parental self-efficacy mediated the association between parental perceived stigma and parental PA support and the moderating effect of having other typically developing children or not.

Relationship Between Mindfulness and Affiliate Stigma in Parents of Children with Autism Spectrum Disorder in China: The Mediating Role of Coping Styles

PURPOSE

This study aims to investigate the current status of affiliate stigma among parents of autistic children, analyze the influencing factors, explore the relationship among mindfulness, coping styles, and affiliate stigma, and verify the mediating role of coping styles between mindfulness and affiliate stigma in parents of children with autism in China.

METHOD

Between February and April 2023, the Child Development Behaviour Centre of a public hospital in China recruited 345 parents of children with autism. These parents completed the general information questionnaire, the Mindful Attention Awareness Scale, the Affiliate Stigma Scale, and the Simple Coping Style Questionnaire. We then adapted the Hayes Process Macro and Bootstrap methods to examine the mediating effects of coping styles between mindfulness and affiliate stigma.

RESULTS

(1) The total affiliate stigma score of parents of children with autism was 48.53 (standard deviation:: 10.74). Parents' age, monthly family income, duration of care, mindfulness, and coping styles were the influencing factors of parental affiliate stigma. (2) Mindfulness was positively correlated with positive coping style (r = 0.33, p < .01) and negatively correlated with negative coping style, affiliate stigma (r = -0.38, -0.39, p < .01), whereas affiliate stigma was negatively correlated with positive coping style (r = -0.34, p < .01) and positively correlated with negative coping style (r = 0.41, p < .01). (3) Positive coping style and negative coping style play a parallel mediating role between mindfulness and affiliate stigma of parents of autistic children.

CONCLUSIONS

Parents of children with autism experience significant levels of affiliate stigma. Mindfulness has a direct impact on associated stigma in parents of children with autism and also indirectly predicts associated stigma through the intermediary influence of positive and negative coping styles. Healthcare professionals could perform mindfulness interventions from an optimistic psychology viewpoint to boost parents' mindfulness and coping abilities, thereby accomplishing the objective of mitigating affiliate stigma.

A Mixed-methods Examination of Culturally Responsive Adaptation to an Evidence-based Parent-mediated Intervention Implemented for Autistic Children

Parent-mediated interventions (PMIs) are considered an evidence-based practice for fostering social communication skills in young autistic children and for promoting parent responsivity and empowerment, yet barriers to caregiver engagement are evident when PMIs are implemented within historically underserved community settings. Issues of caregiver engagement can reflect a lack of fit between PMIs and the needs of diverse families. We used a mixed methods approach to examine barriers to participating in an evidence-based PMI, Project ImPACT (Ingersoll & Dvortcsak, 2019), within an outpatient setting, as well as strategies that clinicians reported using to deliver and adapt Project ImPACT for minoritized families. Participants included 134 caregivers of a child 13 to 48 months with autism or other social communication differences and six clinicians delivering Project ImPACT. Findings suggest that caregivers experience barriers to participating in Project ImPACT and that these barriers are associated with caregivers' ability to complete the program. Although quantitative findings indicate that adaptation to Project ImPACT did not differ by caregiver and child background, qualitative findings highlighted that clinicians attempt to deliver Project ImPACT to respond to the needs of families from minoritized backgrounds by actively considering the family's culture, psychosocial experiences, goals, and specific barriers. Further, both qualitative and quantitative findings suggest that culturally responsive care and adaptations may support caregiver engagement, including rapport, trust, buy-in, and attendance. Approaches to center cultural alongside contextual/psychosocial considerations within family-centered care in the implementation of PMIs are also highlighted.

Effect of individual psychoeducation for primary caregivers of children with autism on internalized stigma and care burden: a randomized controlled trial

This study aims to determine the effects of a six-week individual psychoeducation program provided to primary caregivers of children with autism on stigma and care burden. The study was conducted with 88 primary caregivers (experimental group n = 45, control group n = 43) of children diagnosed with autism. The study, prepared in an experimental design with a pretest, posttest, and control group, was performed between 17 June 2021 and 17 January 2022. In the study, a six-week individual psychoeducation was given to the experimental group. Study data were collected using a personal information form, the Internalized Stigma of Parents in Mental Illness Scale (ISPMIS), and the Caregiver Burden Scale (CBS).The mean pretest ISPMIS total score of the experimental group wasX ¯  =105.756 and the posttest total score after the psychoeducation wasX ¯ =66.489,which was a significant decrease (t = 25.571; p < 0.05). The mean CBS pretest total score of the experimental group wasX ¯ =61.067 and the posttest total score wasX ¯ =31.667, which was a significant decrease (t = 17.499;p < 0.05). The study revealed that the six-week individual psycho education provided to primary caregivers of children with autism decreased the participants' internalized stigma and perceived care burden.

Parents' priorities in choosing treatment options for children with autism - perspectives from Serbia

Parents are essential members of the multidisciplinary teams supporting children with autism. Examining parents' priorities in the field of treatment options for children with autism can be very helpful to educators and therapists in the selection of appropriate treatments. The goal of the present study was to explore the treatment priorities which parents may have for their children with autism in Serbia. Another goal was to examine the relationship between parents' priorities and children's current level of functioning. The sample for this study consisted of 141 parents who completed The survey of treatment priorities. The results showed that parents ranked as their highest priorities the areas of Communication Skills, Community Living, and Social Relationships. These findings can help educators and therapists create treatment plans for children with autism that are aligned with parents' priorities.

Clarification of stigma concepts in research with families of individuals with neurodevelopmental disabilities

Stigma concepts among families of individuals with neurodevelopmental disabilities have received increased attention from researchers in the past decade. With a growing number of studies published, there are also notable discrepancies in conceptualizations and uses of stigma terms among scholars. These variations may result in inadequate comparisons of findings across studies and a failure to generalize the results. Therefore, I have compared various stigma concepts and offered key features of each term as well as suggested methodology for facilitating stigma research.

Use of the Children's Communication Checklist-2 in School-Aged Students with Autism: A Psychometric Analysis

Measurement of social-pragmatic communication skills is essential for clinicians and researchers working with school-aged children on the autism spectrum. Many measures of these skills require time-intensive training and coding that is impractical for clinical assessment settings. Using a sample of 299 elementary school children (M = 8.6 years, sd = 1.7) with autism whose teachers completed the Children's Communication Checklist-2, we evaluated the psychometric properties of the CCC-2, a commonly used measure of social-pragmatic skills in order to assist researchers and clinicians in identifying the utility of this measure related to their assessment needs. Our results indicate strong psychometric properties for the CCC-2 with this population and a 3-factor model fit: Structural Language, Pragmatic Communication, and Pragmatic Social. Evidence of racial/ethnic bias was found for the structural language factor. Clinical recommendations are provided for using the CCC-2 with students with autism as reported by teachers.

A model of internalized stigma in parents of individuals with disabilities

Background: Stigma has negative impacts on both individuals with disabilities and their caregivers, including poor mental health and social isolation. In the present study, we aimed to test a model of stigma internalization among parents of individuals with disabilities, as this process in not yet completely understood. Aim: Specifically, we explored effects of experienced stigma and neuroticism on affiliate stigma and examined whether perceived stigma and self-blame are mediators in a stigma internalization model. Methods: We recruited 82 parents of individuals with disabilities in Serbia over the course of six months. Parents were asked about perceived stigma, experienced stigma, affiliate stigma, self-blame, and they completed an assessment of personality traits. Results: Both experienced stigma and neuroticism were positively correlated with affiliate stigma. In addition, perceived stigma was a mediator between these variables: parents who experienced stigma more and had higher neuroticism scores reported higher degrees of perceived stigma, which in turn positively affected affiliate stigma. Self-blame was not a significant mediator in the tested model. Conclusion: We conclude stigma internalization among parents of individuals with disabilities is a complex process, involving experienced stigma, neuroticism, and perceived stigma. Interventions should include multiple paths to adequately support parents to combat stigma.

Practice Patterns and Potential Barriers to Early Diagnosis of Autism in Bosnia and Herzegovina: A Preliminary Study

The aim of this preliminary study was to identify the practice patterns and potential barriers to diagnosing autism in Bosnia & Herzegovina. 126 children aged 23 to 94 months with developmental concerns referred to treatment centers participated in the study. Although parents had reported developmental problems in their children usually around the age of 17 months, it took them 812 visits to professionals (> 6 visits per child) over several months (mean 16.8, range 2-52 months) to get diagnosed with any developmental disorder. Only 8 children (6.3%) received a diagnosis of autism. However, when we re-examined 110 of the 126 children, 90 of them (71%) were identified with autism. Implications of these findings are discussed.