Wednesday, October 16, 2013

Stress Management for Parents of Children with Developmental Disabilities


Parenting children with developmental disabilities has the potential to provoke unusual stress management needs (Singer, Ethridge, & Aldana, 2007). For strategies to be effective, they must be based on the specific needs of a population, and must meet the demands consistent and continuous for this parent population (Singer et al., 2007). The goal of this paper is to define and describe the population of parents providing care for their developmentally disabled children and the stressors and health issues common for this population. Further, it will characterize effective stress management strategies as well as explicate why these strategies are effective.

                                                  Common Stressors and Health Issues

There is no paucity of contemporary scholarship on the stress experienced by parents of children with developmental disabilities (Singer et al., 2007). This population has traditionally been thought to experience chronic deleterious effects from the stress of parenting their children. These effects include ongoing sadness, isolation, an increased risk of psychological and physiological illness, and a higher likelihood of divorce (Singer et al., 2007). Further, these parents must contend with psychosocial problems in siblings of the child with developmental disabilities.

The ability of parents to adapt to their child's disability can be identified on a spectrum with some parents experiencing long-term, severe chronic stress to reasonable and normal levels of adaptation and the ability to manage the stress of caring for their child (Singer, et al., 2007). Singer (2006) found up to 70% of parents with children with developmental and intellectual disabilities did not experience an increase in stress compared to parents without developmentally delayed or disabled children. However, approximately 35% of mothers of children with developmental and intellectual disabilities had more episodes of depression and the episodes were more severe than parents of typically developing children (Singer, 2006).

In any event, the potential exists for severe stress specific to the population of parents of children with developmental disabilities. The most commonly reported symptom for this population is depression (Singer, 2006) and feelings of intense isolation (Gupta, 2007). Additionally, it is not unusual for these parents to experience economic strain and emotional and social stressors associated with their child's disability (Woolfson & Grant, 2005). Although this parent population may not experience recognizable levels of stress and depression, they may experience an accumulation of stress because of an unrecognized chronic low level of stress associated with parenting their children (Hastings & Beck, 2004).

Interventions and stress management strategies for this population should take place at the time of initial diagnosis, which is ordinarily perceived as a crisis and an experience that provokes a range of emotional responses (Trute & Hiebert-Murphy, 2002). Some disabilities cause more stress than others, and the disability causing the parental stress should be considered (Gupta, 2007). Interventions and stress management strategies must take into account proficiency in English as well. Further, the educational level of the parents has been proven to be determinants of parental stress and should be considered in the development of stress management strategies (Gupta, 2007). Although several factors must be identified and addressed, parental stress can be mitigated through comprehensive care, even when parents face chronically stressful conditions (Hastings & Beck, 2004).

                                                 Stress Management Strategies

Cognitive Behavioral Strategies and Self-Care
For parents of children with developmental disabilities, the element that determines the overall stress load of the parent is the subjective interpretation of the circumstances (Trute & Hiebert-Murphy, 2002). Whether parents appraise the situation as a threat or crisis will ultimately determine their coping strategies and ability to cope. The cognitive appraisal, according to Lazarus (1991) is the interplay of mediating and moderating variables including personality style and the nature of the situation. Singer et al. (2007) found that the most salient aspect of the families coping with the distress of a developmentally disabled child was their ability to be resilient. However, even parents and families who were characteristically resilient faced unmanageable stress at times. Mothers of developmentally disabled children are especially vulnerable to psychological distress and depression (Singer et al., 2007).

Since cognitive appraisals are pivotal in the ability to manage stress, changing parents' subjective interpretation of their family situation may be effective in the development of adaptive coping strategies (Singer et al., 2007). Cognitive behavioral training (CBT) directly targeted parental stress and provided the parents with tools to effectively manage stress. In addition, self-management skills (self-care), which has shown consistent benefits in this population, should be taught and used proactively to reduce and prevent psychological distress (Nixon & Singer, 1993; Singer et al., 2007). By managing their own well-being and their cognitive appraisals, parents were less threatened by their circumstances, and their stress was reduced (Singer et al., 2007). In effect, the parents were given resources that strengthened their ability to cope, which indirectly caused them to reassess the threat of their environment.

Family Systems Therapy

Because family quality of life is affected by a family member having a developmental disability, families, especially those with additional children must find ways to adapt to the challenge of having a developmentally disabled child or sibling (Singer et al., 2007). Family therapy can help each of the family members adapt in a positive and personalized way to the radical change in their family (Pelchat, Bisson, Ricard, Perreault, & Bouchard, 1999). In addition, family therapy seeks to find the benefit and the positive contribution made by each family member, including the child with developmental disability (Pelchat et al., 1999). Strategies for the effective family management of stress should include changing negative and detrimental perceptions developed from the initial psychological shock of learning they have a family member with a developmental disability (Dukmak & Aburezeq, 2012). This therapy should foster healthy family adaptation and encourage spouses to support each other. In addition, families should be taught and encouraged to acknowledge and respect the contribution of each family member in their joined effort to adapt (Pelchat et al., 1999). Fostering relationships with others can help the family develop and maintain resources to help them cope longitudinally (Pelchat et al., 1999).

                                      Explanation of Efficacy of Chosen Strategies

Psychosocial stress has been explained as an incongruence between an individual's needs and the individual's environment (Storch, Gaab, Küttel, Stüssi, & Fend, 2007). Lazarus (2005) further defined stress as a result of the cognitive appraisal of a situation, what is being threatened by the circumstance, and whether and to what extent the individual believes he or she can affect the situation. Trute and Hiebert-Murphy (2002) found similar results that cognitive appraisal is the pivotal point upon which an individual creates the relationship between the stressor and the ability to adjust. This is true with the parental cognitive appraisal of the impact or threat of a child's developmental disability (Trute & Hiebert-Murphy, 2002). CBT and cognitive stress reappraisal has been shown to have powerful and longitudinal effects on stress (Storch et al., 2007).

Multi-faceted interventions implemented over longer time frames are more effective than single component interventions (Singer et al., 2007). The use of CBT, self-management tools, and family therapy was more effective than the use of either intervention alone. Lazarus (1991) believed stress is a complex interplay of a variety of components that include cognitive appraisal, the perception of available resources, and mediating and moderating variables. Utilizing a more complex combination of stress management strategies may be consistent with Lazarus' findings. The addition of family therapy fosters the growth of the family as an entity, and it places value on the psychological experience of each family member (Pelchat et al., 2012). Families have an increased vulnerability to stress because of their primary stress of raising a child with developmental disabilities. This stress affects each family member and influences how the parents raise their other children (Dukmak & Aburezeq, 2012).

                                                                      Conclusion

Parenting children with developmental disabilities has the potential to cause unusual, extensive, and chronic stress (Wolfson & Grant, 2006). Three effective interventions for the management of stress in this population may include CBT, self-management, and family therapy (Singer et al., 2007). Having a child with developmental disabilities has the potential for long-term stress for parents and the family. Complex stress management strategies should be presented to parents and families over the longest possible amount of time, and strategies should be reviewed as necessary (Pelchat et al., 2012). Strategies for this population should address quality of life for the family of the developmentally disabled child and foster the perception that children with developmental disabilities have a positive contribution to make to their families.

References

Dukmak, S. J., & Aburezeq, I. M. (2012). Family functioning, social opportunities and health as predictors of stress in families of children with developmental disability in the United Arab Emirates. Journal Of International Special Needs Education, 15(2), 120-134.

Gupta, V. (2007). Comparison of parenting stress in different developmental disabilities. Journal Of Developmental & Physical Disabilities, 19(4), 417-425. doi:10.1007/s10882- 007-9060-x

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Lazarus, R. S. (1991). Progress on a cognitive-motivational-relational theory of emotion. American Psychologist, 46(8), 819-834. doi:10.1037/0003-066X.46.8.819

Lazarus, R. S. (2006). Emotions and interpersonal relationships: Toward a person-centered conceptualization of emotions and coping. Journal of Personality, 74(1), 9-46. doi: 10.1111/j.1467-6494.2005.00368.x

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Nixon C. D., & Singer G. S. (1993). A group cognitive behavioral treatment for excessive parental self-blame and guilt. American Journal of Mental Retardation 97, 665–672.

Pelchat, D., Bisson, J., Ricard, N., Perreault, M., & Bouchard, J. (1999). Longitudinal effects of an early family intervention programme on the adaptation of parents of children with a disability. International Journal Of Nursing Studies, 36(6), 465-477. doi: 10.1016/S0020- 7489(99)00047-4

Singer, G. S. (2006). Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. American Journal on Mental Retardation, 111(3), 155. doi: 10.1352/0895-8017(2006)111[155:MOCSOD]2.0.CO;2

Singer, G. H., Ethridge, B. L., & Aldana, S. I. (2007). Primary and secondary effects of parenting and stress management interventions for parents of children with developmental disabilities: A meta-analysis. Mental Retardation and Developmental Disabilities Research Reviews, 13(4), 357-369. doi: 10.1002/mrdd.20175

Storch, M., Gaab, J., Küttel, Y., Stüssi, A., & Fend, H. (2007). Psychoneuroendocrine effects of resource-activating stress management training. Health Psychology, 26(4), 456-463. doi:10.1037/0278-6133.26.4.456

Trute, B., & Hiebert-Murphy, D. (2002). Family adjustment to childhood developmental disability: A measure of parent appraisal of family impacts. Journal Of Pediatric Psychology, 27(3), 271-280.

Woolfson, L., & Grant, E. (2006). Authoritative parenting and parental stress in parents of pre- school and older children with developmental disabilities. Child: Care, Health & Development, 32(2), 177-184.







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