Parents' descriptions and experiences of young children recently diagnosed with intellectual disability

Reflexive thematic analysis of a coaching-based, holistic approach to child development

BACKGROUND

The F-words Life Wheel (FWLW) approaches child development by hybridizing a holistic model in the F-words for Child Development, and a coaching model in Occupational Performance Coaching, along with a life-flow approach in the Kawa model. We report the impact of the FWLW as experienced by families.

METHODS

This was a qualitative interview study of parents of children with developmental needs and experts in child development using reflexive thematic analysis.

RESULTS

From 13 interviews, we developed three themes: 1) overwhelming, 2) power rebalance and 3) connectedness. The overwhelming theme addresses how life with developmental needs is challenging, engaging with the health and disability system is difficult and the focus on deficits can lead to a sense of being overwhelmed. The power rebalance theme addresses the transition from professionals calling the shots to giving agency to the child and family. Holistic goal setting empowers parents and children to direct and prioritize therapy, and helps shift from a deficit-focused to a 'can-do' attitude. The connectedness theme addresses the linkages between psychological health, physical health, the extended family and the planet as a whole.

CONCLUSIONS

The FWLW approach appears to be empowering and motivating for children and families.

Meta-analysis on the effectiveness of parent education for children with disabilities

BACKGROUND

Parents of children with disabilities often have difficulty understanding their child's behavior and are unable to do it appropriately because they do not know what to do. The more we properly understand children with disabilities, the more positive the importance of parent education becomes in various aspects.

AIM

To demonstrate the effectiveness of parent education for children with disabilities in various aspects and present it as evidence that can be used clinically.

METHODS

For a meta-analysis on the effectiveness of parent education for children with disabilities, literature was collected from 2002 to 2022 using PubMed, Embase, Web of Science, Directory of Open Access Journals, and Europe PMC. Search terms were "disabled children," "disabled children," "parent education," "parent training," and "parent coaching." The final searched literature included a total of 11 articles. To calculate the effect size, the mean, standard deviation, and sample size of the experimental and control groups were analyzed, and a meta-analysis was performed using RevMan version 5.4.1. To analyze statistical heterogeneity, a chi-square test was performed to evaluate the significance of Q statistics to indicate statistical heterogeneity.

RESULTS

The final literature totaled 11 articles, and a total of 4 items were analyzed. There were 5 studies on parental depression, the heterogeneity was 98%, and the effect size for parental depression was 0.35 [confidence interval (CI: 0.30-0.40)], indicating a small but statistically significant effect size. There were 4 studies on parenting attitude, the heterogeneity was 100%, the effect size on parenting attitude was 0.41 (CI: 0.37-0.46), which was a medium effect size, and the P value showed a statistically significant score. Additionally, face-to-face parent education was found to have a larger effect size than non-face-to-face education. Regarding parent education methods, face-to-face parent education had a medium effect size [0.57 (CI: 0.52-0.61]), while non-face-to-face parent education had a small effect size [0.23 (CI: 0.18-0.28]).

CONCLUSION

Parental education has shown high effectiveness in child development, and it has proven to be even more effective when face-to-face parenting education is conducted. Accordingly, more effective and objective data was presented. Based on this study, it is believed that parent education research applying various diagnostic groups should continue to be conducted.

Parental experiences of having a child with CLN3 disease (juvenile Batten disease) and how these experiences relate to family resilience

BACKGROUND

CLN3 disease is a neurodegenerative condition presenting in the first decade of life typically leading to death in the third decade. The earliest symptom is rapidly progressive visual impairment followed by intellectual and motor impairments, epilepsy and behavioural disturbances. There are limited data on how the condition affects the family system or the role of family resilience in paediatric neurodegenerative diseases.

METHODS

Semi-structured interviews were conducted with eight parents (five mothers and three fathers) of five children with CLN3. Interview questions focused on the experience of having a child with CLN3, its impact on the family system as well as the concept of family resilience. Data were analysed via thematic analysis.

RESULTS

The thematic analysis resulted in four main themes. The theme 'recurring losses' included the feeling of losing a healthy child, the child's loss of abilities and loss of relationships. The theme 'disruption to the family system' included that siblings could be 'side-lined', the potential negative impact on romantic relationships and difficulties finding time to oneself. The theme 'Society is not developed for a progressive disease' highlighted the difficulties parents faced with respect to contacts with the health and/or social insurance system. The paediatric health care system was seen as supportive, but the adult health care system was not seen as fit for the purpose. Regarding family resilience, parents felt that the disease forced them to reconsider what was important in life. Several parents described that they learned to value small moments of joy and create deep connections through involvement in family routines and rituals.

CONCLUSIONS

CLN3 places a very significant burden on the family system including parental feelings of loss, impact on family relationships and lack of understanding within the health/social insurance systems. The concept of family resilience may be useful in understanding the experiences of families affected by paediatric neurodegenerative conditions.

Feeling of grief and loss in parental caregivers of adults diagnosed with intellectual disability

BACKGROUND

The diagnosis of intellectual disability in children can produce complex grief-related feelings in their parents. Previous studies have focused on the moment of the diagnosis or the early life of the children, and little research has been conducted on their feelings of grief in adulthood. The objective was to analyse the process of grief/loss in parents of adult offspring with intellectual disability.

METHOD

The intentional sampling included sixteen parents who responded to semi-structured interviews. A qualitative study was conducted based on grounded theory.

RESULTS

Five categories were identified: "Reception of the diagnosis", "Emotional bonds with the child", "Experience of loss and feelings in response to intellectual disability diagnosis", "Recurrent grief" and "Coping strategies".

CONCLUSIONS

Recurring feelings of loss experienced by parents in relation to their child's diagnosis persist over time. Specialized emotional interventions are needed to help parents to reduce the intensity of their feelings of grief.

Validity and Reliability of the Life Transition Scale in Parents of Disabled Children Across the Life Transition Process

Purpose

The Life Transition Scale (LTS) consists of 24 items that assess the life transition process of parents of autistic children. This study aimed to examine the validity and reliability of the LTS in parents of children with a wide spectrum of disabilities.

Methods

Data were collected from 260 parents of children with disabilities through self-report questionnaires. Validity was examined using exploratory and confirmative factor analysis to determine the factor structures of the LTS; socio-demographic differences in LTS scores were examined using the t-test or ANOVA. Reliability was examined using Cronbach's ⍺ coefficient.

Results

A four-factor structure was validated (x²=640.0, p<.001, GFI=.81, RMSEA=.07, NNFI=.89, CFI=.89, PNFI=.74, Q [x²/df]=2.60). The validity of the LTS was verified by exploratory factor analysis, with factor loading ranging from .30 to .80. There were significant differences in the accepting phase according to children's and parents' age and the type of disability, and in the wandering phase according to parental gender, educational level, job, and socioeconomic status. The Cronbach's ⍺s for the reliability of each of the four structures were acceptable, within a range of .80~.90.

Conclusion

The LTS is a valid and reliable measurement to assess the life transition process of parents with disabled children.

The experiences of Dutch fathers on fathering children with disabilities: 'Hey, that is a father and his daughter, that is it'

BACKGROUND

Due to a predominant focus on mothers, fathers of children with disabilities are greatly overlooked in research. One could argue that there is a lack of research on the multifaceted nature of fatherhood altogether. Therefore, this study aims to gain insight into the perceived experiences of fathers of children with disabilities.

METHODS

These perceptions were studied by analysing data generated through semi-structured interviews, which were conducted with 12 Dutch fathers of children or young adults with disabilities.

RESULTS

Categories found during our data analysis were similar to those illustrated in the 'conceptual framework on responsible fathering' by including role identification, commitment, employment characteristics, cultural expectations and social support.

CONCLUSIONS

Overall, the fathers in this study reported similar experiences, but this study identified new life perspective as an additional category, which might be specific for fathers of children with disabilities. This new life perspective included a positive attitude, living in the moment, appreciation of the little things and transformation of expectations. Some fathers expressed that their child(ren) has enriched their lives, which positively influenced their fathering experience.

Resilience in the face of adversity in adults with an intellectual disability: A literature review

Background

Persons with an intellectual disability are at a higher risk of experiencing adversities. The concept of resilience offers promising insights into facilitating personal growth after adversity. The current study aims at providing an overview of the current research on resilience and the way this can contribute to quality of life in people with intellectual disability.

Method

A literature review was conducted in the databases PsycINFO and Web of Science. To evaluate the quality of the studies, the Mixed Method Appraisal Tool (MMAT) was used.

Results

The themes, autonomy, self‐acceptance and physical health, were identified as internal sources of resilience. External sources of resilience can be found within the social network and daily activities.

Conclusion

The current overview shows promising results to address resilience in adults with intellectual disability. More research is needed to identify the full range of resiliency factors.

Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature

Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients' therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients' perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients' expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.

Parents' Experiences of Health and Needs When Supporting Their Adolescents With Cerebral Palsy During Transition to Adulthood

AIMS

Parents are the primary support providers for adolescents with disabilities, their health and wellbeing is therefore of great importance when planning for youths' transition into adulthood. The aim of this study was to gain a deeper understanding of how parents of adolescents with cerebral palsy (CP) experience their own health and wellbeing and their needs for support during the adolescent's transition to adulthood.

METHODS

An inductive qualitative approach was used, including interviews with 15 mothers and fathers to 10 adolescents with CP aged 17-18 years. Latent content analysis was used for analyzing the data.

RESULTS

The main theme "Friction blisters chafing and healing during transition" illustrates the parents' experiences. Five sub-themes formed the parents' experiences of concerns along with sorrow and stress in life, worries about what was to come, their need for support, strategies for coping, and experiences of cohesion.

CONCLUSIONS

Knowledge of parents' experiences of their health, wellbeing, and needs provide valuable information for the planning of transition for adolescents with disabilities. Help with parents' sorrow, stress, and worry in daily life might be facilitated and parental health safeguarded by a navigator who can both guide and give hands-on support.

[Construct validity of the life transition scale for parents of children with autism]

PURPOSE

The study was done to identify the construct validity and reliability of the life transition scale (LTS) for parents who have children with autism.

METHODS

Exploratory factor analysis (EFA) and confirmative factor analysis (CFA) were conducted to identify the most adequate measurement model for structural validity. Convergent validity and discriminant validity were also conducted for structural validity. Data were collected from 208 parents through self-reported questionnaires and analyzed with SPSS/WIN 15.0 and AMOS 20.0 version.

RESULTS

A four factor-structure was validated (χ²=541.23, p<.001, GFI=.82, RMSEA=.07, IFI=.89, CFI=.89, PNFI=.73, Q (χ²/df)=2.20) at the 3rd order of EFA and CFA, and factors were named as denying, wandering, despairing, and accepting. Both convergent and determinant validity for LTS were 100%. Cronbach's alphas for the reliability of each structure were .77-.90 and .83 for total structure.

CONCLUSION

The four structures, 24-item instrument showed satisfactory reliability and validity. LTS has the potential to be appropriate for assessing the transition process of life for parents who have children with autism and provides basic directions for differentiated support and care at each stage.

"Her energy kind of went into a different place": a qualitative study examining supervisors' experience of promoting reflexive learning in students

For family therapists in training, a key learning outcome is the development of reflexive abilities. This study explores the experience of three experienced training supervisors as they address this learning outcome with students. Transcripts of semi-structured interviews were analyzed using interpretative phenomenological analysis. The Supervisory Relationship emerged as a single overarching theme that contained and contextualized three further themes: Promoting Learning, Dimensions of Power, and The Self of the Supervisor. One theme is reported here, Promoting Learning, with an illustrative example of experiential learning in a student that demonstrates the overriding significance of The Supervisory Relationship. The findings are discussed in the context of current literature and research regarding supervision and training. This study adds richness and detail to material published on supervisory experience, and documents supervisory "micro-skills" relevant to the development of reflexive abilities in students.