Maternal Self-Efficacy of Mothers of Children with Intellectual Developmental Disabilities, Down Syndrome, and Autism in Kuwait

Maternal Self-Efficacy of Mothers of Childrenwith Intellectual Developmental Disabilities,Down Syndrome, and Autism in Kuwait

Hayfaa Yousif Al-Kandari • Humoud Al-Qashan

Published online: 4 October 2009

� Springer Science+Business Media, LLC 2009

Abstract This study aims to identify the perception of maternal self-efficacy

among 95 Kuwaiti mothers of children with Developmental Disabilities (DD) to

determine the differences in perception of maternal self-efficacy variables among

the mothers based on demographic variables: Child’s age, Gender, Type of dis-

ability, Leisure time, and Mother’s age. A survey was conducted using Kandari’s

(2005, Unpublished doctoral dissertation, Simmons College, Boston) Arabic version

of the Caregiving Self-Efficacy Scale. The mothers were selected from different

special education settings in Kuwait. They had 33 children with Intellectual

Developmental Disabilities (IDD), 41 with Down Syndrome, and 21 with autistic

disorder. The children included both males and females, and ranged between the

ages of 6 and 15. The findings showed that (1) mothers of children with DD did not

differ in their beliefs about aspects of maternal self-efficacy according to the Child’s

age, Child’s gender, and the Mother’s age; (2) mothers of children with IDD, when

compared to other mothers, had negative beliefs of all aspects of maternal self-

efficacy; (3) mothers of children who did not attend a respite facility for an after-

noon had negative beliefs of all aspects of maternal selfefficacy except for the

child’s behavioral management; and (4) all mothers’ groups had negative beliefs

about their ability to control their child’s behavior and their own emotions.

Implications are discussed to provide services for mothers to help them develop

their adaptive skills and meet their children’s needs, as well as their own.

Keywords Maternal self-efficacy � Intellectual developmental disability �Down syndrome � Autism � Mothers � Kuwait � Children with disabilities �Respite facility

H. Y. Al-Kandari (&) � H. Al-Qashan

Department of Social Work, Social Science College, Kuwait University, P.O. Box 68168,

71962 Keifan, Kuwait

e-mail: [email protected]; [email protected]

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Child Adolesc Soc Work J (2010) 27:21–39

DOI 10.1007/s10560-009-0189-6

Introduction

The study of beliefs about one’s abilities and the role of such beliefs in human

adaptation and adjustment have a long history in clinical, personality and social

psychology. Addressing efficacy perceptions associated with providing care is

particularly relevant to a caregiving population for which cognitive and emotional

challenges may be frequent and ongoing (Steffen et al. 2002). Researchers suggest

that the extent to which parents will alter their perceived efficacy through caregiving

experiences depends upon, among other variables, the perceived difficulty of

caregiving tasks (Bandura 1997). This particularly applies to mothers of children

with developmental disabilities (DD), such as mild intellectual developmental

disabilities (IDD), Down syndrome (DS), and autistic disorder. These children are

characterized by significant limitations both in their intellectual functioning and in

adaptive behaviors. It is expected that the wide divergence in ability levels among

these children may result in low levels of maternal self-efficacy for the mothers.

Mothers of children with DD often perceive the process of caregiving as

involving intense difficulties (Kandari 2006). Parette et al. (2004), for example,

report that Chinese-American and other Asian-American parents of children with

disabilities have trouble managing their children’s disturbing behaviors. This is

because certain disabilities present rather extreme variations in ability and behavior,

and introduce an amplified diversity of challenges for family members (Cho et al.

2000). Rush (2006) also shows that not only do the disability conditions make the

task of parenting difficult, but parents’ perceptions of the challenges of caregiving to

a child with DD have some kind of impact as well, whether psychological, practical,

or physical.

When caring for a child with DD, parents face tremendous challenges in almost

every area of family life (Simpson et al. 2004). Boothroyd (1997) identifies five areas

in caregiving that may influence parents’ beliefs regarding their ability to care for a

child with DD. These areas include (1) the child’s behavioral management, (2)

parents’ awareness of the child’s needs at school, (3) parents’ ability to advocate for

the child, (4) emotional support for the child, and (5) primary care to meet the child’s

needs. Kandari (2005) suggests that each of these areas can pose extreme challenges

to parents of children with DD. Other researchers have also found that the high level

of difficulties in such areas of caregiving correlate with low levels of parents’ beliefs

about their ability or capacity to care for their children with DD (Boothroyd 1997;

Kandari 2005). As suggested by Sahu and Rath (2003), caring for a child with DD

can potentially cause anxiety and depression in mothers and the perception of self-

efficacy is associated with the mothers’ well-being. Hastings and Brown (2002)

found mothers’ well-being to mediate the effect of a child’s behavior problems.

Bandura and Wood (1989) argue that self-efficacy refers to parents’ beliefs about

their capability to exercise control over events that affect their lives. Thus, self-

efficacy is concerned with not only the skills one has, but also with judgments about

what one can do with those skills. Most researchers conceptualize and study self-

efficacy as task-specific, such as maternal self-efficacy, teaching self-efficacy, or

coping self-efficacy (Bandura 1997). According to Eden (1988), the better the match

between self-efficacy and specific subject (e.g., self-efficacy and parenting), the

22 H. Y. Al-Kandari, H. Al-Qashan

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greater the predictability. In the present study, maternal self-efficacy is defined as

the perceptions mothers have of their ability to successfully complete a specific task

of caregiving; so, for instance, maternal self-efficacy has to do with mothers’

feelings of competency in the maternal role.

For mothers of children with DD, the present study expects that maternal self-

efficacy would be tied to how well mothers perceived parenting and how well they

perceived what their children were doing. Vincent and Houlihan (1991) suggests

that maternal self-efficacy begins with understanding the diagnosis and learning

about how the child can be helped, who the helpers will be, and what they will do in

order to remove some of the difficulties of caring for the child with DD. However,

this can also be the starting point of learning helplessness, or the assumption of

inability. Parette et al. (2004) suggests that this is because mothers of children with

disabilities may, for example, believe that they cannot find a personal bond with

others who will listen, understand, and support them. They may encounter

misunderstanding and sometimes negative reactions from others regarding their

children with disabilities. Mothers may also believe that if they talk about their

child’s problem, they may burden their friends, or they may be rejected by others

who do not understand their emotional needs and concerns. This could be more

critical, if mothers lack social services and external support provided by

organizations and professionals, such as informational, emotional, and material

support. In this particular case, mothers may perceive parenting as a difficult task

and may feel stressed in parenting their child with DD (Dunst et al. 2000).

Boothroyd (1997) also suggests that parents may feel frustrated and hopeless if

they believe that they are unable to have control over some aspects of their child’s

behavior, to organize and execute control over the increased needs and requirements

of the child, to know what the child needs at school, to support the child by seeking

the services needed for him/her, explaining to others the kind of help the child

needs, advocating for the child’s rights, and understanding the child’s problems. In

general, research shows that mothers of children with DD may feel frustrated as

they believe that only professionals, such as those who diagnosed the child or

provided him/her with referral services, can care for their child with DD (Bailey and

Simeonsson 1988). Accordingly, they may perceive caregiving as a difficult task

that needs to be frequently supported by professionals.

In addition, Salih and Kandari (2007) suggest that parents may find the

challenging task of caregiving more difficult when there are negative attitudes

toward the child with DD in one’s immediate environment. A parent who is

employed, for example, may not be able to find a good babysitter for the child at

certain times during the day because of the negative perception of others toward a

child with a disability. Also, friends, relatives, or housemaids may appraise the care

for the child with DD as difficult and may refuse to become involved with his/her

behavioral problems. In addition, there may not be appropriate programs for parents

to take the child out for social activities, which could serve as a respite facility for

the child. Or it may be difficult for parents to take their child with DD out to see

relatives because the relatives may discourage their visits. The interactions of

children with DD with friends’ children may be limited by lack of acceptance of

others or by the hurt experienced by the parents of children with DD, as they

Maternal Self-Efficacy of Mothers of Children in Kuwait 23

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compare the development of their child with that of their niece, nephew, or a

friend’s child. Even when a child with DD enters a school and the opportunities of

outside home activities increase, separating students with disabilities from others

without disabilities can prevent social interactions of children with DD with other,

so-to-speak ‘‘normal,’’ children.

For all of these reasons, efforts to enhance maternal self-efficacy must be made

early on the part of professionals, and they must be kept up to provide education and

reassurance of the mothers’ primary role of parenting. Unfortunately, this kind of

support does not exist in Kuwait. While growing efforts have been made in the

country over the past years to develop services for children with disabilities based

on the law of disabled care (No. 13/96), less attention has been paid to develop a

social policy that advocates the provision of services for parents of children with

DD. In the US, it is a legal requirement of the special education policy (as part of the

Individuals with Disabilities Education Improvement Act of 2004, and the act of the

Individual Family Services Plan of 1997) to engage parents of children with

disabilities into the whole process of special education services starting from

assessments and diagnosis to planning programs. Kuwait needs to follow this model.

At the present time, unlike in the US, there are no services available for Kuwaiti

parents that offer them basic information and instructions about their child’s disability.

What, then, can parents do in a situation of limited material resources to improve their

lives and enhance their caregiving self-efficacy when rearing a child with DD?

Kuwaiti parents of children with disabilities may have two ‘indirect’ focuses that may

help them to adapt to their child’s disability: Community and/or family resources.

However, the reality is that not all parents of children with DD are knowledgeable to

seek for appropriate help and support, even though few feel comfortable in caregiving

tasks. The parents of children with DD may repair to outside resources based on their

awareness of and power to seek out such information and treatment.

Social providers and professionals in the Kuwaiti Ministry of Social Affairs need

to be aware that efficacy for Kuwaiti mothers of children with DD is an important

skill that must be enhanced by providing such services through different stages of

the child’s life. This may become particularly crucial at school age, when the sons

or daughters with DD are spending significant amounts of time at special education

schools away from their mothers. During this time, the mothers’ involvement and

participation and their sense of control in their children’s lives depends greatly on

the type of services provided for them and how well they are able to communicate

with services that are proficient in problem-solving if conflicts occur.

Unfortunately in Kuwaiti culture, disability has a stigmatizing effect on members

of the immediate and extended family, and families tend to keep members with a

disability out of sight. Commonly, persons with a disability are regarded as

burdensome and shameful, because they are incapable of contributing to traditional

social obligations and roles (Kandari and Salih 2008). As long as such traditional

beliefs persist, the present study expects that, with lack of family services, Kuwaiti

mothers will continue to believe that they cannot deal with the stress at home, talk

with friends and family about their child, or ask others for help. They may not be

able to turn to friends, relatives or others in times of need and crisis, believing that

they are isolated and unsupported.


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Kandari’s study (2005) confirms this argument. Conducted on 98 mothers of

children with mild IDD in Kuwait, Kandari concluded that Kuwaiti mothers feel

overwhelmed as they experience intensive difficulties related to parenting their child

with IDD, and lack services that include information on how to help the child or

themselves to remove such difficulties. Previous studies also show that losing some

sense of parental control may lead to high levels of maladaptive behaviors in their

children (Fong 1991), a low level of parental well-being (Kersh et al. 2006), and a

low level of caregiving self-efficacy (Kandari 2005), which in turn may impact the

mothers’ willingness or reluctance to apply for out-of-home placement for their

child (Duvdevany and Vudinsky 2005).

Ahmad (2004) found that between 1992 and 2002, there was an increase in the

number of children and male and female adults with IDD who live in a Social

Welfare Institution for permanent care. The number of residents with IDD in the

institution has recently increased from 223 to 296. This number will most likely

increase in the near future, if there are no services that focus on helping parents with

caregiving. As Beresford (1994) argues, providing such services that enhance the

parents’ mastery would help to remove maternal difficulties and improve coping

skills for the participating parents. Effective mastery of parents involves balancing

the needs of all family members, including the child with DD, and gaining

communicative competence that leads to resilient families (Patterson 1989).

Moreover, a positive attitude towards the self, a belief in one’s ability to master

stressful characteristics and the conviction that the future will be fine is crucial to

successful caregiving to children with DD. Such an attitude would hopefully (1)

lead Kuwaiti mothers to appraise maternal difficulties as a challenge rather than a

threat, (2) foster active attempts to alter stressful situations, and (3) help the mothers

manage the emotional distress of parenting their child with DD.

A wide variety of studies conducted within the framework of social cognitive

theory support the notion that parents’ beliefs about their ability to manage specific

situations in caring for their children with DD strongly influence motivational,

behavioral and emotional processes. Hauser-Cram et al. (1999) state that mothers of

children with DD may believe that they are unable to cope with their child’s

shortcomings in (1) communication, especially with respect to expressive language

(i.e., spoken), (2) social development, and (3) the mastery of adaptive skills

associated with the tasks of daily living. As Kuhn and Carter (2006) suggest,

mothers’ sense of their own inability to exert a positive influence on their children’s

development would be associated with a low level of maternal self-efficacy. In

Kuwait, Kandari’s (2005) study shows that a high level of caregiving self-efficacy

decreases the level of stressors related to the characteristics of the child. Other

research shows that a high level of maternal self-efficacy among mothers of children

with DD (1) is associated with well-being and lowered feelings of guilt (Kuhn and

Carter 2006), (2) promotes greater attachment security to the children with

disabilities (Brauner 2003), (3) reduces vulnerability to anxiety and depression

(Olioff and Aboud 1991), (4) increases the parents’ involvement in their children’s

intervention programs (Solish and Perry 2008), and (5) increases the level of the

mothers’ life satisfaction (Christian 2007). Moreover, Leeson (2007) suggests that

high confidence and efficacy impact people’s perceptions about their ability to


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participate in decision-making in general. Other studies (Ardelt and Eccles 2001;

Bandura et al. 1996; Silver et al. 1995; Williams and Williams 1998) conducted in

the United States and Europe reveal that a person with a high level of maternal self-

efficacy is more optimistic, authoritative, and consistent in her interactions with her

children than are those with lower maternal self-efficacy.

Identity theory predicts that individuals who believe they are performing a role in

a competent manner are more likely to elevate the salience of that role in their

personal role hierarchy (Stryker 1987). Previous research, such as the study of Ujiie

(1997), found that many Japanese mothers of toddlers and preschool-aged children

were anxious and lacked confidence in their childrearing practices, which in turn

made them ‘‘unable to cope decisively and firmly with their children’s opposition

and assertion’’ (p. 482). Anderson and Jennings (1980) show that when parents face

caregiving demands, those with low self-efficacy beliefs focus on negative aspects

of the situation, including their personal deficiencies, the difficulties of the task, and

the negative consequences of failure. Steffen et al. (2002) state that perceived

difficulties in confronting and regulating such perceptions lead to decreased uses of

the cognitive and behavioral coping strategies that are effective in reducing anxiety.

Although the self-efficacy model has been widely used in research on coping, this

construct has not been widely applied in studies that help to explain the beliefs of

mothers of children of different types of DD in caregiving. Gerontologists, for

example, have used self-efficacy to predict different aspects of functioning in older

adults. These include active grandmothers (King and Elder 1998), intellectual

functioning (Berry et al. 1989), functional status following a decrease in physical

capacity (Mendes do Leon et al. 1996), physical activity in osteoarthritis patients

(Rejeski et al. 1996), and adherence to exercise following a structured exercise

program (McAuley 1992). Moreover, Kandari’s study (2005) focused on the

relationship between caregiving self-efficacy and parenting stressors and need for

services among mothers of children with mild IDD in Kuwait. While Kandari

selected mothers of children with mild IDD, the present study focuses on mothers of

children with IDD, DS, and autism.

The assessment of maternal self-efficacy can assist in targeting specific abilities-

related beliefs and situations, predicting areas of potential difficulties and tailoring

interventions to meet the special needs of mothers of children with DD. Such

information can also assist in the timing of specific interventions, because social

workers and mothers would be able to anticipate a situation in which maternal

difficulties with a child with DD are likely to occur, and they would be able to plan

strategies for coping with these situations. The information obtained regarding

maternal self-efficacy also leads to targeting specific caregiving skills and domains

to challenge the caregiving responsibilities. Intervention that allows parents to

develop skills and practice them in their actual caregiving environment will be the

most likely to succeed (Bandura 1997). Enactive mastery experience is the most

influential source of efficacy information, as it provides the most authentic evidence

of whether one can master whatever it takes to succeed and challenge the caregiving

stressors. According to Maddux (1995), psychologists agree that a sense of control

over our behavior, our environment, and our own perceptions and feelings is

essential for psychological adjustment.


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The present study attempts to increase the awareness of social providers in the

Kuwaiti Ministry of Social Affairs to the need of mothers of children with DD for

services specifically provided to enhance maternal self-efficacy. The study aims to

investigate the following questions: (1) Are there differences in perception of the

aspects of maternal self-efficacy among mothers of children with DD based on the

demographic variables, such as Child’s age, Child’s gender, Mother’s age, Child’s

type of disability, and Child’s leisure time (whether or not a child attends a respite

facility in an afternoon); (2) Are there differences in perception of the aspects of

maternal self-efficacy among mothers of children with DD regardless of the

demographic variables?

Methodology

Sample

The study surveyed a sample of 95 mothers of children with DD in Kuwait. Of these

mothers, 33 had children with IDD, 41 had children with DS, and 21 had children

with autistic disorder. The mothers were selected from a variety of special education

settings, such as the special education schools, the Kuwaiti Center of Autism

(KCA), the Kurafy Center of Disabled Activities (KCDA), and the Kuwaiti Center

of Down Syndrome (KCDS). Of the participants, there were 56 male and 39 female

children with DD in the age-range 6–15 (M = 10.13, SD = 2.83). The children

with DD had been diagnosed as having IDD, DS, or autism at the time that they

entered the special education settings. They had an intelligence score (IQ) between

75 and 55. All of the children attended the special education schools (elementary

level) in the morning, and almost 64% of them attended the respite facility for

disabled children in the afternoon.

The mothers who participated in the study were Kuwaiti women between the

ages of 21 and 59 years old (M = 40.04, SD = 7.89). Also, about 85.3% of the

mothers in the sample were married, 1.1% were separated, 8.4% were divorced, and

5.3% were widowed.

Data Collection

Sampling Procedure

In a personal interview with social workers in the special education settings, two

research assistants discussed with them the sample criteria and the data collection

plan. The research assistants asked the social workers in each setting to limit the

database to Kuwaiti mothers of male and female children who were between the

ages of 6 and 15 years old, and excluded children who (1) were not citizens of

Kuwait, (2) did not have home care provided by their mothers or lived with their

grandparents, relatives or in a dormitory, (3) had siblings with a disability, (4)

had a chronic disease or another type of disability, and (5) were of age 16 or

older.


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Social workers in each setting distributed the questionnaire packets to children,

and asked them to deliver the packets to their mothers. Each mother received an

envelope that included a cover letter and a questionnaire comprised of two sections:

(1) a demographic information section, and (2) a caregiver self-efficacy scale.

Mothers voluntarily participated by filling out the self-administered questionnaires.

No names were required on the questionnaires or returned envelopes, to ensure their

confidentiality. In addition, the participants returned the completed questionnaires

either in person, or sent them back with their children. In either case, the

questionnaires were received by the social workers in sealed envelopes. The

research assistants collected the sealed questionnaire packets within 1 week after

distributing them.

Instruments

Demographic Information

A demographic questionnaire was developed, which included background infor-

mation about Child’s age, Child’s gender, Mothers’ age, Type of disability (IDD,

DS or autism), and Child’s respite facility for an afternoon.

The Caregiver Self-Efficacy Scale (CSES)

The Arabic version of the caregiver self-efficacy scale (A-CSES) of Kandari (2005)

was used to assess mothers’ perceptions about their ability to care for their child

with DD. The CSES is a measure designed by Boothroyd (1997) to assess the

caregiving self-efficacy of parents of children with severe emotional disturbances.

The measure was translated into Arabic and adapted to Kuwaiti culture by Kandari

(2005).

The A-CSES is comprised of five subscales: Behavior management (six items),

School issues (four items), Advocacy (four items), Emotional support (five items)

and Provider issues (six items). The five components of caregiving self-efficacy are

defined in the present study as follows: (1) Behavior management: Mothers’ ability

to manage and control the child’s behavior, to get the child to act the way mothers

want, to praise the child for good behavior, to discipline the child, to set limits for

the child and say no to the child; (2) School issues: Mothers’ knowledge of the

child’s needs at school, such as knowing what the child is doing at school,

discussing the child’s situation with the school personnel, helping the child with his/

her homework and participating in school activities with the child; (3) Advocacy:

Mothers’ ability to advocate for the child by seeking the services needed for the

child, such as explaining to others the kind of help the child needs, identifying

services that may help the child, advocating for the child’s rights and understanding

the child’s problem; (4) Emotional support: Mothers’ capacity to deal with their

own emotional needs, such as coping with frustration about the child’s problems,

controlling their anger with the child, talking with friends and family about the

child, dealing with stress at home and asking others for help; and (5) Provider

issues: Mothers’ capacity to meet the child’s basic needs, such as medical needs,


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providing a safe home environment, food, clothing and shelter, taking the child

some place for fun, and spending time with the child.

The total number of items in the scale is 25. In general, the scale asks the

caregivers ‘How comfortable are you with your ability to’ act in particular

situations. An example of these situations/items is, ‘Control your child’s behavior,’

‘Help your child with his/her homework,’ ‘Meet your child’s needs,’ etc. The rating

responses are 1 (very comfortable), 2 (somewhat comfortable), 3 (slightly

comfortable) and 4 (not very comfortable). The response of ‘not very comfortable’

refers to a low level of perception of maternal self-efficacy. All items on the

A-CSES are given in a positive direction so there is no need to reverse individual

item responses to calculate the individual subscale of the total scores.

In the present study, the A-CSES reliability as computed by Cronbach’s Alpha

was at 0.92. For the A-CSES subscales, such as Behavior management, School

issues, Advocacy, Emotional support, and Provider issues, alpha was at 0.62, 0.57,

0.67, 0.69, and 0.92, respectively. Since the A-CSES was used in another study in

Kuwait, the reliabilities were compared with a study of Kandari (2005). The

reliabilities obtained in the present study ranged from 0.57 to 0.92, which were

mostly adequate in some items and high in other items, when compared to those in

Kandari’s study (2005). In Kandari’s study, the alpha values were 0.72, 0.63, 0.58,

0.60, and 0.74 for Behavior management, School issues, Advocacy, Emotional

support, and Provider issues subscales, respectively. The corresponding values of

alpha in the present study were adequate in the subscales of Behavior management

and School issues (0.62 and 0.57, respectively), and high in the subscales of

Advocacy, Emotional support, and Provider issues (0.67, 0.69, and 0.92,

respectively).

Overall, the total reliability of the A-CSES in the present study was acceptable at

0.92. Also, the reliability of most subscales of A-CSES was adequate. Only one of

the subscales in the A-CSES had reliability values less than 0.60 (e.g., School

issues). The other values ranged from 0.62 to 0.92.

Analysis Strategies

The present study adopts several statistical procedures to answer the research

questions. The analysis strategies used are multivariate analysis of variance

(MANOVA), multivariate analysis of covariance (MANCOVA), analysis of

variance (ANOVA), and t test.

Results

Differences in Perception of Maternal Self-Efficacy Variables and

Demographics

The present study questioned whether or not there were significant differences in

perception of the maternal self-efficacy variables (Behavior management, School

issues, Advocacy, Emotional support, and Provider issues) among mothers of


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children with DD, related to the demographic variables (Child’s age, Gender,

Mother’s age, Type of disability, and Child’s leisure time).

Maternal Self-Efficacy Variables Versus Child’s Age, Child’s Gender, and Mother’sAge Separately

To investigate the differences in perception of maternal self-efficacy variables

among mothers of children with DD based on Child Age, Child’s gender and

Mother’s age, the present study used MANOVA (for the categorical variables such

as child’s gender) and MANCOVA (for the continuous variables such as the child

and mother’s age). Though two statistical methods were used, both indicated

whether mothers’ perceptions of the maternal self-efficacy variables vary with the

demographic variables.

As indicated in Table 1, there are no significant mean differences in the aspects

of maternal self-efficacy according to Child’s gender (F = 1.350, p \ 0.251),

Child’s age (F = 1.920, p \ 0.099), and Mother’s age (F = 1.773, p \ 0.126).

This means that mothers of children with DD did not differ in their perceptions

about different aspects of maternal self-efficacy regardless of their age, gender, and

their child’s age.

Maternal Self-Efficacy Variables Versus Type of Child’s Disability

Table 1 shows the results of the MANOVA analysis. As the table indicates, there

are significant mean differences in the aspects of maternal self-efficacy among

mothers based on the children’s type of disability: Children with IDD, Children with

DS, and Children with autism. Accordingly, the mean differences among the

mothers’ groups were computed and compared in each aspect of maternal self-

efficacy separately, using significant multivariate F ratio, followed up by a

univariate analysis of variance (ANOVA) procedure.

As can be seen on Table 2, the data revealed significant mean differences in the

five aspects of maternal self-efficacy at 0.01 and 0.001 among the mothers’ groups.

These aspects are Behavior management, School issues, Advocacy, Emotional

support, and Provider issues. This means that the perception of the aspects of

maternal self-efficacy differs among mothers of children with IDD, DS, and autism.

Table 1 Results of the MANOVA and MANCOVA analyses for mean differences in the aspects of

maternal self-efficacy according to demographics

Demographics F df1 df2 p-Value

Child’s gender 1.350 5 89 0.251

Child age 1.920 5 89 0.099

Mothers’ age 1.773 5 89 0.126

Child’s type of disability 15.130 10 178 0.000*

N = 95 mothers of children with DD

* p B .001


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Comparing the means of maternal self-efficacy variables among the three groups

of mothers, Table 2 shows that the means of maternal self-efficacy variables for

mothers of children with IDD seem to be higher than those of other groups. This

result, in general, indicates that mothers of children with IDD, in contrast to mothers

of children with DS and mothers of children with autism, believe that they are

unable to care for their child. This result can be supported by the high mean (close

to 3.0) of maternal self-efficacy variables for mothers of children with IDD. As can

be recalled, the response ‘slightly comfortable’ for each scale item is scored as 3.0.

Thus, we can conclude that the average belief of mothers of children with IDD in

their ability to parent the child was negative.

In addition, as indicated on Table 2, the standard deviations of maternal self-

efficacy variables of mothers of children with IDD varied from a low of 0.47 to a

high of 0.55. Comparing these values with the standard deviation of the normal

distribution (95% of the scores cover 4 standard deviations), it can be concluded that

not only did the respondents hold negative beliefs about their ability to care for the

child with IDD, but they were also fairly homogeneous in their beliefs.

The aforementioned result indicates that mothers of children with IDD, when

compared to mothers of children with DS and mothers of children with autism, had

negative beliefs about their abilities to (1) manage and control the behavior of the

child with IDD, (2) meet the child’s needs at school, (3) support the child’s rights in

regard to services, (4) deal with their own emotional needs when facing the child’s

problems, and (5) meet the child’s basic needs.

Maternal Self-Efficacy Variables Versus Child’s Leisure Time

This part of the present study investigated whether or not there were significant

differences in the perceptions of the aspects of maternal self-efficacy among

mothers of children with DD based on the Child’s leisure time—children (n = 61)

who attend a respite facility in an afternoon versus children (n = 41) who did not

attend such settings in an afternoon.

Table 2 Means, standard deviations and F values of the aspects of maternal self-efficacy for mothers of

children with IDD, DS, and autism

Variable Mothers of children

with IDD

Mothers of children

with DS

Mothers of children

with autism

F

M SD M SD M SD

Behavior management 2.73 0.55 2.31 0.57 2.52 0.42 5.468*

School issues 2.81 0.53 1.98 0.71 2.32 0.49 17.328**

Advocacy 3.07 0.51 2.03 0.69 2.04 0.49 32.494**

Emotional support 2.92 0.55 2.21 0.73 2.15 0.54 14.540**

Provider issues 3.37 0.47 1.46 0.54 1.71 0.49 141.610**

N = 33 mothers of children with IDD, N = 41 mother of children with DS, and N = 21 mothers of

children with autism

* p B .01, ** p B .001


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To investigate the mean differences of maternal self-efficacy variables, the two

groups of mothers were compared using t test. As would be expected, the t test

procedure showed a significant mean difference between the two groups of mothers

in four aspects of maternal self-efficacy: School issues (t = 3.585, p = 0.001),

Advocacy (t = 4.940, p = 0.000), Emotional support (t = 2.754, p = 0.007), and

Provider issues (t = 6.322, p = 0.000).

As Table 3 indicates, mothers of children with DD who did not attend a respite

facility for an afternoon have higher means in the four aspects of maternal self-

efficacy than those of the other group. The high means of the four aspects of

maternal self-efficacy among the former group were close to 3.00. Again, it would

be recalled that the response ‘slightly comfortable’ for each scale item is scored as

3. Thus, it could be concluded that the average beliefs of mothers of their abilities of

parenting the child who did not attend respite facility in an afternoon was negative.

This means that, when compared to another group, mothers of children with DD

who did not spend their leisure time in a respite facility in an afternoon, have a

belief that they are unable to (1) meet the child’s needs at school, (2) support the

child’s rights in regard to services, (3) deal with their own emotional needs when

face child’s problems, and (4) meet the child’s basic needs.

Differences in Perception of Maternal Self-Efficacy Variables Among All

Mothers

Regardless of the demographics and other variables, this part of the present study

investigated the differences in perception of the five aspects of maternal self-

efficacy among all mothers of children DD (Mothers of children with IDD, DS, and

autism together). It discovered the differences in mothers’ beliefs of their abilities of

caring for the child with DD. To investigate the mean differences of the maternal

self-efficacy variables for all mothers, the means of the efficacy variables were

Table 3 Means, standard deviations and t values of the aspects of maternal self-efficacy according to

child’s leisure time

Variable Mothers of children with DD

Children attend a respite

facility

Children did not attend a respite

facility

t

M SD M SD

Behavior management 2.42 0.56 2.64 0.54 1.844

School issues 2.16 0.69 2.67 0.61 3.585**

Advocacy 2.13 0.69 2.86 0.69 4.940**

Emotional support 2.29 0.68 2.71 0.70 2.754*

Provider issues 1.77 0.83 2.92 0.89 6.322**

N = 61 mothers of children with DD who attended a respite facility, N = 34 mother of children with DD

who did not attend a respite facility

* p B .01, ** p B .001


123

computed using MANOVA. Table 4 present the means, standard deviations and Fvalues of the efficacy variables among mothers of children with DD.

The multivariate analysis of variance showed significant differences between the

means of the efficacy variables at 0.001 (F = 378.051, p = 000). As shown on

Table 4, it seems that Behavior management and Emotional support have the higher

means (M = 2.50 and 2.44, respectively), whereas the other variables such as

Advocacy, School issues, and Provider issues have the lower means (M = 2.39,

2.34, and 2.18, respectively). In general, this result indicates that mothers of

children with DD believe that they are unable to care for the child. More

specifically, mothers have a high level of beliefs that they are unable to manage

their child’s behavior and that they cannot deal with their own emotional needs

when faced with their child’s problems and demands.

Discussion

The investigation in this study focused on differences in mothers’ beliefs about their

ability to care for their child with DD, which highlights the importance of the

number of variables in supporting maternal self-efficacy. Similarities were found in

assessing the impact of various demographic variables on mothers’ perceptions of

maternal self-efficacy. Investigations of the relationships between aspects of

maternal self-efficacy and Child’s age, Child’s gender, and Mother’s age revealed

no significant results. This finding indicates that the different groups of mothers

perceive maternal self-efficacy similarly, regardless of their background.

The findings were significant with regard to the differences in perception of the

aspects of maternal self-efficacy based on child’s type of disability. Mothers of

children with IDD, when compared to mothers of children with DS and autism, had

a low level of maternal self-efficacy—Behavioral management, School issues,

Advocacy, Emotional support, and Provider issues that suggest a strategy for

organizing and understanding mothers’ belief in their ability to parent a child with

IDD.

Table 4 Means, standard deviations and F values of the aspects of maternal self-efficacy for all mothers

of children with DD

Variable Mothers of children with DD F

M SD

Behavior management 2.50 0.56 1,889.287*

School issues 2.34 0.70 1,050.471*

Advocacy 2.39 0.77 915.234*

Emotional support 2.44 0.71 1,109.264*

Provider issues 2.18 1.01 442.026

N = 95 mothers of children with DD

* p B .001


123

The above finding is very important for social providers in the Ministry of Social

Affairs, because it indicates several critical issues about caring for children with

IDD. It indicates that mothers believe that they (1) are unable to manage the child’s

behavior in terms of getting the child to act properly, praising him/her for good

behavior, disciplining the child, setting limits for the child and saying no to him/her

when demands are increased; (2) are unaware of the child’s needs at school, such as

knowing what the child is doing at school, discussing the child’s situation with the

school personnel, helping the child with his/her homework, and participating in

school activities with the child; (3) are unable to support the child by seeking the

services needed for him/her, explaining to others the kind of help the child needs,

advocating for the child’s rights, and understanding the child’s problem; (4) are

unable to deal with their own emotional needs, such as coping with their frustration

about the child’s problems, controlling their anger with the child, talking with

friends and family about the child, dealing with stress at home, and asking others for

help; and (5) have less capacity to meet the child’s basic needs, such as medical

needs, providing a safe home environment, food, clothing and shelter, taking the

child some place for fun, and spending time with the child.

Contrary to the findings of the current study, studies in Western countries

revealed that parents of children with IDD and autism described a more difficult life

situation than parents of children with DS (Olsson 2004). Rutgers et al. (2007)

found that parents of children with autism, when compared to parents of children

with IDD and language disorder, have a low level of control over caregiving. Also,

Cho et al. (2000) suggested that parents of a child with autism frequently experience

difficulties with regard to providing a safe home environment and shelter, meeting

the child’s medical needs, taking the child some place for fun, and spending time

with the child. Schieve et al. (2007) found that parents of children with autism

reported high levels of aggravation in parenting, when compared to parents of

children without developmental problems.

The negative beliefs of Kuwaiti mothers of children with IDD with regard to

caregiving, in contrast to other mothers, may be related to several factors. First,

although all children with DD have special needs and make increased demands on

their parents through different developmental stages, it seems that the lives of

Kuwaiti mothers of children with IDD get overly disrupted with the daily hassles

and higher demands of the child. This may be because mothers believe that the care

of their child with IDD is largely under the control of others (e.g., teachers and

professionals in special education schools). Therefore, the mothers may mistakenly

conclude that they themselves cannot care for the child when he/she is home, and

that only professionals or teachers in the schools can care for and educate their

child. If this is true, then professionals in the special education schools in Kuwait

may need to increase their programs that focus on family counseling to support

parents with their child’s behavior management. Professionals can encourage

mothers to get more involved in their child’s education and cooperate with teachers

to help organize caregiving routines, meet the child’s needs at school, and support

the children’s rights.

A second explanation may be related to the services provided in educational

settings. For example, Kuwaiti mothers of children with autism and Down


123

Syndrome may receive services that are not available to mothers of children with

IDD in the special education schools. As noted in the annual report of each setting,

the Kuwaiti Center of Autism, Kurafy Center of Disabled Activities, and the

Kuwaiti Center of Down Syndrome provided parents with services that included

training, lectures, meeting with experts to discuss a child’s problems, and camping

for children during the year. These services were not available for mothers of

children with IDD in the special education schools. Kroodsma (2008) suggests that

educational workshops for parents of children with DD (i.e., autism) impact their

efficacy of caregiving. Chislett and Kennett (2007) find that parents who attend

educational programs about caregiving would have increased levels of maternal

resourcefulness, better parent–child interactions, and more effective child manage-

ment skills.

Yet a third explanation for Kuwaiti mothers’ negative beliefs about caring

properly for their child with IDD may be that services provided for mothers of

children with IDD in the special education schools do not meet the family’s needs

and desires. Kandari (2005) states that 77% of mothers of children with mild IDD

who were enrolled in the special education schools reported their needs for

counseling in regard to the child’s problems; 76.5% expressed the need to have

more time to talk to their child’s teacher or therapists; 81.6% said they needed to

locate another school for their child; and 45.9% wished they had suitable family

recreational activities for them and their child with IDD. It is important to provide

mothers with appropriate services that help them develop skills to cope with their

child’s behavioral problems, meet the child’s needs at school, support the child’s

rights, deal with their own emotions when they experience difficulties with the

child, and meet the child’s basic overall needs.

An additional finding of the present study showed differences in perception of the

aspects of maternal self-efficacy based on variables such as the child’s leisure time.

The finding indicated that mothers of children with DD who did not attend a respite

facility for an afternoon, when compared to mothers who could send their children

to a respite facility, had a negative belief regarding all aspects of maternal self-

efficacy except for the child’s behavioral management. This suggests that mothers

whose children spent all their time at home may feel overwhelmed because they

would have less time for themselves, and would be unable to master the adaptive

skills to carry out the tasks of daily living. At the same time, the mothers may have

difficulty taking the child some place for fun, and spending time with the child.

Consequently, they may feel frustrated and hopeless about having any control over

aspects of their child’s care. Thus, it may be concluded that the more recreational

activities available for children with DD in an afternoon, the greater the level of

maternal self-efficacy. Powers et al. (1995) suggest that parents would perceive their

children as competent when they got involved in a variety of activities.

Another important finding of the present study is related to the mothers’ beliefs in

their ability to care for their child with DD regardless of the demographics. The

finding showed that mothers of children with DD had a low level of maternal self-

efficacy with regard to their child’s behavioral management and emotional support.

Mothers of children with IDD, DS, and autism lack efficiency to control their child’s

behavior and mood in general or in specific problematic situations.


123

According to Bandura (1997), the more knowledgeable and skilled the mothers

are, the more efficacious they will feel in controlling their child’s behavior. This

means that the mothers’ lack of information about how to deal with their child’s

behavior may contribute to their lack of efficacy on behavioral management. Also,

as Fortier and Wanlass (1984) state, knowledgeable mothers will be prepared to

reduce stressors and cope with their anger in a demanding situation. This, in part,

will help mothers to use coping strategies to adapt to their child’s behavioral

problems as well as deal with their own emotional needs. Table 5 provides a

summary of the present findings.

Recommendations and Implications

The execution of this study, together with its findings, has brought the researcher’s

attention to a number of concerns and interests. These concerns can be presented in

the form of some recommendations for future studies. First, the influence of the

demographic variables on the aspects of maternal self-efficacy needs to be further

investigated. It is possible, for instance, that the interaction between Child’s age and

Child’s gender plays a role in the differences among the three groups of mothers’

perception of maternal self-efficacy. Further studies may use other variables such as

mother’s occupation, number of children in the family, siblings with a disability,

polygamy, the presence of a housemaid or nanny, coping resources, and family

support to investigate maternal self-efficacy.

Second, the lack of efficacy among mothers of children with IDD, when

compared with mothers of children with DS and autism, highlight the need for

educational programs in the special education schools or in the community to

develop the mothers’ adaptive skills to deal with the daily hassles of caring for their

child. Third, since the finding of this study has emphasized the importance of

outside activities for children and their positive influence on the mothers’ self-

efficacy, it is recommended that social providers in the Ministry of Social Affairs

increase the number of respite facilities to promote a healthy environment for both

Table 5 The perception of maternal self-efficacy variables among mothers of children with DD: a

summary of the findings

Maternal

self-efficacy

variables

Child’s

age

Child’s

gender

Mother’s

age

Type of

disability

(in favor of

mothers of

children with

IDD)

Child’s leisure

time (in favor

of mothers of

children who

did not attend

a respite facility)

Mothers

of children

DD

Behavior management N N

School issues N N

Advocacy N N

Emotional support N N N

Provider issues N N

N refers to negative beliefs


123

the children and their families. Finally, in light of the finding that showed the

mothers’ negative beliefs about their ability to control their child’s behavior as well

as their own emotions, further research is recommended to investigate the impact of

respite facilities on enhancing maternal self-efficacy.

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Documents

Maternal Self-Efficacy of Mothers of Children with Intellectual Developmental Disabilities, Down Syndrome, and Autism in Kuwait