M.W. Hodes

Tailoring a video-feedback intervention for sensitive discipline to parents with intellectual disabilities: a process evaluation

Parenting support programs for the general population may not be effective for parents with intellectual disabilities (ID). A videobased intervention program based on attachment and coercion theory (Video-feedback Intervention to promote Positive Parenting with additional focus on Sensitive Discipline; VIPP-SD) was tailored to parents with ID and the implementation of the adapted program was evaluated by the home visitors conducting the program. Home visitors (N = 17) of 36 families rated the intervention process during each session. Home visitors’ evaluations showed a significant increase in positive ratings of parents’ easiness to work with, amenability to influence, and openness. Cooperation remained stable. A case example illustrated this process, showing how feedback using video facilitated changes in the perceptions and attributions of a mother with mild ID.

Parenting stress and child behaviour problems among parents with intellectual disabilities: the buffering role of resources.

BACKGROUND Parents with intellectual disabilities (ID) are at risk for high levels of parenting stress. The present study evaluated resources, including parental adaptive functioning, financial resources and access to a support network, as moderators of the association between child behaviour problems and parenting stress. METHOD A total of 134 parents with ID and their children (ages 1-7 years) were recruited from 10 Dutch care organisations. Questionnaires were administered to the parents to obtain information on parenting stress in the parent and child domain, financial resources and their support network. Teachers and care workers reported on child behaviour problems and parental adaptive functioning, respectively. RESULTS Parents experienced more stress with regard to their children than towards their own functioning and situation. Parenting stress was less in parents who were not experiencing financial hardship. Child behaviour problems were associated with high child-related parenting stress, not parent-related parenting stress. Large support networks decreased the association between child behaviour problems and child-related parenting stress. Financial resources did not significantly moderate the association. CONCLUSIONS Parenting stress among parents with ID is focused on problems with the child, especially when little social support is available.

Parents with intellectual disabilities seeking professional parenting support: The role of working alliance, stress and informal support

Delaying or refraining from seeking advice and support in difficult parenting situations is identified as an important risk factor for child abuse and neglect. This study tested whether the extent of delays in support seeking is associated with working alliance for parents with mild intellectual disabilities (MID) and whether the importance of working alliance may depend on parenting stress and availability of informal support. Delays in support seeking were measured as parental latency (time waited) to approach the support worker. This latency was assessed in the intended response to hypothetical situations (vignettes) and in the reported behavioral response to real life difficult parenting situations from the preceding weeks. Multiple regression analyses were conducted for testing main and interaction effects of predictors on latency for support seeking. Better quality of the working alliance was associated with shorter intended latency to seek support for parents with MID, if parents had little access to informal support. Higher parenting stress predicted a shorter latency for intended support seeking. Parental support seeking intentions were positively associated with support seeking behavior. A good quality of the working alliance might be important to connect needs of parents with MID to resources that professional support can offer, in particular for the most vulnerable parents. Parental reluctance to seek professional support may be the result of a combination of risk and protective factors and is not always a sign of poor working alliance. Implications for risk assessment and support practice are discussed.

Expecting change: Mindset of staff supporting parents with mild intellectual disabilities

This study of staff supporting parents with mild intellectual disabilities or borderline intellectual functioning (MID) focused on staff mindset regarding the extent to which parenting skills of parents with MID can change (an incremental mindset) or are static (an entity mindset). Staff mindset was tested as a predictor of two outcome variables: quality of the working alliance and parental waiting time to ask professional support. In addition, mindset was tested as a moderator of associations between parental adaptive functioning and the two outcome variables. A small majority of staff (56%) held a more incremental oriented mindset. A more incremental oriented mindset was associated with a shorter intended waiting time to seek professional support. Staff mindset moderated the association between parental adaptive functioning and working alliance, that is, lower levels of parental adaptive functioning were associated with lower working alliance quality, but the association was less strong when staff held a more incremental oriented mindset. The results of the current study show that staff mindset might be important for the quality of support for parents with MID and for reducing the risks for families where parents have MID. Attention is due to staff mindset in improving support for parents with MID.

Effects of video-feedback intervention on harmonious parent–child interaction and sensitive discipline of parents with intellectual disabilities: A randomized controlled trial

BACKGROUND This study tested whether video-feedback intervention based on attachment and coercion theory increased harmonious parent-child interaction and sensitive discipline of parents with mild intellectual disabilities or borderline intellectual functioning. METHODS Observer ratings of video-recorded structured interaction tasks at home formed pretest, post-test, and 3-month follow-up outcome data in a randomized controlled trial with 85 families. Repeated measures analyses of variance and covariance were conducted to test for the intervention effect and possible moderation by IQ and adaptive functioning. RESULTS The intervention effect on harmonious parent-child interaction was conditional on parental social adaptive behaviour at pretest, with lower adaptive functioning associated with stronger intervention benefit at post-test and follow-up compared to care as usual. Intervention effects were not conditional on parental IQ. Intervention effects for sensitive discipline were not found. CONCLUSION Although the video-feedback intervention did not affect observed parenting for the average parent, it may benefit interaction between children and parents with lower parental adaptive functioning.

Parents with intellectual disability

Questions around parents with intellectual disability have changed according to sociocultural shifts in the position and rights of people with intellectual disability. The early research focus on capacity for parenting has given way to a contextual model of parenting and child outcomes, increasingly tested in population-based samples. Epidemiological research shows that contextual variables such as low income, exposure to violence, and poor mental health partly account for negative outcomes. As theoretical models developed for other at risk populations prove increasingly helpful for understanding the challenges of parenting with intellectual disability, it becomes viable to adapt existing evidence-based parenting interventions and test these for this population. Ultimately, parenting research should become fully inclusive.