Can I have a second child? Dilemmas of mothers of children with pervasive developmental disorder: a qualitative study

The everyday occupations of East Asian mothers who have children with disabilities: A scoping review

BACKGROUND

Everyday occupations refer to activities that people do associated with their roles, to bring meaning and purpose to life. The occupations of non-Asian mothers of children with disabilities have been well-documented but less is known about the occupations of East Asian mothers.

AIMS

This scoping review described the everyday occupations of East Asian mothers who have children with disabilities.

METHODS

A well-documented five-stage framework was utilised, guided by PRISMAScR. A search was conducted across five data bases for peer-reviewed research between 2008-2020, which informed the occupations of mothers living in China, Hong Kong, Taiwan, Japan, Korea and Vietnam.

RESULTS

Thirty-two articles met criteria, of which twenty-nine were qualitative studies and three were mixed-methods studies. 415 mothers were represented. The themes were: doing, roles, volitional components and processes, cultural values and practices, environmental enablers, barriers and transformation, which provided rich description of various aspects of occupations of East Asian mothers, who have children with disabilities.

CONCLUSIONS

The everyday occupations of East Asian mothers who have children with disabilities were shaped by their cultural values. This review provided insights into mothers' activity choices and valued roles, which highlighted for practitioners in disability services, the importance of cultural awareness and sensitivity when supporting East Asian mothers and their families.

Having another child without intellectual disabilities: Comparing mothers of a single child with disability and mothers of multiple children with and without disability

To investigate how having a child without a disability is related to maternal mental health and its predictors, we compared mothers of a single child with intellectual disabilities (single-child group, n = 117) and mothers of children with and without intellectual disabilities (multiple-children group, n = 457), in Japan. Compared to the multiple-children group, the single-child group had lower hope and social capital and poorer mental health; furthermore, 42.5% of them had decided not to have another child, despite desiring one. Hope was the strongest predictor of mental health in both groups but was more positively related to mental health in the multiple-children group. The fear of the possibility of the next child having a disability and receiving inadequate support were the obstacles for mothers who had decided not to have another child. Thus, greater support and more opportunities for obtaining adequate information about the implications of having another child may be needed.

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.

Mental health and positive change among Japanese mothers of children with intellectual disabilities: Roles of sense of coherence and social capital

We investigated predictors of mental health and positive change among mothers of children with intellectual disabilities in Japan based on the concept of the Double ABCX model. We used variables of having a child with autism spectrum disorder (ASD) and dissatisfaction with systems as stressors, availability of social support and social capital (SC) as existing resources, sense of coherence (SOC) as appraisal of the stressor, and mental health and positive change as adaptation. A self-administered questionnaire was distributed to 10 intellectual disability-oriented special needs schools in Tokyo, and obtained 613 responses from mothers of children under age 20 attending these schools. The results showed that our Double ABCX model explained 46.0% of the variance in mothers' mental health and 38.9% of the variance in positive change. The most powerful predictor of this model was SOC, and SC may be directly and indirectly related to maternal mental health and positive change through mothers' SOC. Increasing opportunity for interaction between neighbors and family of children with disabilities may be one effective way to enhance SOC through SC. Since maternal SOC, SC, mental health, and positive change were significantly correlated with each other, synergy among these elements could be expected.

Family planning and family vision in mothers after diagnosis of a child with autism spectrum disorder

The diagnosis of a child with autism has short- and long-term impacts on family functioning. With early diagnosis, the diagnostic process is likely to co-occur with family planning decisions, yet little is known about how parents navigate this process. This study explores family planning decision making process among mothers of young children with autism spectrum disorder in the United States, by understanding the transformation in family vision before and after the diagnosis. A total of 22 mothers of first born children, diagnosed with autism between 2 and 4 years of age, were interviewed about family vision prior to and after their child's diagnosis. Grounded Theory method was used for data analysis. Findings indicated that coherence of early family vision, maternal cognitive flexibility, and maternal responses to diagnosis were highly influential in future family planning decisions. The decision to have additional children reflected a high level of adaptability built upon a solid internalized family model and a flexible approach to life. Decision to stop childrearing reflected a relatively less coherent family model and more rigid cognitive style followed by ongoing hardship managing life after the diagnosis. This report may be useful for health-care providers in enhancing therapeutic alliance and guiding family planning counseling.

[Chromosomal location of submicroscopic duplications in patients with neurodevelopmental disorders to identify cases with high risk of familial recurrence]

BACKGROUND AND OBJECTIVE

An important proportion of neurodevelopmental disorders (NDDs) results from unbalanced genomic alterations (duplication or deletion). These chromosomal rearrangements may be considered as de novo, despite they arise as a result of a balanced rearrangement not detected in a phenotypically normal parent. Therefore, if the rearrangements are inherited, the recurrence risk and the genetic counseling of these cases change radically. Fluorescence in situ hybridization (FISH) is a technique that allows detecting both balanced and unbalanced rearrangements, identifying also the location of duplicated segments. We tried to locate in the genome the duplicated segments detected in patients with NDDs in order to identify those cases due to inherited rearrangements.

PATIENTS AND METHOD

The study was conducted in 13 patients with NDDs and genomic duplications detected by compared genomic hybridization-array (CGH-array). Two approaches of FISH technique were taken: hybridization with painting chromosome probes and with specific probes for each duplication.

RESULTS

In the studied series of 13 patients with duplication, 11 patients were found to carry tandem duplications, one with an intrachromosomal insertional translocation, and another with an interchromosomal insertional translocation. Therefore, 2 of the duplications considered de novo were actually an unbalanced rearrangement inherited from a parent who is a balanced carrier.

CONCLUSION

The results illustrate the need to characterize by FISH technique the rearrangements that are detected by CGH-array to identify those cases with a high risk of recurrence.

The lived experience of mothers of multiple children with intellectual disabilities

In this study, we explored the lived experience of Japanese mothers who have delivered multiple children with intellectual disabilities (ID), using interpretative phenomenological analysis. We identified three superordinate themes and seven subordinate themes from the narrative data collected from 10 participants. The superordinate themes were: abandoned hope for having an ordinary family, accumulating physical and mental fatigue, and searching for positive experiences in parenting multiple children with disabilities. How they perceived the birth of children with disabilities for the second time differed depending on the disability types; specifically, whether they detected the disabilities early or not. Encountering the disability in another child overwhelmed mothers, especially when the disabilities were diagnosed after several years with or without suspicion; they struggled to accept the fact. Despite mothers facing extreme difficulties in parenting multiple children with disabilities, they tried to alter the negative perceptions and find an optimistic way of living.

[Evolution of the frequency of congenital defects in newborn infants and fetuses from terminations of pregnancy after prenatal diagnosis in the period 1982-2009]

BACKGROUND AND OBJECTIVE

The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency.

PATIENTS AND METHODS

Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years.

RESULTS

The mean frequency for newborns with CD is 13.54‰ and for newborn and TOP with CD is 18.73‰. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62‰ for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period.

CONCLUSION

We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counselling.