Difficulties experienced by families with disabled children

Strength in silence: the journey of mothers raising children with hydrocephalus

BACKGROUND

Raising a child with hydrocephalus can be very challenging, especially in low- and middle-income countries. In Pakistan, mothers being the primary caregivers for their hydrocephalic children are under tremendous stress.

METHODS

This study explores the challenges faced by Pakistani mothers raising children with hydrocephalus, employing a qualitative methodology through focus group discussions comprising ten mothers of hydrocephalic babies at Tertiary Care Hospital in Pakistan.

RESULTS

The findings highlight three main themes: emotional toll, social isolation, and financial strain. Mothers experience significant emotional stress due to societal stigma and a lack of support, particularly from their husbands and family. Social isolation is prevalent, as mothers fear sharing their burdens and face physical confinement due to their children's needs. Financial strain is another major issue, with high medical costs adding to their economic difficulties.

CONCLUSION

The study emphasizes improved access to specialized care, awareness campaigns to reduce stigma, financial assistance, and stronger community support networks to support these mothers better. Addressing these unmet needs is crucial for empowering Pakistani mothers in their caregiving roles and improving the quality of life for their children with hydrocephalus.

Quality of Life of Children with Short Bowel Syndrome from Patients' and Parents' Points of View

Despite limited research, existing studies using generic quality of life (QOL) tools indicate decreased physical health and compromised emotional functioning in children with IF. This study investigates QOL in children with short bowel syndrome (SBS) and its determinants. The study included 57 pediatric patients with SBS treated at Mannheim's University Hospital between 1998 and 2014. To evaluate QOL, the KINDL questionnaire was used. Three age-specific questionnaire variants were employed, and parental proxy reports were collected. Most patients underwent intestinal lengthening procedures, with varying primary diagnoses. A comparison with healthy children from the patient's perspective revealed no difference but from the parent's perspective showed lower QOL in SBS patients, especially regarding physical and mental well-being. QOL varied with age, with 7-10-year-olds reporting the lowest scores. Several factors, including independence from parenteral nutrition and the presence of a complete colon, positively influenced QOL. The independence of parenteral nutrition and the presence of a complete colon positively influenced QOL. The Bianchi technique for intestinal lengthening has also shown promise but needs further research. The observation sample in this study is too small to generalize about the whole population of SBS patients. However, this study shows that many health and treatment factors affect QOL, and a large multicenter study is necessary. Our findings underline the importance of appropriate psychological support for children with SBS and their families.

O processo de adaptação e desempenho ocupacional de mães de crianças no transtorno do espectro autista

Resumo Introdução A adaptação a um filho no Transtorno do Espectro do Autismo (TEA) pode impactar o desempenho ocupacional das mães em razão dos cuidados demandados, que podem dificultar a realização das suas ocupações. Objetivo Investigar a adaptação e o desempenho ocupacional das mães de filhos com TEA. Método Estudo descritivo transversal de abordagem quantiqualitativa com 11 mães de filhos no TEA com idade entre 2 e 9 anos. Os dados foram coletados por meio da Escala Parental de Adaptação à Deficiência (EPAD) e da Medida Canadense de Desempenho Ocupacional (COPM). Os dados da EPAD foram analisados pela soma dos escores de cada participante e cálculo da média geral e os da COPM a partir dos valores atribuídos para o desempenho e satisfação. Resultados As mães estavam em adaptadas a seus filhos; entretanto, avaliaram a presença de problemas funcionais para o desempenho ocupacional após o nascimento deles. Problemas na categoria produtividade, especificamente para trabalhar, por conta das demandas de cuidados com o filho, foram referidos pela maioria das mães. Na categoria autocuidado, algumas mães referiram problemas para ir ao salão de beleza e tomar banho. Na categoria lazer, algumas mães indicaram problemas para realizar leitura, atividade física, viajar e/ou visitar amigos. Conclusão As mães deste estudo demostraram que a adaptação a seus filhos envolve fatores como transmissão do diagnóstico, informação, características dos filhos, condições socioeconômicas, resiliência, crenças e expectativas pessoais. Conclui-se que as mães de filhos no TEA investigadas apresentaram problemas funcionais para o desempenho ocupacional após o nascimento desses filhos.

Adaptation process and occupational performance of mothers of children with autism spectrum disorders

Abstract Introduction Adapting to a child with Autism Spectrum Disorder (ASD) can impact the occupational performance of mothers because of the care they demand, which can lead to difficulties in carrying out their occupations. Objective To investigate the occupational performance and adaptation of mothers to their children with ASD. Method Cross-sectional, descriptive, quantitative and qualitative study conducted with 11 mothers of children with ASD aged 2-9 years. Data were collected using the Parental Disability Adaptation Scale (EPAD) and the Canadian Occupational Performance Measure (COPM). EPAD data were analyzed by adding the scores of each participant and calculating the general average, whereas COPM data were analyzed from the values assigned to performance and satisfaction. Results The mothers were well adapted to their children; however, they evaluated the presence of functional problems for occupational performance after their birth. Functional problems in the productivity category, specifically in work performance due to the demands of caring for the children, were mentioned by most mothers. In the self-care category, some mothers reported problems related to going to the salon and taking a shower. In the leisure category, some mothers indicated problems with reading, physical activity, traveling and/or visiting friends. Conclusion The mothers in this study reported that adapting to their children with ASD involves factors such as transmission of the diagnosis, information, children characteristics, socioeconomic conditions, resilience, and personal beliefs and expectations. In conclusion, the mothers of children with ASD investigated presented functional problems regarding their occupational performance after the birth of these children.

The effect of motor and functional independence of disabled children on musculoskeletal disorders in pediatric caregivers: A cross-sectional study

Background/Aim: There are conflicting results regarding the effect of motor and functional independence levels of disabled children on the burden of care. In addition, this burden, as well as musculoskeletal problems of pediatric caregivers, has not been examined in detail. The aim of this study is to examine the effects of motor and functional levels of the disabled child. Methods: The study was planned as a single-blind, multicenter, cross-sectional study. Children between ages 1-12 with physical disabilities from various problems, and 65 caregivers over the age of 18 who cared for them for at least 6 months, were included. Caregivers were divided into two groups, as per the BAKAS Caregiver Impact Scale score as high care burden (n = 33) or low care burden (n = 32). The motor level of the disabled child was determined by the Gross Motor Function Classification System, and the functional level of the Pediatric Functional Independence Measurement. The Nordic Musculoskeletal Questionnaire was used to evaluate musculoskeletal problems in caregivers. Results: There was no significant difference between the Gross Motor Function Classification System levels of children in groups (P > 0.05). The Pediatric Functional Independence Measurement scores of children in the high care burden group were significantly lower than those in the low care burden group (P < 0.05). According to a comparison of pain in parts of the body for 12 months, using the Nordic Musculoskeletal Questionnaire, the percentage of pain in the neck, shoulder, back, elbow, hand, hip, and foot regions of caregivers was significantly higher in the group with a high care burden (P < 0.05). There was no significant difference between percent of low back and knee pain in the last 12 months (P > 0.05). A weak positive correlation was found between the BAKAS Caregiver Impact scores and the Pediatric Functional Independence Measurement of children with disabilities (r = 0.26; P = 0.03). Conclusion: The lower functional level of the disabled child may cause an increase in caregiver burden of both the caregivers and musculoskeletal disorders.

Effects of clinical Pilates exercises on cardiovascular endurance and psychosomatic parameters on primary caregivers of special needs children: A randomized controlled trial

OBJECTIVE

Our objective was to investigate the effects of clinical Pilates exercises (CPE), applied to the primary caregivers of special needs children, on cardiovascular endurance (CVE) and psychosomatic parameters in comparison to a control group.

METHODS

Fifty-five primary caregivers of special needs children, divided into two groups as the CPE and control groups, were included in the study. The six-minute walk test, the Fatigue Severity Scale, the Coping Orientation for Problems Experienced (COPE) Inventory, the Beck Depression Inventory and the State-Trait Anxiety Inventory were used to measure CVE, fatigue severity, attitudes toward coping with problems, depression levels and anxiety levels, respectively.

RESULTS

Statistically significant differences between the groups in favor of the CPE group were found concerning the denial parameter of COPE, fatigue (which was the primary outcome), depression and anxiety (all p values < 0.05). Statistically significant intragroup comparison differences were only detected in the CPE group in the fatigue, depression, anxiety and COPE (use of instrumental and emotional social support and focus on and venting of emotions) questionnaire results (all p values < 0.05).

CONCLUSIONS

CPE are an applicable and effective method for the primary caregivers of special needs children in improving psychosomatic parameters, albeit not effective for CVE. It is recommended to investigate the long-term effects of clinical Pilates exercises on a similar group.

African families' and caregivers' experiences of raising a child with intellectual disability: A narrative synthesis of qualitative studies

Background

The prevalence of intellectual disability was high in Africa, particularly amongst low socio-economic communities. Despite this, there was limited literature on primary caregivers and parents of people with intellectual disabilities regarding their experience raising an individual with the condition, especially within the African context.

Objectives

The aim of the current systematic review was to investigate experiences of caregivers and parents of children with intellectual disability in Africa.

Method

We used strict eligibility criteria to identify suitable studies. We identified Medical Subject Headings (MeSH) terms and other keyword terms and, after conducting searches in electronic databases, identified articles that met the inclusion criteria for articles published between 1975 and the end of 2019.

Results

164 articles were assessed for eligibility. Nine studies met the review's criteria. Six major themes emerged: understanding of intellectual disability (ID), worries about the future, burden of care, lack of services, coping strategies and stigma and discrimination.

Conclusion

Caregivers of children with intellectual disability in Africa faced substantial challenges. Current findings suggested that there was the need for both formal and alternative healthcare workers to work together towards an understanding and management of intellectual disability in Africa.

Mindfulness-Based Stress Reduction (MBSR) and Self Compassion (SC) Training for Parents of Children with Autism Spectrum Disorders: A Pilot Trial in Community Services in Spain

This study aims to develop a clinical trial to test the efficacy of a mindfulness-based stress reduction (MBSR) and self-compassion (SC) program on self-reported values of anxiety, depression, and stress in parents of children with autism spectrum disorder (ASD) in primary school, in order to assess their integration into the framework of community intervention programs in Spain.

METHODS

A brief 8-week training program using mindfulness-based intervention (MBSR) and self-compassion (SC) has been applied to twelve Valencian ASD parents, ten of whom completed the program. Participants were assigned to two groups; both groups received the same treatment but at two different measurement moments. Depression, anxiety, stress, satisfaction with life and mindful attention awareness measurements were performed, in all participants, in three testing stages.

RESULTS

Analysis of variance results suggested that MBSR and SC training reduces stress and anxiety and increases mindful attention awareness. No significant changes were found in life satisfaction measurements.

CONCLUSIONS

The small number of participants prevents us from generalizing the results found. More MBSR and SC clinical trials are needed in parents of ASD with results on anxiety, depression and stress in order to demonstrate the relevance of the inclusion of these programs in community-based early intervention services.

Bedouin mothers of young children with developmental disability - Stigma, quality of life and collaboration with professionals

BACKGROUND

Although children across the world experience Developmental Disabilities, most research on DD has been conducted using Western cultural perspectives. Similarly, though much has been written on the subject of collaboration between parents and professionals around the world, this subject has hardly been studied among Bedouin mothers in the Middle East, leaving significant gaps in the literature. This study intends to fill some of these gaps by exploring and gaining an understanding of the experiences of Bedouin mothers raising young children with DD.

AIMS

The aims of the study were to examine: A) Do stigma and the QoL of mothers of young children with DD affect the collaboration between them and professionals? B) Do relationships exist between stigma, QoL, and collaboration among the mothers?

METHODS

Ninety Bedouin mothers of children with DD completed: a socio-demographic questionnaire, a questionnaire of collaboration between parents and professionals, and a QoL questionnaire.

RESULTS

A significant negative relationship was found between stigma and the collaboration of the mothers with the professional, and a significant positive relationship between QoL and collaboration. The model for predicting collaboration using stigma and QoL was significant.

CONCLUSIONS AND IMPLICATIONS

This study emphasizes the need for collaboration between this mothers and professionals, and to develop community programs.

Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs

The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.

'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa

BACKGROUND

Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them.

METHODS

We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers' and parents' views.

RESULTS

Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation.

CONCLUSION

Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.

"We have been magnified for years - Now you are under the microscope!": Co-researchers with Learning Disabilities Created an Online Survey to Challenge Public Understanding of Learning Disabilities

Public attitudes towards learning disabilities (LDs) are generally reported as positive, inclusive and empathetic. However, these findings do not reflect the lived experiences of people with LDs. To shed light on this disparity, a team of co-researchers with LDs created the first online survey to challenge public understanding of LDs, asking questions in ways that are important to them and represent how they see themselves. Here, we describe and evaluate the process of creating an accessible survey platform and an online survey in a research team consisting of academic and non-academic professionals with and without LDs or autism. Through this inclusive research process, the co-designed survey met the expectations of the co-researchers and was well-received by the initial survey respondents. We reflect on the co-researchers' perspectives following the study completion, and consider the difficulties and advantages we encountered deploying such approaches and their potential implications on future survey data analysis.

Spiritual Orientation, Meaning in Life, Life Satisfaction, and Well-Being in Mothers with Disabled Children

This study was planned in order to investigate the relationship between spiritual orientation with meaning in life, life satisfaction and well-being in mothers with disabled children. The research was carried out with 128 mothers in a private rehabilitation center at eastern Turkey. The Spiritual Orientation Scale (SOS), Meaning in Life Questionnaire (MLQ), Life Satisfaction Scale (LSS), and Well-Being Index (WBI) were used in the data collection. The mean score of the mothers on the SOS was found to be high (89.34 ± 7.14). It was determined that as the mean scores of mothers on the SOS increased, their mean scores on MLQ, LSS, and WBI increased and that the relationship between them was significant (p < 0.05). It was found that as the spiritual orientation of the mothers increased, meaning in life, life satisfaction, and well-being increased as well.

Multilingual Diversity in the Field of Applied Behavior Analysis and Autism: A Brief Review and Discussion of Future Directions

This review addresses multilingual diversity within the field of Applied Behavior Analysis (ABA) as it relates to treatment for autism spectrum disorders (ASD). The United States was founded as a diverse, multicultural "melting pot" and migration patterns continue to increase cultural and linguistic diversity, making it increasingly important to address these issues within the field of ABA. The role of multilingualism in ABA treatment for autism has scarcely been addressed in practice or in research and yet these factors likely impact the ABA treatment process significantly. The purpose of this review is to discuss how multilingualism might be better addressed within the field of ABA. We briefly review the very small amount of existing research on multilingual approaches when using ABA and discuss directions for future research. In addition, we discuss potential future directions for the field, in terms of increasing the number of international students in graduate programs, enhancing diversity curricula within graduate programs and continuing education, and efforts by professional organizations to address diversity.

The effect of the Hambisela programme on stress levels and quality of life of primary caregivers of children with cerebral palsy: A pilot study

BACKGROUND

Caregivers of children with cerebral palsy (CP) are at risk of having high stress levels and poor quality of life (QOL) which could have a detrimental effect on themselves and their children. Taking caregivers' well-being into consideration is therefore important when providing rehabilitation to children with CP. Interventions to mediate primary caregiver stress and QOL using an educational tool have not been tested in this population in South Africa.

OBJECTIVES

The aim of this study was to determine the effect of a group-based educational intervention, Hambisela, on stress levels and QOL of primary caregivers of children with CP in Mamelodi, a township in Gauteng, South Africa.

METHOD

Eighteen primary caregivers of children with CP participated in a quasi-experimental pretest-post-test pilot study. Hambisela, a group-based educational intervention, was carried out once a week over 8 consecutive weeks. Caregiver stress and QOL were assessed before and after the intervention using the Parenting Stress Index-Short Form (PSI-SF) and the Paediatric Quality of Life-Family Impact Module (PedsQL^TM-FIM). Sociodemographic information was assessed using a demographic questionnaire. The Gross Motor Function Classification System (GMFCS) was used to assess the gross motor level of severity of CP in the children.

RESULTS

Data were collected for 18 participants at baseline and 16 participants at follow-up. At baseline, 14 (87.5%) participants had clinically significant stress which reduced to 11 (68.8%) at follow-up. There was no significant change in primary caregiver's stress levels (p = 0.72) and QOL (p = 0.85) after the Hambisela programme. Higher levels of education were moderately associated with lower levels of primary caregiver stress (r = -0.50; p = 0.03).

CONCLUSION

Most primary caregivers in this pilot study suffered from clinically significant stress levels. Hambisela, as an educational intervention, was not effective in reducing the stress or improving the QOL in these primary caregivers of children with CP. Future studies with a larger sample size are needed to investigate the high stress levels of primary caregivers of children with CP.

CLINICAL IMPLICATIONS

Rehabilitation services for children with disabilities should include assessments to identify caregivers with high stress levels. Holistic management programmes should also include care for the carers.

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

BACKGROUND

Better daily living skills (DLS) are associated with increased independence and positive functional outcomes in Autism Spectrum Disorder (ASD).

METHOD

The present study aimed to investigate daily living skills (DLS) and the associated factors in 51 children with ASD and intellectual disability (ASD group) and 51 age- and gender-matched controls with intellectual disability (ID group). The severity of the autistic symptoms was measured with the clinician-rated Childhood Autism Rating Scale and the parent-reported Autism Behavior Checklist (ABC) in all children. The mothers also completed the Pediatric Quality of Life Inventory and the Basic DLS Questionnaire.

RESULTS

The ASD group scored lower than the comparison group in the total DLS score, personal hygiene, dressing, safety and interpersonal skills, despite being comparable in the parent-reported quality of life. Regression analysis of the whole sample demonstrated that the child's age, intellectual level, speech level, autism symptom severity and the monthly household income were independent correlates of the total DLS. Exploratory analyses for each group revealed differential effects of these variables: in the ASD group; a higher speech level and monthly income, while in the ID group; an older age, a higher intellectual level and monthly income and a lower ABC score emerged as significant predictors of higher DLS.

CONCLUSIONS

Deficient DLS in Turkish children with ASD, given their IQ, suggest that lower level of adaptive skills is inherent in ASD, rather than culture-specific to US and Western Europe.

Understanding and awareness of autism among Somali parents living in the United Kingdom

Using vignettes and interviews, this study examined understanding and awareness of autism, and (a)typical development more broadly, among 32 Somali parents living in the United Kingdom. Results demonstrated that parents of both autistic (n = 16) and non-autistic (n = 16) children were just as likely to identify vignettes of typically developing children, yet parents of autistic children appeared more astute to signs of atypical development. Across the whole sample, parents commonly identified and labelled vignettes of autistic children, but experienced more difficulty labelling vignettes that described children with other forms of atypical development, sometimes mislabeling these children as autistic. This suggests that there is a need for greater support in recognising and identifying different types of atypical development in the Somali community (to mitigate the risk that the term 'autism' may take on its own meaning within the Somali community, becoming a euphemism for a range of developmental conditions). Analysis of interview data identified key sociocultural factors that either helped or hindered the inclusion of families with autistic children within the community, including the Somali community's: (1) perceptions of disability, (2) beliefs about the causes of autism in the Western world and (3) strong reliance on religious beliefs in understanding and accepting an autism diagnosis.

Associations of Coexisting Conditions with Healthcare Spending for Children with Cerebral Palsy

OBJECTIVE

To determine which coexisting conditions have the strongest associations with healthcare use and spending among children with cerebral palsy (CP).

STUDY DESIGN

Retrospective analysis of 16 695 children ages 0-18 years with CP - identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes - using Medicaid from January 1, 2013 to December 31, 2013 from 10 states in the Truven MarketScan Medicaid Database. Using generalized linear models, we assessed which coexisting conditions (including medical technology) identified with Agency for Healthcare Research and Quality's Chronic Condition Indicators had the strongest associations with total healthcare spending across the healthcare continuum.

RESULTS

Median per-patient annual Medicaid spending for children with CP was $12 299 (IQR $4826-$35 582). Most spending went to specialty (33.1%) and hospital (26.7%) care. The children had a median 6 (IQR 4-10) coexisting conditions; epilepsy was the most common (38.1%). Children with epilepsy accounted for 59.6% ($364 million) of all CP spending. In multivariable analysis, the coexisting conditions most strongly associated with increased spending were tracheostomy (median additional cost per patient = $56 567 [95%CI $51 386-61 748]) and enterostomy (median additional cost per patient = $25 707 [95%CI $23 753-27 660]).

CONCLUSIONS

Highly prevalent in children with CP using Medicaid, coexisting conditions correlate strongly with healthcare spending. Tracheostomy and enterostomy, which indicate significant functional impairments in breathing and digestion, are associated with the highest spending. Families, providers, payers, and legislators may leverage these findings when designing policies positioned to enable the best health and care for children with cerebral palsy.

Satisfaction with Life among Mothers of Pediatric Cochlear Implant Candidates: The Impact of Implant Operation and Sociodemographic Factors

OBJECTIVES

To evaluate the satisfaction with life among mothers of pediatric cochlear implant candidates regarding implant surgery and sociodemographic factors.

MATERIALS AND METHODS

Mothers of 160 pediatric patients with profound sensorineural hearing loss who underwent unilateral cochlear implant surgery were included. A questionnaire form with items on sociodemographic-familial characteristics and Satisfaction with Life Scale (SWLS) was employed via face-to-face interview method before and 12 months after the implant surgery.

RESULTS

The SWLS scores significantly improved after the implant surgery [from 19.1 (7.0) to 28.9 (4.0), p<0.000]. Being unemployed vs. employed [17.9 (6.9) vs. 24.0 (5.3), p=0.000], having another child with hearing disability [13.5 (5.7) vs. 19.7 (6.9), p=0.001], younger (12-24 months) vs. older (>24 months) age of the child at the time of implant surgery [7.1 (0.4) vs. 19.7 (6.6), p=0.001], absence vs. presence of regular follow-up visits [13.0 (0.0) vs. 19.4 (7.1), p=0.002], and presence vs. absence of change in social life after the diagnosis of disease [17.3 (6.5) vs. 20.9 (7.1), p=0.001] were associated with significantly lower SWLS scores among mothers. SWLS scores were positively correlated with patient's age at the time of implant surgery (r=0.206, p=0.009), whereas negatively correlated with the number of household members (r=-0.406, p=0.000) and number of children (r=-0.310, p=0.000).

CONCLUSION

In conclusion, our findings revealed the association of cochlear implantation with a significant increase in mother's life satisfaction, despite the unemployment, presence of another child with hearing disability, and crowded household. Our findings emphasize on the consideration of family systems with special attention to mother's emotional experiences and occupational competence in the intervention programs.

Phenomenological needs assessment of parents of children with cochlear implants

Background

The use of cochlear implants has been a remarkable success in reducing disabilities in those with impaired hearing, which have made a significant change in the patients’ quality of life. Only by relying on cochlear implants, disabilities cannot be eliminated in the hearing impaired, and, alongside this intervention, rehabilitation practices such as through family and community support are necessary.

Aim

To explain the needs of parents of children with cochlear implants to increase the quality of rehabilitation services and family-based interventions.

Methods

A descriptive phenomenology study was performed with the participation of 16 people, including eight mothers, three fathers, and five experts involved with the rehabilitation of children aged 2–7 years with cochlear implants. The research setting was centers with speech therapy service providers for hearing-impaired children in the city of Shiraz (Iran) in 2015. Information was gathered through in-depth interviews with participants and analyzed by using Colaizzi’s nine-step analysis method and MAXQDA (Ver10) applications.

Results

The mean age of participants was 34 years, and the average age of diagnosis of hearing problems in children was 12 months. The obtained data from the analysis of interviews about the needs of parents of children with cochlear implants were categorized into 19 sub-contents and five contents, as follows: the need for access to health care services; psychological needs; mood-related needs of a child; educational needs and financial requirements.

Conclusion

Parents of children with cochlear implants have numerous needs, and they encounter problems based on their situation and experiences. The results indicate the necessity of close cooperation among different professionals such as an audiologist, pediatrician, psychologist, and speech therapist for the program’s success.

Vision assessment in persons with intellectual disabilities

PURPOSE

To investigate the degree of visual acuity in workers with intellectual disabilities and the impact of vision on their working conditions.

METHODS

We recruited 224 workers (mean age 43.77 years, SD ± 12.96; range, 19-72 years) from a workshop for those with intellectual disabilities, to participate in a vision examination program. The assessment consisted of objective refraction, visual acuity, ocular motility, near-point of convergence, cover/uncover test, stereo acuity and colour perception. Individuals with vision deficits were fitted with spectacles following the screening program.

RESULTS

Within the past three years, 38.9 per cent of the participants received eye care, 14.3 per cent of participants had not received eye care in more than three years, and 6.7 per cent had not received any eye care. As many as 39.7 per cent of participants did not know whether they had ever received eye care. Entering visual acuity for far vision was 0.52 dec (-0.29 logMAR) and 0.42 dec (-0.38 logMAR) for near vision. Only 14.9 per cent, 11 of all participants aged ≥50 years, owned spectacles for near vision before the examination. After subjective determination of refraction, best corrected visual acuity for far vision was 0.61 dec (-0.22 logMAR) and 0.56 dec (-0.25 logMAR) for near vision (in both cases with p < 0.001). After the examination, 44.6 per cent (33) of all workers aged ≥50 years received a recommendation for reading or bifocal spectacles. In 46 per cent of workers, the threshold of stereopsis was higher than 63 arc seconds, and some form of colour vision deficiency was measured in 12.5 per cent of participants.

CONCLUSIONS

Workers with intellectual disabilities are often unaware of their visual deficits. We found that some of their abnormalities can be solved by appropriate optical means and that they could benefit from regular eye care. These workers should be encouraged to be tested and to improve their vision with appropriate lenses.

Barriers to unmet needs among mothers of children with disabilities in Kelantan, Malaysia: A qualitative study

Objectives

The present study aimed to determine the barriers that deter mothers of children with disabilities from attaining their unmet needs.

Methods

In-depth interviews of 12 mothers of children with disabilities were conducted from November 2014 to January 2015 in Kelantan, Malaysia. The mothers were recruited by purposive sampling. Thematic analysis was used for identifying, analysing and reporting the data.

Results

Barriers to the unmet needs among mothers of children with disabilities were found to stem from the mothers' expectation and further propagated by lack of support, the role of healthcare professionals in providing care, inappropriate policies and shortage of resources required for survival and maintaining care.

Conclusions

Identification of the barriers to the attainment of unmet needs among mothers of disabled children is crucial for resolving the issue of unmet needs. Deeper understanding of these barriers may facilitate positive actions toward addressing the needs of these mothers and to alleviate the stress on mothers of disabled children. A concerted effort to coordinate services across all disciplines is required to dismantle these barriers by improving the provision of health care delivery and evaluation of welfare policies and services.

Children with disabilities and trajectories of parents' unsecured debt across the life course

Prior research shows that having a child with a disability is economically burdensome for parents but we know little about whether this burden extends to unsecured debt. In this study, we examine the link between having a child with a disability that manifests between birth and age 4 and subsequent trajectories in unsecured household debt. We have three key findings. First, we find that having a child with an early-life disabling health condition is associated with a substantial increase in indebtedness in the years immediately following the child's birth, and that this association persists net of a range of potential confounders. Second, we find that parents do not quickly repay this debt, such that parents of a child with a disabling health condition have different trajectories of unsecured debt across the life course than do parents of children without a disabling health condition. Third, we find that the association between early-life child disability and debt is stronger for more severe conditions, such as those that require ongoing medical treatment. The results of this study are informative for understanding an important aspect of economic functioning-indebtedness-for parents of children with disabilities, as well as the causes and correlates of rising unsecured debt in the U.S.

Family adaptation to cerebral palsy in adolescents: A European multicenter study

BACKGROUND AND AIM

Factors promoting family adaptation to child's disability are poorly studied together. The aim of the study was to describe the family adaptation to disability and to identify determinants associated with using a global theoretical model.

MATERIALS AND METHODS

286 families of teenagers [13-17 years] with cerebral palsy (CP) from 4 European disability registers were included and visited at home. Face to face interviews were performed in order to measure parental distress, perceived impact in various dimensions of family life, family resources and stressors. Relationships were modelled with structural equations.

RESULTS

31.8% of parents living with an adolescent with CP showed clinically significant high stress requiring professional assistance. The main stressors were the level of motor impairment and behavioural disorders in adolescent. A good family functioning was the best protective factor. Respite in care and a parents' positive attitude were significantly related to less parental distress. Material support, socioeconomical level, marital status or parental qualifications did not appear to be significant protector factors.

CONCLUSIONS

Particular attention must be paid not only on physical condition but also on adolescent psychological problems to improve family adaptation. Families at risk of experiencing severe distress should be targeted early and proactive caregiver interventions on the whole family should be performed.

WHAT THIS PAPER ADDS

Family is a dynamic system: facing disability, it tries to recover its balance with available resources and its perception of the situation. Literature highlights potential stressors and protecting factors that could affect the disabled child's family adaptation but few papers study a global model including most of these factors. This study validated a global theoretical model of family adaptation to disability at adolescence. It identified behaviour disorders and motor impairment level as main stressors, family functioning as the largest protecting factors, and equipment and financial support as non significant protective factors.

Health and quality of life among the caregivers of children with disabilities: A review of literature

Families caring for children with disabilities face particular challenges and demands compared to those caring for children without disabilities. Evidence suggests that there is considerable variation in how caregivers of children with disabilities adapt to their caregiving demands and stressors. The different adaptations to the children with disabilities may cause different impacts on the health and well-being of caregivers. This paper provides a brief overview of the literature on the impact of caring for children with disabilities on the health and quality of life of caregivers and the factors related to the health outcomes and quality of life. A literature search was conducted by using various electronic databases, including PsychINFO, ScienceDirect, ProQuest, and MEDLINE using specific key terms. Thirty-one articles published in peer-review journals from the last six years (2009-2014) were reviewed. Most of the studies were quantitative studies. Factors discussed that impact on caregivers' health and quality of life include the caregivers' sociodemographic background and child's disability-related factors. Several mediators and moderators including coping strategies, social support, parental stress, self-esteem and self-efficacy are described in this paper. This review highlighted the importance of these factors to better understand the complex nature of stress processes and the caregivers' adaptations to their children's disabilities.

Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country

PURPOSE

There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia.

METHOD

Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18-36 months, 81 in Bangladesh (mean = 27.6 months, 61.7% males), and 130 in Australia (mean = 27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) - Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution.

RESULTS

(i) Bangladesh sample: proportion OPD = 68.1%; severity = 10.4 SD = 7.9. Australia sample: proportion OPD = 55.7%; severity = 7.0 SD = 7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR = 2.4, p = 0.051 and β = 1.2, p = 0.08, respectively).

CONCLUSIONS

Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context. Implications for Rehabilitation The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs). Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework. The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes. Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III-V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).

Anticipatory Planning in Children with Autism Spectrum Disorder: An Assessment of Independent and Joint Action Tasks

Autism Spectrum Disorder (ASD) is one of the most common neurodevelopmental disorders. Although not a diagnostic feature, motor impairments have been recently acknowledged as prevalent and significant, such that these children have difficulties planning, organizing and coordinating movements. This study aimed to further investigate anticipatory motor planning in children with ASD by means of assessing end- and beginning-state comfort, considering inconsistent reports of end-state comfort in independent action, and the study of beginning-state comfort being limited to one study with young adults. Five- to eleven-year-old children with ASD, and chronologically age- and sex-matched typically-developing children picked-up a glass and: (1) poured a cup of water; and (2) passed it to the researcher to pour a cup of water. End-state comfort was deemed evident if participants grasped the glass thumb-down followed by a 180° rotation; therefore ending with a thumb-up posture. Beginning-state comfort was deemed evident if participants passed the glass to the researcher oriented upright. Findings revealed less end-state comfort in children with ASD, attributed to motor planning deficits. Beginning-state comfort did not differ, ascribed to the habitual nature of the task; therefore reflecting a stimulus-driven response as opposed to an action which reflects anticipatory planning. The findings support difficulties with motor planning and control for children with ASD in an independent task. However, when acting with a familiar object in joint action, behavior does not differ, likely indicative of a habitual, stimulus-driven response.

'I Wanted to Come Here Because of My Child': Stories of Migration Told by Turkish-Speaking Families Who Have a Son or Daughter with Intellectual Disabilities

BACKGROUND

Despite growing interest in the experiences and social barriers experienced by people with intellectual disabilities from ethnic minorities, the specific challenges associated with migration from abroad faced by these individuals and their families have been overlooked. This research focuses on narratives told by Turkish-speaking families about migrating to the UK with a family member with intellectual disabilities.

METHOD

Semi-structured interviews were carried out with five Turkish-speaking families who have a son or daughter with an intellectual disability and had migrated to the UK. Interviews were analysed using narrative analysis.

RESULTS

Seeking help for the person with intellectual disabilities in a new country was a central part of migration narratives. The family member with intellectual disabilities was described as being caught up in wider geo-political conflicts. Families continued to face challenges within their own communities and with accessing local services.

CONCLUSIONS

Eliciting narratives about families' migration to their new homes can provide professionals with important information about family experiences of trauma and clarify hopes and expectations regarding service provision.

Quality of life in mothers of children with cerebral palsy: The role of children's gross motor function

Four hundred and twenty-four Iranian mothers of children with cerebral palsy (CP) were recruited using the convenience sampling approach in a cross-sectional study. The researchers assessed the quality of life (QOL) in mothers according to the gross motor function levels and types of CP. The evaluation was done using a well-validated Persian version of the 36-item Short Form Health Survey (SF-36) questionnaire. In 2012, demographic data and clinical relevant information were also collected in rehabilitation clinics affiliated to Tehran University of Medical Sciences. The results indicated that the mean score for the study sample on physical component summary (PCS) and mental component summary (MCS) was 39.21 and 41.23, respectively. This suggests that participants considered themselves to have a low QOL (p < .05). The mean PCS scores for SF-36 were significantly different between mothers having CP children of different age, levels of motor function, and CP types (p < .05 and p < .01, respectively). The results indicate that mothers of children with CP suffer from poor physical and mental health. Therefore, particular attention should be paid to the QOL in mothers of children with CP, and rehabilitation professionals should offer supportive strategies to promote aspects of their QOL.

Factors Associated with Quality of Life in Mothers of Children with Cerebral Palsy in Iran

Objective/Background

Children with cerebral palsy (CP) need more attention and care, especially from their mothers. This can affect the mothers’ quality of life (QOL) adversely. This study aimed to assess the QOL of Iranian mothers who have a child with CP, compared with mothers with a healthy child, focusing on some individual and social underlying factors.

Methods

Using a cluster-sampling approach, two groups of eligible mothers having children aged 4–12 years, with and without CP, from Tehran's randomly selected clinics, were chosen in a convenient way and enrolled in a cross-sectional study. A group of mothers with healthy children whose demographics closely matched with the group of mothers having children with CP were selected and recruited in the study. The group with mothers with children with CP was selected randomly from a convenience sample in 14 rehabilitation and occupational therapy clinics in Tehran, Iran. To collect data on characteristics of interest, mothers were interviewed, and the SF-36 Questionnaire was used to measure their QOL. The relationship between each characteristic and the mothers’ level of QOL was assessed, and the crude odds ratios (ORs) and adjusted ORs were measured by logistic regression.

Results

Sixty mothers with CP children, and 60 mothers with healthy children participated in this study. Their mean (±standard deviation) age was 33.79 (±6.02) years, and their children's mean age was 7.11 (±2.71). The two groups were significantly different in QOL mean score (57.35 ± 18.39 vs. 71.7 ± 13.58; p ≤ .001). It was shown that having a child with CP with intellectual disability is significantly related to a worse level of QOL of mothers (adjusted OR = 5.4, p ≤ .001), whereas having full-time jobs is reversely associated with it (adjusted OR = 0.2, p = .02).

Conclusion

Two important factors that lead to a worse QOL of mothers with a CP child are the unemployment of mothers and having a CP child with concurrent intellectual disabilities. To diminish the adverse effects of having a CP child on QOL of mothers, unemployed women who have a CP child with concurrent intellectual disabilities need more psychological support and help.

Stress and resolution in mothers of children with cerebral palsy

Parental resolution of diagnosis represents coming to terms with and accepting the diagnosis of a serious condition in their child. As risk factors for achieving resolution, we investigated: a child's functional status, cumulative stress, and maternal depression. The current study tested the hypothesis that mothers who are unresolved to their child's diagnosis would have considerably higher levels of risk factors, compared to resolved mothers. We also examined whether the observed risk factors could predict the resolution status. Maternal resolution was assessed by means of the Reaction to Diagnosis Interview. The sample consisted of 100 mothers of children aged 2-7, diagnosed with cerebral palsy. The results showed that unresolved mothers had children with poorer functional status, experienced more stressful life events, and were more depressed compared to resolved ones. The functional status of a child and maternal depression were shown to be significant resolution predictors. Importantly, they were more successful in predicting the resolved than the unresolved status. Further research is needed in order to investigate more extensively the unresolved parental status.

Early mortality and primary causes of death in mothers of children with intellectual disability or autism spectrum disorder: a retrospective cohort study

Introduction

Mothers of children with intellectual disability or autism spectrum disorder (ASD) have poorer health than other mothers. Yet no research has explored whether this poorer health is reflected in mortality rates or whether certain causes of death are more likely. We aimed to calculate the hazard ratios for death and for the primary causes of death in mothers of children with intellectual disability or ASD compared to other mothers.

Methods

The study population comprised all mothers of live-born children in Western Australia from 1983–2005. We accessed state-wide databases which enabled us to link socio-demographic details, birth dates, diagnoses of intellectual disability or ASD in the children and dates and causes of death for all mothers who had died prior to 2011. Using Cox Regression with death by any cause and death by each of the three primary causes as the event of interest, we calculated hazard ratios for death for mothers of children intellectual disability or ASD compared to other mothers.

Results and Discussion

During the study period, mothers of children with intellectual disability or ASD had more than twice the risk of death. Mothers of children with intellectual disability were 40% more likely to die of cancer; 150% more likely to die of cardiovascular disease and nearly 200% more likely to die from misadventure than other mothers. Due to small numbers, only hazard ratios for cancer were calculated for mothers of children with ASD. These mothers were about 50% more likely to die from cancer than other mothers. Possible causes and implications of our results are discussed.

Conclusion

Similar studies, pooling data from registries elsewhere, would improve our understanding of factors increasing the mortality of mothers of children with intellectual disability or ASD. This would allow the implementation of informed services and interventions to improve these mothers' longevity.

Silver linings

The purpose of this interpretive phenomenological study was to gain a better understanding of the experiences of 11 mothers of preschool children with autism spectrum disorder (ASD). Mothers were interviewed three times over a 6 week period. Interviews were analyzed using interpretive methods. This manuscript highlights one particular theme-a positive perspective mothers described as the "silver lining." This "silver lining" represents optimism despite the adversities associated with parenting a child with ASD. A deeper understanding of this side of mothering children with ASD may help health care providers improve rapport, communication, and result in more authentic family centered care.

Growing up with cerebral palsy: perceptions of the influence of family

BACKGROUND

Cerebral palsy (CP) is a non-progressive condition present from birth or infancy that includes various neurological patterns of dysfunction. It is characterized by abnormal motor control and/or posture and can involve communication difficulties. Children and youth with CP face multiple social and developmental challenges during their formative years including mild to severe physical limitations, poor socialization, limited recreational activities, and stigmatization. Families play a key role in supporting adaptation to CP. The purpose of this paper was to explore women's perceptions of the ways their families contributed to their overall quality of life with CP.

METHODS

Drawing on data from a qualitative study of eight women with CP, the purpose of this analysis was to examine perceptions of the ways in which their families and individual family members contributed to participants' overall quality of life and adaptation to CP. Respondents ranged in age from 22 years to 55 years and had varied forms of CP. The study was based on a feminist biographical approach, which combines biographical methods with feminist principles.

RESULTS

Participants provided considerable, rich contextual data on their family life and the pivotal role family played. The analysis identified four themes related to supportive family roles: (1) being an advocate, and teaching advocacy; (2) promoting inclusion and acceptance; (3) integrating therapy into daily life; and (4) the importance of siblings as friends and mentors.

CONCLUSIONS

Health-care providers can contribute to the family's ability to facilitate quality of life by providing guidance on how to be advocates and teach advocacy, including the child with CP in family activities, accessing therapy and incorporating beneficial therapies at home, and promoting healthy sibling relationships.

Nutritional problems in children with neuromotor disabilities: an Italian case series

Background and aims

Several neuromotor disorders share exclusive, although often overlooked, nutritional problems. The objective of this study is therefore to delineate the frequency of malnutrition, evaluate the effectiveness of nutritional care, and identify issues needing to be possibly strengthened when caring for these patients into a general pediatrics department.

Patients and methods

The study included 30 patients, 21 males and 9 females, aged between 2 and 15 years, affected by cerebral palsy, epileptic encephalopathy, and severe psychomotor developmental delay.

Nutritional status was assessed by a dietary questionnaire administered to parents to investigate feeding difficulties; 3 days food diary to quantify daily calorie intake; anthropometrical (weight, height/length, body mass index percentiles, plicometry, specific body segments measurement) and blood (blood count, serum iron, albumin, transferrin, calcium, phosphorus) parameters.

Results

More than 44% individuals of the study population was at risk of malnutrition, according to feeding difficulties, progressive depletion of weight, reduced daily calorie intake, reduced albumin and transferrin levels. This occurred despite a massive caregivers commitment, as documented by almost universal parental constant assistance during their long-duration meals.

Conclusions

Our results individuate the nutritional aspect being still a problem in the care of children with severe neuromotor disability.

Social support provided to caregivers of children with cerebral palsy

OBJECTIVE

To describe the perception of caregivers of children with cerebral palsy (CP) concerning social support received and to verify how the characteristics of the children (i.e. type of CP and severity of motor impairment) and those of their caregivers (i.e. age, level of education, occupation, income and number of children) are significantly related to this perception.

METHOD

A total of 50 children with CP aged between 3 and 12 years and their respective caregivers participated in this study. Children were grouped in terms of type of CP and according to the severity of motor impairment through the Gross Motor Function Classification System (GMFCS). The Social Support Questionnaire (SSQ) was used to evaluate the perception of caregivers concerning the social support they receive (number of people offering support - SSQ-N index, and level of satisfaction concerning such support - SSQ-S index).

RESULTS

The caregivers reported receiving support from a mean of 1.67 people. Core and extended family members (i.e. husband, mother, siblings) and friends are the most common providers of support. In regard to level of satisfaction, caregivers considered the support they received to be positive, obtaining a mean of 5.52 out of a total of six points. Children's and caregivers' characteristics were not significantly related to the SSQ-N and SSQ-S indexes.

CONCLUSION

Family members are the caregivers' primary source of social support and caregivers reported being satisfied with the support they received.

Attitudes of nursing students toward people with disabilities

BACKGROUND

Attitudes of healthcare professionals are major factors in the rehabilitation and self-acceptance of people with disabilities. Consequently, it is important that nurses develop or maintain positive attitudes towards people with disabilities during their education. Nevertheless, more knowledge is needed about current attitudes of nursing students and factors influencing these attitudes.

OBJECTIVES

To investigate the attitude of Turkish nursing students towards people with disabilities and demographic variables mostly influence this attitude.

PARTICIPANTS

The sample of the study comprised of 587 undergraduate nursing students.

DESIGN AND SETTING

This descriptive study was conducted at two nursing schools and two health schools at undergraduate level located in three different cities in Turkey.

METHOD

Data were collected in a class composed of students from schools between January and April 2009. The questionnaire used in the study consisted of four parts: (1) a demographic data sheet; (2) background in disability (3) contact and experiences with disabled people (4) The Attitudes Toward Disabled Persons Scale (ATDP-form O).

RESULTS

All of the participants were female with a mean age of 22.25 ± 1.53. Only 2% of the participants reported having a physical disability themselves. The mean ATDP score was 64.27 ± 0.36 (range 33-96). The age, school type, prior knowledge, giving care to disabled people in the family and social life were found statistically significant factors for having positive attitudes (p<0.05).

CONCLUSIONS

The age group, type of school, prior education regarding the disabled and the condition of caregiving to disabled people are factors influencing nursing students' attitudes towards people with disabilities.

Impact of an educational film on parental knowledge of children with cerebral palsy

Parents of children with cerebral palsy (CP) must have knowledge about the disease and its management to improve the outcome. This uncontrolled interventional trial was carried out to evaluate the parental knowledge of CP and assess the impact of an educational programme on it. Preset questionnaires were filled before and 1 week after a single session educational programme using an educational film. Out of a total of 53 subjects, majority (75.5%) were from lower socioeconomic status. Initially, none knew the correct name of child's illness; afterwards 45.3% could name it. When compared to previous status, there occurred significant improvement in the knowledge of parents after viewing the film with regard to knowing the cause of CP, knowing that motor involvement was predominant in CP, knowledge regarding curability of the disease, and knowledge about special schooling (P < 0.05). Change in knowledge was not related to socioeconomic or educational status (P > 0.05). Majority (94.3%) found the film useful and 96.2% learned how they could help in the management of their children. Parental knowledge of CP is inadequate which can be improved by incorporating such educational programmes in special clinics to improve management.

Determinants of quality of life in children with cerebral palsy: a comprehensive biopsychosocial approach

This study investigated the determinants of quality of life (QOL) of children with cerebral palsy (CP) considering possible variables comprehensively from a biopsychosocial perspective by adopting the International Classification of Functioning, Disability and Health (ICF) and using a CP-specific QOL questionnaire. A total of 167 children with CP (mean age 9.06 years, SD 2.61 years) and their caregivers participated in this study. Children's QOL was measured by the Cerebral Palsy Quality of Life for Children (CP QOL-Child) - primary caregiver proxy-report form. The potential determinants of QOL were collected based on all ICF dimensions. Results of seven multiple regression models showed that the determinants of QOL in children with CP were multidimensional and biopsychosocial in nature, i.e., encompassing the domains of health condition, body functions and structures, and contextual factors of the ICF. Children's behavioral and emotional problems as well as caregiver's psychological and family-related factors were important determinants of QOL in children with CP. Knowledge of the determinants of QOL could serve as a guide in a holistic approach to evaluation and intervention targeted at these determinants to improve the QOL of children with CP.

Social support and anxiety levels of parents with disabled children

PURPOSE

This is a descriptive study carried out to determine the state-trait anxiety and social support perceptions of parents with disabled children.

DESIGN/METHODS

This study has been carried out on 75 parents whose children attended the Private Rehabilitation Center. The data included the personal information form composed by the investigators, the state-trait anxiety inventory, and the multi-dimensional scale of perceived social support.

FINDINGS

The disabilities of the children were mental in 26.7%, physical in 25.3%, and physical/mental in 12%. As the degree of disability increased and the income levels decreased, the trait anxiety scores of the parents increased. There was a significant negative correlation between parental age and social support. Among the parents, 37.3% experienced problems with their spouses after having a child with a disability.

CONCLUSIONS

The development and implementation of alternative support systems for of parents with disabled children would be beneficial.

Mothers' lived experiences of support when living with young children with congenital heart defects

PURPOSE

The purpose of this study was to illuminate the meanings of support as disclosed by mothers of children with congenital heart defects (CHD).

DESIGN AND METHOD

Narrative interviews were conducted with 10 mothers of children with CHD. A phenomenological-hermeneutic method was used for interpretation of the transcribed interviews.

RESULTS

The comprehensive understanding of mothers' lived experiences of support emerged as the experiences of receiving good support, receiving "poor support," and absence of support.

PRACTICE IMPLICATIONS

Mothers receiving person-centered and family-centered care feel more supported and are more likely to adapt to the stresses of parenting a child with CHD.

Effects of a nursing intervention program on the depression and perception of family functioning of mothers with intellectually disabled children

AIMS AND OBJECTIVES

This study was conducted to examine the effect of psychosocial education provided to mothers with intellectually disabled children on the risk of depression and perception of family functioning in those mothers.

BACKGROUND

Families with intellectually disabled children need encouragement, support and training to more actively participate in their children's education and to positively affect their children's growth and development.

DESIGN

Randomised controlled study.

METHODS

The study included the mothers of 75 intellectually disabled children (40 intervention, 35 control). The mothers in the intervention group who participated in a routine program at private education and rehabilitation centres attended four different psychosocial educational sessions. Sessions were conducted once a week for four weeks and lasted 120 minutes. The control group attended only the routine program of the private education and rehabilitation centre.

RESULTS

Our study results showed that after completion of the educational program, there was a greater decrease in the risk for depression in the intervention group when compared to the control group, and the former perceived their family functions better. These differences were statistically significant (p < 0·001).

CONCLUSIONS

The education given by nurses to mothers who have children with intellectual disabilities may be effective in reducing the risk for depression and in increasing the perception of healthy family functioning.

RELEVANCE TO CLINICAL PRACTICE

Psychosocial nursing education program can contribute to the use of evidence-based education strategies in nursing practice to improve the mental health for mothers with intellectually disabled children.

The impact of children with disabilities on parent health-related quality of life and family functioning in Kelantan and its associated factors

OBJECTIVES

Caring for children with disabilities brings about a significant impact on the parents and families. The purposes of this study were to determine the impact of having children with disabilities on parents' health-related quality of life (HRQOL), family functioning, and total family impact and to identify the associated factors.

METHOD

A total of 425 parents/caregivers of children with disabilities who were registered to community-based rehabilitation centers in 5 districts in Kelantan, Malaysia, participated in this study. The Malay version of PedsQL Family Impact Module was used as research instrument. General linear regression was applied to analyze the association between family impact scores (Total Impact, Parent HRQOL Summary, and Family Functioning Summary) and study factors using Stata/SE 11 software.

RESULTS

The mean (SD) Total Impact Score and Parent HRQOL Summary Score of the parents/caregivers was 75.1 (16.85) and 75.0 (18.74) respectively, and the median (IQR) of Family Functioning Summary Score was 84.4 (28.13). Mothers, non-Malays, and widowed parents/caregivers, parents/caregivers having male children with disabilities, and children with more complex disability had significantly lower parent HRQOL and family functioning.

CONCLUSIONS

Both parents/caregivers' characteristics and children's characteristics contributed to family impact in local setting. Results of this study emphasize the importance of the whole family involvement as the focus of services and supports by health care providers.

Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review

PURPOSE

To systematically review the literature on the effects of assistive technology (AT) on family caregivers of children with physical disabilities.

METHOD

Electronic searches of Medline, CINAHL Plus, PubMed, and PsychInfo were conducted. The main search terms were AT, caregiver, physical disability, cerebral palsy and quality of life. Studies were included if they related to the impact of AT on the family caregiver of children with physical impairment. Data extraction and quality assessments were conducted by three reviewers.

RESULTS

Five articles were eligible for inclusion. Two studies rated weak quality of evidence (level 5), two studies rated moderate quality of evidence (level 3), and one article was a systematic review, rating high level of quality (level 1). A paucity of literature, small sample sizes, descriptive study designs and weak methodological quality meant a narrative review was possible. Three articles reported that AT lightened caregiver assistance in the areas of mobility, self- care and social function.

CONCLUSIONS

Evidence suggests that AT has a positive impact on children with physical impairments and their caregivers. Future studies in this area could include valid and reliable outcome measures of AT use and the psychological impacts of AT on caring for a child with physical impairments.