Stress in Mothers with Intellectual Disabilities

Journal of Child and Family Studies, Vol. 6, No. 4, 1997, pp. 471-485

Stress in Mothers with Intellectual Disabilities

Maurice A. Feldman, Ph.D.,1,4 Michele Leger, Hon., B.A.,1 andNicole Walton-Allen, Ph.D.2

Both low parental IQ and stress have been shown to be associated withparenting difficulties and adverse child outcomes. We examined stress inparents with low IQ as a potential contributor to their documented parentingproblems. Eighty-two mothers with intellectual disabilities (IQ < 80; labelledas having mental retardation) were given the Parenting Stress Index and theywere found to be enduring very high levels of overall stress (95th percentile),stress related to child characteristics (95th percentile), and stress related toother life experiences (90th percentile) as compared to the normative test group.We divided the 82 mothers with intellectual disabilities into three groupsdepending on the age of their children. The mothers with school-age childrenreported significantly higher stress than parents of infant/toddler and preschoolchildren. A hierarchical regression analysis revealed that child age and livingin a crowded environment were significant predictors of parenting stress. Theresults confirm that mothers with intellectual disabilities experience extremestress that, together with other factors, may hinder adequate parenting.

Stressful life experiences have been shown to affect parental psycho-logical functioning, parenting behaviors, and child outcomes. Stress isexperienced when the subjective demands of a situation are incompatible

1Associate Professor, Department of Psychology, Queen's University and Chief Psychologist,Ongwanada Centre, Kingston, Ontario, Canada.

2Student, University of Ottawa, Ottawa, Ontario, Canada.3Private Practice, Hamilton, Ontario, Canada.4Correspondence should be directed to Maurice Feldman, Department of Psychology, Queen'sUniversity, Kingston, Ontario, Canada K7L 3N6. Electronic mail may be sent [email protected].

KEY WORDS: stress; parents with intellectual disabilities; parenting problems.

471

1062-1024/97/1200-0471$12.50/0 © 1997 Human Sciences Press, Inc.

with the response capabilities of the individual (Straus & Kantor, 1987).From an interactional perspective, the impact of stress on parental emo-tional functioning and parenting is mediated by characteristics of theparent, child, and the environment (Belsky, 1984; Dohrenwend & Dohren-wend, 1969).

Most research in stress and parenting has been conducted withmothers, who typically take primary responsibility for child-care. Stress isrelated to adverse physical and emotional problems in mothers (Bee,Hammond, Eyres, Barnard, & Snyder, 1986; Ilfeld, 1977). Maternal stressis associated with negative mother-child interactions (Crnic, Greenberg,Robinson, & Ragozin, 1984; Forehand, Lautenschlager, Faust, &Graziano, 1986; Webster-Stratton, 1988; Weinraub & Wolfe, 1983).Weinraub and Wolfe (1983) found that the frequency of stressorsexperienced by mothers tended to correlate negatively with child-rearingabilities and that increased stress interfered with the mother's ability torespond appropriately and bond to her infant. Stressful life events, maritaldiscord, and self-reported depression in mothers were correlated withmore maternal commands, criticisms, and physical punishment of children(Forehand et al., 1986; Webster-Stratton, 1988). Socially isolated motherswho reported feeling stressed were negative, confrontational, andunpredictable with their children (Dumas & Wahler, 1985, Panaccione &Wahler, 1986).

In addition to its relation to negative maternal behaviors, familystress places children at an increased risk for developmental and behav-ioral problems. Maternal stress was associated with low developmentaltest scores at 8 months of age (Garcia-Coll, Vohr, Hoffman, & Oh, 1986),and emotional maladjustment and school problems in older children(Sandier & Block, 1980). Bee et al. (1986) found that stress is not justa reaction to but also may precipitate child problems. That is, mothersexperiencing high levels of stress and life change (that adversely affectedmaternal health) during the child's first year of life had children withlower IQ, delayed language, and more problem behavior at 4 years ofage (Bee et al., 1986). In a series of structural equation modelling studiesinvolving hundreds of boys, Patterson, DeBaryshe, and Ramsey (1989)have found that parental stressors tend to act indirectly on child behaviorproblems by disrupting positive parenting practices that directly affectchild behavior.

Factors correlated with increased risk of maternal stress and relatedparenting problems include low socioeconomic status (Brown & Harris,1979, Garmezy & Rutter, 1983), martial discord (Emery & Tuer, 1993),single parenting (Weinraub & Wolfe, 1983), social isolation (Dumas & Wa-hler, 1985; Panaccione & Wahler, 1986), dissatisfaction with supports

Feldman, Leger, and Walton-Allen472

(Weinraub & Wolfe, 1983), and unemployment (Brown & Harris, 1978).In addition, high parental stress was associated with having three or moreyoung children (Brown & Harris, 1978), a child with disabilities (Benedict,Wulff, & White, 1992; Frey, Greenberg, & Fewell, 1989; Minnes, 1988),and/or behavior problems (Eyberg, Boggs, & Rodriguez, 1992; Mash &Johnston, 1983; Quine & Pahl, 1991).

Thus, parental stress has been implicated with adverse consequencesfor parents and children. One group of parents who are likely to be athigh risk for stress and parenting incompetency are parents with intellectualdisabilities (ID). Parents with ID are those with IQ less than 80 and manyof them are labelled as having mental retardation. Parents with ID expe-rience many of the risk factors that may exacerbate their poor parentingskills.

There have been longstanding concerns about people with mentalretardation becoming parents (Dowdney & Skuse, 1992). As a result ofthe community living movement, banning of involuntary sterilization,repeal of discriminatory marriage laws, and other factors, the number ofadults with mental retardation living in the community and raising childrenhas steadily increased (Dowdney & Skuse, 1992; Tymchuk & Feldman,1991). They are overrepresented in child maltreatment cases (Seagull &Scheurer, 1986; Taylor et al., 1991) and have documented parentingdeficiencies that place their children at-risk for neglect and developmentaland behavior problems (Feldman, 1994, 1997; Feldman, Case, Towns, &Betel, 1985; Feldman, Case, & Sparks, 1992; Feldman, Sparks, & Case,1993; Feldman & Walton-Allen, 1997; Gillberg & Geijer-Karlsson, 1983;Reed & Reed, 1965).

The reasons for parenting inadequacy in parents with ID remainunclear. While it has been accepted that maternal IQ is not solely asso-ciated with inadequate parenting unless the parent's IQ is below 55-60(Dowdney & Skuse, 1992; Tymchuk & Feldman, 1991), there is still apropensity to attribute incompetent parenting and adverse child out-comes directly to the parents' cognitive deficiencies (Hayman, 1990, Vo-gel, 1987). But, because not all children of parents with ID have problemsor the same types of problems (Feldman et al., 1985; Feldman & Wal-ton-Allen, 1997), other factors besides, or in addition to, low parentalIQ may be involved. For example, it is not certain to what extent parentswith ID endure considerable stress that may contribute to their parentingproblems.

There is reason to believe that having intellectual disabilities may placea person at increased risk for high levels of stress. Persons with ID mayexperience extraordinary stress resulting from a history of abuse (Tymchuk,1990), low socioeconomic status (Conley, 1973), stigmatization (Abramson,

473Stress in Mothers with Intellectual Disabilities

Parker & Weisberg, 1988, Edgerton & Bercovici, 1976), a history of failureand learned helplessness (Floor & Rosen, 1975), unemployment (Green-span & Schoultz, 1981), and social isolation (Reiss & Benson, 1985).Parents with ID may also undergo additional stress due to the constantthreat of child removal by child protection agencies (Hayman, 1990; Tym-chuk & Feldman, 1991), the lack of support for their parenting role(Tymchuk, 1992), single parenting and the lack of a supportive, ultimatepartner (Walton-Allen & Feldman, 1991). These risk factors may individu-ally, collectively, and/or cumulatively create a highly stressful situationwhich may impede adequate parenting by persons with ID. Nevertheless,stress in parents with ID has received little attention.

The purpose of our study was to examine parental stress encoun-tered by mothers with ID who had children belonging to one of threeage categories: infants/toddlers (age range = 0-2 years), preschool chil-dren (age range = 2-5 years), and school-age children (age range =6-12 years). We were interested in determining if stress level is relatedto child age. Caring for infants may be less stressful for parents thancaring for older children because babies are well below the parents in-tellectually. Although parenting a child of any age is complicated, thebasic physical child-care and relatively simple interactions needed forinfants may be easier to provide than the parenting skills required toaddress the complex emotional, social, and cognitive needs of older chil-dren. As children get older, parents may face more complicated parent-ing problems that require more sophisticated problem-solving skills. Wehypothesized that mothers with ID would report significantly higherstress levels than a normative sample of parents without disabilities, andthat stress levels will be higher in mothers with older children. In addi-tion to child age, we also explored other potential stressors, such as liv-ing in crowded conditions and the threat of child removal by childprotection agencies.

METHOD

Participants

The participants were 82 mothers who were intellectually disabled (IQ< 80), with no known biological reasons for their cognitive deficiencies. Allmothers had been previously independently diagnosed as having mental re-tardation (usually when in school), although some did not meet all theDSM-IV diagnostic criteria for mental retardation — IQ < 70-75 (Ameri-can Psychiatric Association, 1994). The parents continued to be eligible for,


and received, specialized services and funding reserved for people withmental retardation (e.g., a disability pension, an advocate, community livingskills training). Sixty parents had recent WAIS-R scores with a range of57-80; 62% of update IQs were 75 or below. Participants were referred bycommunity agencies providing services to adults with mental retardation,child protection agencies, advocates, nurses, physicians, hospital socialworkers, and family members. All mothers were welfare recipients and, inaddition to being eligible for benefits and services for persons with mentalretardation, they were also able to access services for economically disad-vantaged families (e.g., public health nurse, early intervention, parenteducation, and community drop-in centers). All participants gave consentto allow the information collected about them to be used in a confidentialmanner for research purposes.

Mothers were placed in one of three groups depending on the age ofthe target child: (a) the Infant/toddler Group consisting of 30 mothers whohad children less man 2 years of age; (b) the Preschool Group consistingof the 19 mothers who had children aged 2 to 5 years; and (c) the School-Age Group consisting of the 33 mothers who had children older than 5years of age. Demographic data on the three groups of mothers and theirchildren are presented in Table 1. For those mothers who had more thanone child, the mother's youngest child was the target child in our study.None of the children in our study had any known biological disabilitieswhich could affect their development.


Table 1. Means and Standard Deviations of Demographic Variables for Three Groups ofMothers

Variables

Mean Mat. IQMean Mat. Age (years)Mean No. of ChildrenMean Crowding Ratioa

Mean No. of Services% Single% Subsidized housing% Child Protect. Involv.Mean Child Age (months)

Infant Group(n = 30)

71.64 (6.29)26.33 (5.40)

1.29 (0.54)0.73 (0.92)2.57 (0.94)

40%75%89%

10.80 (5.41)

Preschool Group(n = 19)

71.69 (7.09)29.89 (6.64)

1.41 (0.51)0.64 (0.56)1.74 (2.88)

32%82%**77%

36.74 (11.23)

School-age Group(« = 33)

65.85 (7.03)*35.36 (4.67)*

1.94 (0.79)*1.21 (0.59)*2.27 (1.44)

15%67%27%

117.24 (25.89)***

Notes: numbers in parentheses are standard deviations; *Mothers of School-age children weresignificantly different from mothers in both the Infant/toddler and Preschool Groups (p <.05); **PreschooI Group significantly different from both the Infant/toddler and School-AgeGroups (p < .05); ***A11 groups are significantly different from one another (p < .05);Group comparisons based on one-way ANOVAs and Scheffe post-hoc tests; acrowding ratio= no. of persons living in house (apartment) divided by the ro. of rooms.

Measures

Demographics

The demographics questionnaire asked questions about: (a) historicalinformation (e.g., upbringing, medical history, institutional history, educa-tion, employment, previous marriages and children); (b) maternal andpaternal characteristics (e.g., age, race, current health, marital, and em-ployment status); (c) family variables (e.g., income, number of children athome and in care, child protection agency and social services involvement);and (d) living accommodations (e.g., type, size, total number of people liv-ing in the house, subsidized). Much of the demographic data werecorroborated by direct observation and/or interviews of family members andworkers who knew the family well. The paternal information that was col-lected was not used in this study because there was too much missing datadue primarily to an insufficient number of fathers being available to giveconsent for their participation and confirm details about them given by themother.

Parenting Stress Index

The Parenting Stress Index (PSI; Abidin, 1990) is a 101-item self-re-port questionnaire designed to measure stress in the parent-childrelationship. Participants respond to each item on a 5 point Likert-typescale, where high scores indicate high levels of stress. This instrument yieldsa Total Stress score and two subscale scores: a Child Domain score and aParent Domain score. The Child Domain measures six different areas ofstress associated with child characteristics including adaptability, accept-ability, demandingness, mood, distractibility/hyperactivity, and reinforcesparent. The Parent Domain measures seven areas of stress related to parentcharacteristics including depression, attachment, restriction of role, senseof competence, social isolation, relationship with spouse, and parent health.The PSI has acceptable internal consistency, construct validity and test-re-test reliability (Wantz, 1989).

Procedure

After giving consent, mothers were visited in their homes by projectstaff during which time the demographics questionnaire and the PSI wereadministered. Assessors were aware of the nature of the mothers' disabili-ties, but staff were not privy to the specific hypotheses of this study. The

476 Feldman, Leger, and Walton-Allen

assessor would read each item outloud and repeat the five choices for eachquestion of the PSI. Mothers could read along if they wished, and clarifi-cations and simpler language were used as needed to increase the mothers'understanding of questionnaire items. None of the mothers had difficultycomprehending and answering the questions when presented in this man-ner.

RESULTS

Table 2 presents the means, standard deviations, percentile rankings,and z-test results of the PSI Total, Child, and Parent Domains scores ofthe entire study sample of mothers with ID compared to the normativesample of parents provided by the test author. As seen in Table 2, the 82mothers with ID reported considerable stress and scored significantlyhigher than the normative sample (n = 600) on the PSI Total, Child Do-main, and Parent Domain items.

Table 3 presents the mean PSI Total, Child, and Parent Domainsscores, and z-test comparisons with the normative group for the three agegroups. Individual z-tests showed that all three child age groups had sig-nificantly higher PSI stress scores than parents in the normative group(Table 3). One-way analyses of variance accompanied by Scheffe post hoctests on the PSI Total, Child, and Parent Domains scores revealed thatmothers in the School-Age Group had significantly higher PSI Total scoresand Child Domain scores than mothers in both the Infant/toddler and Pre-school groups, F(2, 79) = 11.73, p < .01, and F(2, 79) = 17.89, p < .01,respectively. Mothers with school-age children also had significantly higherParent Domain scores than mothers in the Infant/toddler Group, F(2, 79)= 5.08, p < .05. No other group differences involving PSI Total, Child andParent Domains scores were significant.

Table 4 presents the percentile ranking of each group on each PSIsubscale. According to Abidin (1990), scores >80th percentile are consid-


Table 2. Parenting Stress Index of Mothers with ID Compared to the Normative Sample

PSI Scales

TotalChild DomainParent Domain

Mothers with ID (N = 82)

Mean

281.7128.4153.3

SD

32.118.120.3

%tile Rank

959590

Normative Sample (N = 600)

Mean

221.198.4122.7

SD

38.919.224.6

z-test

z = 19.00**z = 14.17**z = 11.24**

**p < .001.

ered to represent clinically significant stress. As seen in Table 4, out of apossible 16 PSI total, domain, and subscale scores, the Infant/toddler grouphad 13 at or above the clinical threshold, the Preschool group had 12, andthe School-age group had 15. Group statistical comparisons of the 13 PSIsubscales were not conducted to reduce the likelihood of chance significantfindings because of multiple testing

Means and standard deviations for the demographic variables are pre-sented in Table 1. One-way analyses of variance accompanied by Scheffepost-hoc tests on the demographic variables revealed that mothers in theSchool-Age Group were older, had lower IQs, had more children, lived inmore crowded conditions, and had less child protection agency involvement

Table 4. Percentile Rankings" for Each Age Group on the PSI Subscales

PSI Scales

Total ScoreChild Domain

AdaptabilityAcceptabilityDemandingnessMoodDistract/HyperactivityReinforces Parent

Parent DomainDepressionAttachmentRestriction of RoleSense of CompetenceSocial IsolationRelationship to SpouseParent Health

Infant

9090858575858090

8580956585807580

Preschool

9090859085757590

8580956590808575

School-age

9599959995958595

9090957595859080

aPercentile ranking >80 is considered to be clinically significant stress.

478 Feldman, Leger, and Walton-Allen

Table 3. Parenting Stress Index Scores for the Three Age Groups and z-test Comparisonwith Normative Group

PSI Scales

TotalChildParent

Infant Group(n = 30)

Mean (SD) z-test

266.2 (27.9) 6.36**120.3 (11.8) 6.26**145.9 (19.6) 5.16**

Preschool Group(n = 19)

Mean (SD) z-test

270.2 (29.3) 5.51**119.9 (12.8) 4.88**150.4 (20.6) 4.89**

School-age Group(n = 33)

Mean (SD) z-test

302.4 (36.2) 12.00**140.7 (18.8) 12.66**161.7 (20.3) 9.11**

**p < .001.

than mothers in the Infant/toddler and Preschool groups. In addition, sig-nificantly more mothers with preschool children were living in subsidizedhousing than participants in the two other groups; as designed, the childage differences were significant across groups.

Given these group differences in demographic characteristics, hierar-chical regression analyses were computed to determine which variableswere significant predictors of PSI Total, Child Domain, and Parent Domainscores. A correlation matrix for the three dependent measures and thedemographic variables was computed to determine which variables shouldbe included in hierarchical regression analyses. Child age, child protectionagency involvement, and crowding ratio were the only variables that weresignificantly correlated with the PSI Total score (rs = .40, .33, .36, respec-tively), Child Domain score (rs = .41, .37, .40, respectively), and ParentDomain score (rs = .33, .25, .28). These variables were subsequently en-tered into hierarchical regression analyses in which both crowding ratio andchild protection agency involvement were entered on Step 1. Child age wasentered by itself on Step 2 to determine whether child age was a significantpredictor after partialling out the variance attributed to the other variables.

Standardized regression weights (betas) of the regression analyses arepresented in Table 5. The analyses revealed that living in crowded condi-tions and child age were significant predictors of the PSI Total score. Theaddition of child age to the equation on Step 2 resulted in an incrementin R2 from .19 to .26. Child age and living in crowded conditions were alsosignificant predictors of the Child Domain score. The addition of child ageon Step 2 produces an increment in R from .26 to .34. Hierarchical re-gression analyses further revealed that child age was a significant predictorof the Parent Domain score. The addition of child age on Step 2 producedan increment in R from .10 to .15 for the Parent Domain.

DISCUSSION

We found that mothers with ID raising infants/toddlers, preschoolers,or school-age children endured clinically significant levels of stress and thatmaternal stress increased when the child reached school age. Mothers ofschool-age children reported stress related to child characteristics in the99th percentile on the PSI (Abidin, 1990). These mothers reported signifi-cantly more stress than mothers of infants/toddlers and preschoolers.Hierarchical regression analyses revealed that crowded living conditionsand child age predicted PSI total stress scores and Child Domain stressscores (i.e., stress related specifically to child characteristics such as de-mandingness, adaptability, mood); child age was also a significant predictor


of Parent Domain stress scores (i.e., stress related to the parent's life andaffect such as depression, marital satisfaction, sense of competency).

Following the interactional model of parenting (Belsky, 1984), differ-ences in parent, environmental, and child characteristics of families with chil-dren of different ages may contribute to the findings in our study thatmothers with ID who had school-age children reported more stress thanparents of younger children. Indeed, with respect to parental and environ-mental variables, demographic information suggested that mothers ofschool-age children were older, had lower IQs, lived in more crowded con-ditions, and had less child protection scrutiny than mothers of infants/tod-dlers and preschoolers.

One experience that parents of older children have that parents ofyounger children do not, is interacting with the school system. Many parentswith ID who have school-age children have told us that they experiencedconsiderable stress in dealing with the school system. Interacting with teach-ers and other school personnel may be very stressful for these parentsbecause of their limited cognitive abilities and ongoing stigmatization offamily members by school staff, other parents, and students. Parents mayfeel stressed because of their inability to help their children with school-work. Just being in the school may revive unpleasant memories about theparents' own aversive school experiences that often consisted of failuresand put-downs. This feedback from the parents requires further explora-tion.


Table 5. Standardized Regression Weights (Betas) from Hierarchical Regression Analysesfor Variables Predicting PSI Total, Child Domain and Parent Domain Scores (N = 82)

Independent Variables

Step 1Crowding RatioChild Protection AgencyInvolvement

R SquareFStep 2

Crowding RatioChild Protection AgencyInvolvementChild Age

R SquareF

Total Score

0.26*

0.29*0.197.56**

0.22*

0.140.31*0.267.56**

Dependent Variables

Child Domain

0.32**

0.33**0.26

11.51**

0.28*

0.180.32**0.34

10.77**

Parent Domain

0.18

0.220.103.49*

0.14

0.090.26*0.153.67*

Note. *p < .05, and **p < .01.

It is also possible that parents of school-age children experience morestress because their children have certain characteristics that make themmore difficult to parent than younger children. Some of the older childrenmay surpass their parents intellectually and their parents could have prob-lems understanding their child's more sophisticated communication andabstract reasoning. The brighter children may also take advantage of theirparents and the parents may have trouble enforcing discipline (O'Neill,1985). Feldman and Walton-Allen (1997) found high rates of behavior dis-orders in school-age children of mothers with ID and that the moreintelligent children were more likely to have multiple behavior problems.As child behavior problems are associated with high levels of stress in par-ents without ID (Eyberg et al., 1992), it is possible that many parents withID experience stress related to their inability to control their children's be-havior. Future research will need to determine if child behavior disordersincrease with age in these families and the extent to which child behaviorproblems predict stress in parents with ID.

Another child characteristic that may be related to increased parentalstress is developmental delay (Benedict et al., 1992; Minnes, 1988). Indeed,cumulative evidence suggests that children of parents with ID are at increasedrisk for low IQ, learning disabilities, and academic problems (Feldman et al.,1985; Feldman & Walton-Allen, 1997, Gillberg & Geijer-Karlsson, 1983;Reed & Reed, 1965). Research with parents (without ID) of children withdevelopmental disabilities has shown that raising school-age children may bemore stressful than caring for younger children (Gallagher, Beckman &Cross, 1983; Orr, Cameron, Dobson, & Day, 1993). Future research will needto investigate the impact of child developmental and learning disabilities onthe stress of parents with ID raising children of different ages.

Certain limitations of our study should be noted. First, the mothersin our study were already known to, and referred by, community agencies;in many cases, concerns were raised about parental competencies. Addi-tional research is needed to confirm the generalizability of our findings toall mothers with ID, although it may not be feasible to identify a trulyrepresentative sample (i.e., finding those who have not come to the atten-tion of the social service and child welfare systems). Second, reliableinformation on the fathers was not available for our study. The scores onthe PSI marital satisfaction subscale in our study suggested that themother's intimate relationship was a source of stress. Future research in-vestigating stress in parents with ID should include fathers and explore thecontribution of the spousal relationship on parental and child wellbeing.Our study also lacked child outcome measures to correlate with the PSIscores. Future studies should include longitudinal measures of child intel-lectual development and behavior problems to ascertain the complex


relationship between parental stress and child problems (Bee et al., 1986;Patterson et al., 1989). Psychopathology of the mothers with ID was notextensively investigated in this study. People with mental retardation areat-risk for psychiatric disorders (Reiss, 1990; Yu & Atkinson, 1993) andthe PSI depression subscale scores in our study suggested that the motherswere feeling despondent; further research is needed to delineate the rela-tionship between stress, parenting, child outcomes, and mental healthproblems in mothers with ID.

Parental stress is known to have detrimental effects on parenting andchild outcomes. High levels of maternal stress have been associated notonly with negative mother-child interactions (Crnic et al., 1984; Forehandet al., 1986), but also with adverse child outcomes such as lower IQ, be-havior and developmental problems (Bee et al., 1986; Sandier & Block,1980). Previous research has shown that mothers with ID may have par-enting problems that seriously threaten their children's health andwell-being (Feldman et al., 1992); their children are also at-risk for signifi-cant problems in development and social adjustment (Feldman et al., 1985,1993; Feldman & Walton-Allen, 1997). We see now that mothers with in-tellectual disabilities also endure extreme stress in their role as parents andit is likely that stress plays a role in parenting failure.

This is the first study to empirically document heightened stress levelsin mother with ID and to show that their stress is related to child age. Theimpact of stress on parenting and child outcomes needs further investiga-tion. The potential dehabilitating effects of parental stress should beconsidered when assessing parenting competency, and designing and pro-viding interventions for these families.

ACKNOWLEDGMENTS

This research was supported by grants from the Ontario Mental HealthFoundation and Ontario Ministry of Community and Social Services Re-search Grants Program (administered by the Research and Program Evalu-ation Unit). We thank Jayne Carnwell, Laurie Case, Amy Cheung, MariaGarrick, Wanda MacIntyre-Grande, Sylvia Hains, and Bruce Sparks for theircontributions to the collection, organization, and analysis of the data.

REFERENCES

Abidin, R. R. (1990). Parenting Stress Index — Manual. Charlottesville, VA: PediatricPsychology Press.


Abramson, P., Parker, T., & Weisberg, S. (1988). Sexual expression of mentally retardedpeople: Educational and legal implications. American Journal on Mental Retardation, 93.328-334.

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders.Fourth Edition (DSM-IV). Washington, DC: Author.

Bee, H. L., Hammond, M. A., Eyres, S. J., Barnard, K. E., & Snyder, C. (1986). The impactof parental life change on the early development of children. Research in Nursing andHealth, 9, 65-74.

Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 55,83-96.

Benedict, M.I., Wulff, L. & White, R. (1992). Current parental stress in maltreating andnonmaltreating families of children with multiple disabilities. Child Abuse & Neglect, 16,155-163.

Brown, G. W. & Harris, T. (1978). The social origins of depression: A study of psychiatricdisorder in women. London: Tavistock Publications.

Conley, R. W. (1973). The economics of mental retardation. Baltimore: John HopkinsUniversity Press.

Crnic, K. A., Greenberg, M. T., Robinson, N. M., & Ragozin, A. S. (1984). Maternal stressand social support: Effects on the mother-infant relationship from birth to eighteenmonths. American Journal of Orthopsychiatry, 54, 224-235.

Dohrenwend, B., & Dohrenwend, B (1969) Social status and psychological disorders, New York:Wiley.

Dowdney, L., & Skuse, D. (1992). Parenting provided by adults with mental retardation.Journal of Child Psychology and Psychiatry, 34, 25-47.

Dumas, J., & Wahler, R. (1985). Indiscriminate mothering as a contextual factor inaggressive-oppositional child behavior. Journal of Abnormal Child Psychology, 13, 1-17.

Edgerton, R. B., & Bercovici, S. M. (1976). The cloak of competence: Years later. AmericanJournal of Mental Deficiency, 80, 485-497.

Emery, R. E., & Tuer, M. (1993). Parenting and the marital relationship. In T. Luster & L.Okagaki (Eds.), Parenting: An ecological perspective (pp. 121-148). Hillsdale, NJ: LawrenceErlbaum Associates.

Eyberg, S. M., Boggs, S. R., & Rodriguez, C. M. (1992). Relationships between maternalparenting stress and child disruptive behavior. Child and Family Behavior Therapy, 14,1-9.

Feldman, M. A. (1994). Parenting education for parents with intellectual disabilities: A reviewof outcome studies. Research in Developmental Disabilities, 15, 299-332.

Feldman, M. A. (1997). The effectiveness of early intervention for children of parents withmental retardation. In M. J. Guralnick (Ed.). The effectiveness of early intervention:Directions far second generation research (pp. 171-191). Baltimore: Paul H. Brookes.

Feldman, M. A., Case, L., Towns, F., & Betel, J. (1985). Parent education project I:Development and nurturance of children of mentally retarded parents. American Journalof Mental Deficiency, 90, 253-258.

Feldman, M. A., Case, L,, & Sparks, B. (1992). Effectiveness of a child-care training programfor parents at-risk for child neglect. Canadian Journal of Behavioural Science, 24, 14-28.

Feldman, M. A., Sparks, B., & Case, L. (1993). Effectiveness of home-based early interventionon the language development of children of parents with mental retardation. Researchin Developmental Disabilities, 14, 387-408.

Feldman, M. A., & Walton-Allen, N. (1997). Maternal mental retardation and poverty:Intellectual, academic, and behavioral status of school-age children, American Journal onMental Retardation, 101, 352-364.

Floor, L, & Rosen, M. (1975). Investigating the phenomenon of helplessness in mentallyretarded adults. American Journal of Mental Deficiency, 79, 565-572.

Forehand, R., Lautenschlager, G., Faust, J., & Graziano, W. G. (1986). Parent perceptionsand parent-child interactions in clinic referred children: A preliminary investigation ofthe effects of maternal depressive moods. Behaviour Research and Therapy, 24, 73-75.


Frey, K., Greenberg, M., & Fewell, R. (1989). Stress and coping among parents ofhandicapped children: A multidimensional approach. American Journal on MentalRetardation, 94, 240-249.

Gallagher, J., Beckman, P., & Cross, A. (1983). Families of handicapped children: Sourcesof stress and its amelioration. Exceptional Children, 50, 10-19.

Garcia-Coll, C, Vohr, B., Hoffman, J., & Oh, W. (1986). Maternal and environmental factorsaffecting developmental outcome of infants of adolescent mothers. DevelopmentalBehavioral Pediatrics, 7, 230-236.

Gammezy, N., & Rutter, M. (1983). Stress, coping and development in children. New York:McGraw-Hill.

Gillberg, C, & Geijer-Karlsson, M. (1983). Children born to mentally retarded women: A1-21 year follow-up study of 41 cases. Psychological Medicine, 13, 891-894.

Greenspan, S., & Schoultz, B. (1981). Why mentally retarded adults lose their jobs: socialcompetence as a factor in work adjustment. Applied Research in Mental Retardation, 2,23-38.

Hayman, R. L. (1990). Presumptions of justice: Law, politics and the mentally retarded parent.Harvard Law Review, 103, 1201-1274.

Ilfeld, F. W. (1977). Current social stressors and symptoms of depression. American Journalof Psychiatry, 134, 161-166.

Mash, E. J., & Johnston, C. (1983). Parental perceptions of child behavior problems, parentingself-esteem, and mother's reported stress in younger and older hyperactive and normalchildren. Journal of Consulting and Clinical Psychology, 51, 86-99.

Minnes, P. M. (1988). Family resources and stress associated with having a mentally retardedchild. American Journal on Mental Retardation, 93, 184-192.

O'Neill, A. M. (1985). Normal and bright children of mentally retarded parents: The HuckFinn syndrome. Child Psychiatry and Human Development, 15, 255-268.

Orr, R. R., Cameron, S. J., Dobson, L. A., & Day, D. M. (1993). Age-related changes instress experienced by families with a child who has developmental delays. MentalRetardation, 31, 171-176.

Panaccione, V F, & Wahler, R (1986) Child behavior, maternal depression and social coercionas factors in the quality of child care. Journal of Abnormal Child Psychology, 14, 263-278.

Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective onantisocial behavior. American Psychologist, 44, 329-335.

Quine, L., & Pahl, J. (1991). Stress and coping in mothers caring for a child with severelearning difficulties: A test of Lazarus' transactional model of coping. Journal ofCommunity and Applied Social Psychology, 1, 57-70.

Reed, E. W., & Reed, S. C. (1965). Mental retardation: A family study. New York: Saunders.Reiss, S. A. (1990). Prevalence of dual diagnosis in community-based day programs in the

Chicago metropolitan area. American Journal on Mental Retardation, 94, 578-585.Reiss, S., & Benson, B. A. (1985). Psychosocial correlates of depression in mentally retarded

adults: I. Minimal social support and stigmatization. American Journal of MentalDeficiency, 89, 331-337.

Sandier, W., & Block, M. (1980). Life stresses and maladjustment of poor children. AmericanJournal of Community Psychology, 8, 41-52.

Seagull, E. A., & Scheurer, S. L. (1986). Neglected and abused children of mentally retardedparents. Child Abuse and Neglect, 10, 493-500.

Straus, M., & Kantor, G. (1987). Stress and child abuse. In R. Heifer & R. Kempe (Eds.),The battered child (pp 42-59) Chicago: The University of Chicago Press.

Taylor, C. G., Norman, D., Murphy, J., Jellinek, M., Quinn, D., Poitrast, F. & Goshko, M.(1991). Diagnosed intellectual and emotional impairment among parents who seriouslymistreat their children: Prevalence, type and outcome in a court sample. Child Abuse &Neglect, 15, 389-401.

Tymchuk, A. J. (1990). Parents with mental retardation: A national strategy. Journal ofDisability Policy Studies, 1, 43-55.

Tymchuk, A. J. (1992). Predicting adequacy of parenting by people with mental retardation.Child Abuse and Neglect, 16, 165-178.


Tymchuk, A. J., & Feldman, M. A. (1991). Parents with mental retardation and their children:A review of research relevant to professional practice. Canadian Psychology/PsychologieCanadienne, 32, 486-496.

Vogel, P. (1987). The right to parent. Entourage, 2, 33-39.Walton-Allen, N., & Feldman, M. A. (1991). Perceptions of service needs by parents who are

mentally retarded and their workers. Comprehensive Mental Health Care, 1, 57-67.Wantz, R. A. (1989). Review of the Parenting Stress Index. In J. C. Conoley & J. J. Kramer

(Eds.), The tenth mental measurements yearbook (pp. 602-603). Lincoln, NE: Universityof Nebraska Press.

Webster-Stratton, C (1988). Mother's and father's perceptions of child deviance: Roles ofparent and child behaviors and parent adjustment. Journal of Consulting and ClinicalPsychology, 56, 909-915.

Weinraub, M., & Wolfe, B. M. (1983). Mother-child interactions in single and two-parentfamilies. Child Development, 54, 1297-1311

Yu, D., & Atkinson, L. (1993). Developmental disability with and without psychiatricinvolvement: Prevalence estimates for Ontario. Journal on Developmental Disabilities, 2,92-97.


Documents

Stress in Mothers with Intellectual Disabilities