Journal of Pediatric Psychology, Vol. 27, No. 3, 2002, pp. 271-280
© 2002 Society of Pediatric Psychology
Family Adjustment to Childhood Developmental Disability: A Measure of Parent Appraisal of Family Impacts
1 McGill University, 2 University of Manitoba
All correspondence should be sent to Barry Trute, School of Social Work, McGill University, Montreal, Quebec, Canada H3A 2A7. E-mail: btrute{at}po-box.mcgill.ca .
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Objective: To develop the Family Impact of Childhood Disability Scale (FICD) to assess subjective interpretation or "primary appraisal" of parents regarding the impact of a child with developmental disabilities on the family.
Method: A random sample of 87 families was assessed while children with developmental disabilities were in the preschool years. After 7 years had elapsed, 64 of these families were interviewed again when the children were in the preteen years. A set of standardized self-report measures provided mother and father views of child, parent, and family functioning.
Results: The FICD demonstrated adequate internal consistency, with some evidence of discriminant and predictive validity. The FICD total score, based on the discrepancy between positive and negative subscale scores, was found to be a significant predictor of future parenting stress of mothers and of fathers, even when controlling for other important explanatory variables such as marital adjustment and level of disability in a child.
Conclusions: The 15-item FICD offers a brief assessment of both positive and negative parent appraisals, with a total discrepancy score that predicts long-term parenting stress.
Key words: developmental disability; parent stress; cognitive appraisal; measurement.
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Introduction |
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The diagnosis of developmental disability in a child can trigger a range of emotional responses in parents and across family systems. For some, it will constitute a crisis that requires extraordinary psychological adjustment on a parent's part and contains elements of harm, loss, and weakness. For others, the birth of a disabled child will be viewed as an unfortunate event, yet one that has positive implications; it may provoke psychological growth in some family members or heightened overall family functioning. Indeed, this wide scope of behavioral and emotional responses, from largely positive to entirely negative, can result in most stress reactions in which potentially threatening or hurtful events are met by a range of possible subjective interpretations (Dohrenwend, 1978
;
Lazarus & Folkman, 1984).
The measurement of the subjective interpretation, or the meaning that
childhood disability holds for parents in their view of their family life, is
of central interest in this study.
Subjective interpretation is a key element in the ABCX model of family
stress (the "C" factor) that can determine whether an event
constitutes a family crisis (McCubbin
& Patterson, 1983). If the subjective interpretation of the
event is such that the event represents little threat or danger, then the
occurrence of that event will not constitute a crisis for the person or family
appraising that event. Lazarus, Averill, and Opton
(1974) consider the subjective
interpretation of the situation, or in their terms "the cognitive
appraisal," to be the interaction of situational and personality
variables and a key element in understanding the coping process. Coping is
generally defined as the cognitive and behavioral efforts made to ameliorate
demands that tax or overwhelm a person's resources
(Cohen & Lazarus, 1979;
Pearlin & Schooler, 1978).
Coping can be seen as the role the individual or social system plays in
utilizing physical, social, and psychological resources to manage a stressful
situation in the environment (Kessler,
Price, & Wortman, 1985). Reiss and Oliveri
(1980) question whether
subjective interpretation of a life event can be regarded as occurring
conceptually and temporally prior to the formation of a family's coping
responses. They view the process as a dynamic one in which subjective
interpretation and coping are intertwined and may shift as the family responds
to stress and seeks to achieve stability.
Brinchmann (1999) and Larson
(1998) confirm the importance
of assessing familial stress in situations of childhood developmental
disability. They note that assessment of parenting stress is important not
only to assist mothers and fathers with their own psychological distress but
also to guide the provision of needed psychosocial, educational, and health
services that can strengthen family coping and positive adjustment. They
suggest that the reduction of parenting stress is paramount in the enhancement
of a child's family life and in the child's ultimate integration within
society.
Donenberg and Baker (1993)
contend that most investigations to date, which have attempted to assess
family impact of childhood disability, have tended to focus on "levels
of stress, feelings of competence in parenting, or mother-child
interactions" (p. 180). They suggest that these studies did not directly
ask parents about the effects of the child with disabilities on family life.
Further, Donenberg and Baker note that an important difference exists between
stress levels due to childhood disability and perceived family impact, for not
all potential stressors will result in negative family impact. They assert
that "stress has a negative connotation, whereas impact can be both
positive and negative" (p. 181). This is consistent with the work of
Larson (1998), who describes
the tension within parents because of contradictory emotions and beliefs about
the disability. Consideration of perceived positive impacts may be of
particular relevance to understanding the levels of stress these parents
experienced. Tennen and Affleck
(1999) underscore the
importance of attending to the role of finding benefit in adapting to
challenging circumstances. Folkman and Moskowitz
(2000) have suggested that the
positive appraisal of the efforts involved in caregiving may be especially
important in helping people sustain such efforts over long periods.
This study focuses on parental primary appraisal of the impact of childhood
disability on positive and negative elements of functioning in the family
system. We based the development of a measure of primary appraisal on Lazarus
and Folkman's (1984)
definition of primary appraisal as the initial determination of whether an
event is stressful, and, if so, whether it is harmful, inconsequential, or
benign-positive. Of central interest in this study is the design and
evaluation of a brief measure of parents' primary appraisal of the entry of
their child with disability into the family system and its impact on the
family as an entity. That is, this measure focuses specifically on the family
rather than on the parental subsystem or on the child in his or her social
world. With this tight focus on family impact, our measure differs from other
similar scales presently available (e.g.,
Donenberg & Baker, 1993).
Our intent here is to evaluate the predictive power of our measure, the Family
Impact of Childhood Disability Scale (FICD), to determine its utility as an
assessment tool that may identify mothers and fathers who will be most at risk
for long-term parenting stress.
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Participants and Procedures
This is a longitudinal family survey in which parents were first interviewed in their homes in 1987 when their children were 5 years old on average (T1), and then again in 1994, when children were 12 years of age on average (T2). At T1, a sampling frame was created with the aid of Children's Special Services, Department of Family Services of the Province of Manitoba in Canada, of all families in the City of Winnipeg that had preschool children with developmental disabilities. This sampling frame contained 253 children. A random sample of half of the children was selected for study, yielding a sample of 127 households. The eligible sample was reduced by 25 households (10 moved from the city, 6 did not speak English, and 9 did not meet study criteria). There were five interview refusals. The final sample of 88 households represents a completion rate of 86% of eligible research households. In two-parent families, both parents were involved in the interview process that, on average, lasted 2 hours. All interviews were completed in the family home and, when necessary, babysitting services were provided so that both parents could participate. At T2, parents were contacted again with the following attrition: 11 families could not be located, 8 families were no longer appropriate for study (e.g., parent or child died), and 5 families refused the interview (yielding a 93% response rate of eligible families). This left a final T2 cohort of 64 families.
The Children. At T1 the cohort of children included in our study had an average age of 5 years (SD = 2 years). The sex distribution was 62% male and 38% female. This is consistent with the gender distribution of disabled children in the study's geographic locale. On average, the study families contained two children. Thirty-two percent of the children were the only child in a family, 33% were from two-child families, and 45% were from families with three or more children. Forty-seven percent of the children had multiple handicaps in which there was a primary diagnosis of developmental delay, but also additional incapacitation such as a hearing or visual impairment. Twenty-four percent of these children also had serious physical disabilities to the extent that they would need constant assistance over the course of their lives to do everyday activities like eating, bathing, and toileting. Twenty-nine percent were children with Down syndrome.
The Parents. These were largely two-parent households, with 17%
(n = 15) single-parent families, and 7% (n = 5) remarried
families. Ninety-four percent (n = 83) of the parents were Caucasian.
The average age of mothers in the study was 33 years (SD = 6 years).
Twenty-one percent had some high school education, 60% had finished high
school, 25% had some training beyond high school, and 15% had a university
degree. Half the mothers remained at home as full-time homemakers, 24% worked
part-time outside the home, and 26% had full-time employment. Twenty-three
percent of the mothers had given up paid jobs, and 41% had declined paid jobs
to care for their children with disabilities. Fathers in the study had an
average age of 36 years (SD = 7 years). Forty-nine percent had
finished high school, 29% had some training beyond high school, and 19% had a
university degree. Eighty-five percent of the fathers were employed full time
and 7% were unemployed at the time of the survey. Four percent of the fathers
had left a paid job, and 6% had refused a job transfer because of the needs of
their child. Eight percent of the fathers had purposely reduced employment
hours to help care for their youngster. Sixteen percent of the households had
a total annual family income of less than $20,000, and 11% reported total
incomes over $50,000. When compared with the 1986 Winnipeg Survey (Currie,
1986), income of research
families appeared to be equivalent to the distribution of family incomes in
the city. There was a slight over-representation of families within the
$40,000-$50,000 income bracket in the sample.
Although a 7-year period had elapsed between the first and second wave of interviews, and the overall sample size was reduced by 24 families, the overall characteristics of the study cohort remained the same. Comparisons between households that participated at T1 and T2 showed no significant differences in FICD score at T1 or in key sociodemographic variables (i.e., sex of child, disability level of child, mother or father education, size of family, or family income level). The only important difference was in the number of single-parent households. At T1, when children were on average 5 years of age, there were 17% single parents. At T2, when children were on average 12 years of age, there were 36% single-parent households.
Measures
Several standardized scales were employed that were compatible with
previous stress research (e.g., Pearlin,
Menaghan, Lieberman, & Mullan, 1981) and that allowed
comparisons to be made with normative scale scores:
- Parenting Stress Index-Short Form (PSI-SF). The PSI-SF
(Abidin, 1995) is a 36-item
short form of the Parenting Stress Index and is composed of three subscales:
Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult
Child. The Total Stress score on the short-form has a.94 correlation with the
Total Stress score of the full-length PSI, an alpha of.91, and a test-retest
reliability coefficient of.84 over a 6-month retest interval
(Abidin, 1995).
- Dyadic Adjustment Scale (DAS). The DAS
(Spanier, 1976) was the
primary measure employed to assess marital adjustment. It is reported to have
strong internal consistency, with alpha of.96 for the total scale score. In
more recent reevaluations of the DAS, Spanier and Thompson
(1982) report alpha at.91, and
Sharpley and Cross (1982)
report alpha at.96. Our data indicated alpha is.92 for mothers and.79 for
fathers.
- Family Assessment Measure III-Short Form (FAM-SF). The FAM III
(Skinner, Steinhauer, & Santa-Barbara,
1983,
1995) is a 50-item scale that
offers seven subscales relating to major aspects of family organization and
functioning. This measure offers normative data from samples of
"normal" and "clinical" families and has demonstrated
discriminant validity in significantly differentiating between clinical and
nonclinical families (Skinner et al.,
1995). The FAM-SF is composed of the two heaviest loading items on
each of the seven subscales and offers a unidimensional measure of overall
family functioning that correlates highly with the total FAM III score
(r =.90). Lower scores indicate higher levels of family well-being.
Our sample yielded an alpha of.80 for the FAM-SF.
- Family Coping Stategies Scale (F-COPES). This is a composite
measure of family coping styles (McCubbin, Larsen, & Olson, 1982).
Construct validity has been estimated through use of factor analyses that
confirm subscale coping strategies. In scale construction analyses, alpha
was.77 overall, with subscales ranging from.64 to.87. Total scale test-retest
reliability was reported as r =.78 (4-week interval) with subscales
ranging from.61 to.95. The Reframing subscale, which was of particular
interest in this study, was reported to have an alpha of.82 and test-retest
reliability of.61.
- Beck Depression Inventory. The short form of the Beck Depression
Inventory (BDI-SF) (Beck & Beck,
1972) is a screening measure of clinical depression with excellent
psychometric properties (Beck & Steer,
1987). The short form of the BDI correlates highly (r
=.93) with the longer version (Reynolds
& Gould, 1981). It is a short-term screening device that
counts symptoms of depression over the prior week.
- Rosenberg Self-Esteem Inventory (RSE). The RSE
(Rosenberg, 1965) was used as
a measure of self-acceptance in mothers and fathers. This brief, 10-item
measure has adequate reliability and validity characteristics
(Robinson, Shaver, & Wrightsman,
1991). The RSE has been found to be closely consistent with other
frequently used measures of self-esteem and more independent of irrelevant
variables (Tippett & Silber,
1965). The RSE has a coefficient of reproducibility of.92 and a
coefficient of scalability of.72, suggesting that it is unidimensional
(Rosenberg, 1965). This scale
also demonstrates strong consistency over time with a test-retest reliability
of.85 (Silber & Tippett,
1965).
- Disability Index. A four-item Disability Index (DI) was used
(Trute, 1990) to assess degree
of physical and mental incapacitation in children. Item-total correlations in
this Likert-type scale ranged from.44 to.64, with alpha of.74. Parents were
asked to report their child's present level of disability for degree of
intellectual impairment, physical disabilities, need for ongoing medical
attention, and future need for physical assistance in everyday functions
through the course of their lives. The DI correlates significantly with
disabled children's Developmental Quotient (r =.59, p
<.01) but goes beyond the assessment of mental ability to include physical
incapacitation. We found the DI to be unrelated to social desirability scores
in mothers and fathers.
- Marlowe Crowne Social Desirability Scale. A short form of the
Marlowe Crowne Social Desirability Scale (Crowne & Marlow, 1960) was
completed by each parent to test for potential "social
desirability" response style bias in self-report measures. Scores on the
short form have been found to be closely related to scores on the longer
version (r =.80 to.90), and the 10-item version had equal
Kuder-Richardson formula reliability to the full scale
(Strahan & Gerbasi,
1972).
All measures were collected at T1 and T2 with the exception of the PSI-SF, which was collected only at T2, and the DAS, which was collected only at T1.
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Results |
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The Family Implications of Childhood Disability Scale (FICD)
As the first step in scale development, a pool of Likert items was developed through past research that involved interviews with parents in resilient families with children with disabilities (Trute & Hauch, 1988a
,
1988b). It was our intent to
develop a series of items that would reflect both positive and negative parent
appraisals of the impact of their child's disability on family life. The
initial intention was to create a unidimensional scale of parent appraisal
with higher scores representing more positive appraisal. However, negative and
positive items did not appear to be unidimensional and additive. In a
preliminary review, a short scale emerged from item reliability analyses with
interitem correlations that ranged from.39 to.69, with an acceptable alpha
(.80) that contained only five of the negative impact items. In subsequent
analyses, this brief negative appraisal scale was found to be an important
predictor of depression levels in mothers and fathers of young children with
developmental disabilities (Trute,
1995). These findings encouraged renewed study of the parent
appraisal items. A factor analysis, with simple varimax rotation set to two
factors a priori, indicated that negative and positive items loaded solely on
each of the two unique factors, yielding a negative factor (eigenvalue = 4.88)
that explained 32.6% of total scale variance, and a positive factor
(eigenvalue = 2.48) that explained a further 16.5% of scale variance. Only
items with communality greater than.30 were retained. The final negative scale
was composed of 10 items and the positive scale was comprised of 5 items.
There was no correlation between the scores on these two subscales (r
[76] =.14, p =.22). Items on the FICD are identified in the
appendix.
Stein, Folkman, Trabasso, and Richards
(1997) assert that beliefs
regarding life challenges carry positive or negative valences that co-occur
and that these beliefs can be based on differentially weighted harmful and
beneficial appraisal. Consistent with this conceptual distinction between
negative and positive appraisals of challenging life events, we not only use
positive and negative subscale scores but also employ discrepancy scores
(assessing the degree of divergence of negative and positive views) in the
empirical measurement of parent appraisal of the family impact of childhood
disability. For the calculation of the discrepancy score, the FICD positive
total score was subtracted from the negative total score. Given the
disproportionate number of items in the two subscales, we converted subscale
raw scores to z scores prior to calculating standardized discrepancy
scores. However, zero order correlations with FICD raw and z scores,
and other key study variables, were not different, and because raw scores are
easier for other researchers to calculate, interpret, and use, all results
here are based on FICD raw scores.
Parents completed the FICD together as a joint assessment at T1 and did the
FICD separately at T2. At T2, while there was a correlation between mothers'
and fathers' negative subscale scores (r [35] =.50, p
<.002), no relationship was found between mothers' and fathers' positive
subscale scores (r [33] =.28, p =.12). Mothers' and fathers'
independent FICD scores at T2 were found to be strongly related to averaged
FICD scores (mothers' r [32] =.92, p <.001; and fathers'
r [32] =.86, p <.001). This suggested that averaged
scores were closely reflective of both parents' individual appraisals of
family impact of disability. Further, these averaged scores were more reliable
compared to mothers' or fathers' scores alone
(Mathijssen, Koot, Verhulst, De Bryn,
& Oud, 1997).
At T1, our family sample yielded a negative subscale score of M = 21.43 (SD = 6.88), a positive subscale score of M = 12.65 (SD = 3.53) and a FICD total (negative-positive discrepancy) score of M = 8.92 (SD = 7.22). FICD total score was not related to social desirability in mothers (r [75] = -.15, p =.22) or fathers (r [67] = -.16, p =.20). Positive subscale scores were not related to social desirability in mothers (r [77] =.07, p =.52) or fathers (r [67] =.15, p =.20). Negative subscale scores were not related to social desirability in mothers (r [76] = -.10, p -.36) or fathers (r [67] = -.12, p =.29).
Reliability and Long-Term Stability of the FICD. The reliability of the FICD was assessed by examining the internal consistency of the subscales. The subscales showed good internal consistency with alphas of.88 for the negative subscale and.71 for the positive subscale. Over a period of 7 years, parental FICD scores at T1 were found to be significantly related to parental FICD score at T2(r [32] =.64, p <.001). This cross-sectional sample of parents with children with disabilities showed almost no average change, in their cognitive appraisal of the impact that childhood disability had on family life, between the time their children were approximately 5 and 12 years of age (T1: M = 9.3, SD = 7.7; T2: M = 9.6, SD = 5.9; t[31] = -.27, p =.79).
Discriminant Validity: The FICD and Related Measures. The FICD was not found to be related to overall assessments of family functioning (FAM-SF) by mothers or fathers at T1 (see Table I) or T2 (see Table II). Furthermore, the Positive Appraisal subscale of the FICD does not appear to be an alternative measure of "positive reframing," as a general coping style when responding to life challenges, in either mothers or fathers. At T1, the Positive Reframing subscale of the F-COPES was not significantly related to the Positive Appraisal score on the FICD for mothers (r [78] =.17, p =.14) or for fathers (r [68] =.08, p =.52).
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FICD scores at T1 were weakly related to mothers' level of depression and self-esteem, but not fathers' depression or self-esteem scores (see Table I). At T2 (see Table II), FICD scores were not found to be strongly related to mothers' or fathers' psychological measures (i.e., depression, self-esteem).
Predicting Parenting Stress. Separate two-step hierarchal regressions were completed for mothers and fathers, employing parenting stress (PSI-SF) at T2 as the dependent variable of study. In the first step, two key T1 predictor variables were entered: marital adjustment (DAS) and mother or father self-esteem (RSE). These variables were selected as they both emerged as significantly related to marital and family adjustment (see Table I). In the second step, FICD scores at T1 were entered to study variance accounted for by FICD alone, after controlling for marital adjustment and parent self-esteem.
When DAS and RSE were entered as predictor variables of mothers' PSI-SF scores, at step one of the hierarchal regression analysis, the relationships were significant, F(2, 45) = 5.63, p <.01. Marital adjustment (DAS) emerged as a significant predictor (t[48] = -2.82, p <.05), while mothers' self-esteem was not significant (t[48] = 1.27, p =.21). In step two, FICD was entered (see Table III). Results show that parenting stress in mothers at T2 was significantly predicted by their DAS and FICD scores at T1. Further, the hierarchal regression analysis confirms that FICD is a significant predictor of mothers' parenting stress after removing variance explained by marital relations and self-esteem. In step one of the regression analysis for fathers, the combination of marital adjustment (DAS) and self-esteem (RSE) as predictor variables approached significance, F(2, 33) = 3.19, p =.054, but neither predictor alone was significant. After step two, with the entry of FICD, the overall regression equation was significant, F(3, 32) = 3.72, p <.02, and FICD emerged as the sole significant predictor of father parenting stress, (t[36] = 2.05, p <.05) (see Table IV).
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Although there is no significant zero-order statistical relationship between levels of parenting stress in mothers and in fathers (r [35] =.28, p =.10), the hierarchal regression analyses show similar results. FICD is a significant predictor of level of parenting stress for both mothers and fathers.
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Discussion |
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The results of this study support the assertion that cognitive appraisal is an important factor in delineating the relationship between a stressor and adjustment. The findings provide evidence of the usefulness of the FICD in assessing primary parental appraisal of the impact of childhood disability. Consistent with Lazarus and Folkman's (1984
) definition of primary
appraisal, and Donenberg and Baker's
(1993) view of family impacts,
the FICD assesses both positive and negative appraisals of the impact of
childhood disability on the family. Factor analysis confirmed that the 15-item
FICD consists of two independent dimensions: positive and negative appraisal.
This finding is consistent with prior research, which has demonstrated the
independence of positive and negative affect. Bradburn and Caplovitz
(1965) were the first to
confirm that positive and negative affect are not inversely related (or
negatively correlated) but appear to be orthogonal or independent factors.
Their finding has been confirmed by subsequent research
(Watson & Clark, 1984).
This study also supports prior findings that positive and negative appraisals
co-occur and that the proportions of each can be salient predictive measures
of caregiver psychological well-being
(Stein et al., 1997). Our findings relating to the reliability and predictive validity of the FICD support its importance as a brief 15-item family assessment measure. That is, it is a measure that can serve as a useful assessment tool in psychological intervention for parents early in the life of a child who has been diagnosed as having a developmental disability. Internal consistency analysis suggests the reliability of the measure. Further, no average change was found in parents' cognitive appraisal of the impact the childhood disability had on family life over the 7-year interval in our longitudinal survey. This would suggest that the appraisal parents hold, of the family impact of childhood disability, is formed early in the life of the child with disabilities and tends to remain unchanged through to the preadolescent years of the child. In terms of the predictive validity of the FICD, regression analyses confirmed the utility of the measure in predicting long-term parenting stress in mothers and fathers.
It appears that FICD is not an alternative measure of parent psychological adjustment. Mother scores on this scale are weakly related to their levels of psychological well-being during the preschool period of their child with a disability, but this relationship does not appear to be present when the children with disabilities are in their pre-teenage years. Fathers' assessment of the family impact of childhood disability does not appear to be related to their psychological adjustment (i.e., depression, self-esteem) during the early or later childhood years of their son or daughter with a disability. In a similar vein, the Positive Appraisal subscale on the FICD is not tapping a tendency of mothers or fathers to employ positive reframing as a general parent coping style. Our results confirm that the FICD should not be viewed as an alternative measure of parent coping style, but as a unique assessment of parent appraisal of the impact of childhood disability on the family.
In addition to establishing the psychometric properties of the FICD, the
study has several interesting findings. First, no differences were found
between mother and father appraisals of the impact of their child's
developmental disability on the family. The scores of mothers and fathers were
moderately correlated on the negative subscale score, although there was no
correlation between their scores on the positive subscale. This suggests that
while parents have similar perceptions of the negative impact of the
disability on family life, their views of the positive impact are independent.
The consistency in the view of fathers and mothers on the negative impact of
childhood disability on their family life replicates prior research, which has
found no differences between parents in their level of pessimism or report of
parent and family problems (Rousey, Best,
& Blacher, 1992).
Second, the study confirmed the importance of the marital relationship in
predicting parenting stress, which, in turn, is highly correlated with overall
family adjustment. This is consistent with previous research that has
established the importance of the marital relationship in family adjustment to
childhood developmental disabilities
(Abbott & Meredith, 1986;
Friedrich, 1979;
Nihira, Meyers, & Mink,
1980; Trute,
1990). Whereas satisfaction in marital relations was useful in
predicting mothers' long-term parenting stress, the predictive power of
marital relations for mothers' well-being was increased by the inclusion of
the FICD, which assesses parent perception of the impact of developmental
disability on the family. Only limited research has focused on the
differential saliency of marital relations for parenting stress and family
adjustment of mothers and fathers
(Deater-Deckard & Scarr,
1996). Our findings suggest that the impact of marital relations
on the well-being of fathers of children with developmental disabilities may
be less profound than it is for mothers. Our findings confirm the importance
of cognitive appraisal of the fathers regarding the impact of their child's
disabilities on family life, as an important element of their parenting stress
in the longer term.
These research findings suggest that child and family mental health practitioners should pay careful attention to the cognitive appraisal of mothers and fathers regarding the impact of a child with developmental disabilities on family life. Identifying parents in families at risk for high levels of parenting stress while the child is young provides an important opportunity for preventive child mental health services. In this function, the FICD shows promise as a clinical assessment tool that may assist practitioners to better understand parental cognitive appraisal and that might highlight cognitions or beliefs in mothers and fathers that could interfere with subsequent parent and family adjustment.
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Appendix |
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Items in the Family Implications of Childhood Disability Scale (FICD)
Scale Question: "In your view, what consequences have resulted from having a child with a disability in your family." Score each item on a four-point Likert scale: (1) Not at all, (2) To a mild degree, (3) To a moderate degree, or (4) To a substantial degree.
- There have been extraordinary time demands created in looking after the
needs of the disabled child. (-)
- There has been unwelcome disruption to "normal" family
routines. (-)
- The experience has brought us closer to God. (+)
- It has led to additional financial costs. (-)
- Having a disabled child has led to an improved relationship with spouse.
(+)
- It has led to limitations in social contacts outside the home. (-)
- The experience has made us come to terms with what should be valued in
life. (+)
- Chronic stress in the family has been a consequence. (-)
- We have had to postpone or cancel major holidays. (-)
- It has led to a reduction in time parents could spend with their friends.
(-)
- The child's disability has led to positive personal development in mother
and/or father. (+)
- Because of the situation, parents have hesitated to phone friends and
acquaintances. (-)
- The situation has led to tension with spouse. (-)
- Because of the circumstances of the child's disability, there has been a
postponement of major purchases. (-)
- Raising a disabled child has made life more meaningful for family members.
(+)
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Acknowledgments |
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This study was supported by a Sister Bertha Baumann Research Award from the St. Amant Society of Winnipeg, Canada, and was assisted by Children's Special Services, Province of Manitoba.
Received July 7, 2000; revision received February 22, 2001; revision received August 24, 2001; accepted September 25, 2001
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References |
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TopAbstractIntroductionMethodResultsDiscussionAppendixReferences |
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