The relationship between parenting stress and social support in mothers of children with learning disabilities: A Chinese experience

Sot. Sri. Med. Vol. 37, No. 2, pp. 261-214, 1993 Printed in Great Britain. All rights reserved

0277-9536193 $6.00 + 0.00 Copyright % 1993 Pergamon Press Ltd

THE RELATIONSHIP BETWEEN PARENTING STRESS

AND SOCIAL SUPPORT IN MOTHERS OF CHILDREN WITH LEARNING DISABILITIES: A CHINESE

EXPERIENCE

VERONICA PEARSON’ and TIM W. L. CHAN’

‘Department of Social Work and Social Administration, University of Hong Kong, Pokfulam Road and 2Family Welfare Society, Hong Kong

Abstract-This study examined the relationship between parenting stress and social support in a random sample of 100 mothers with children at a school for children with learning disabilities, and a control group of 75 mothers with similarly aged non-handicapped children. Mothers of children at Zhi Ling school were found to have significantly more stress and significantly less support than those in the control group. Parenting stress in the control group was also found to be relatively high when compared with what are considered to be normal levels in the West. No significant correlation was found between total parenting stress and social support. It is suggested that further studies need to differentiate between satisfaction with support that is actually received and the perceived quality of available support.

Key words-parenting stress, social support, learning disability, China

Impetus for this study came from the second author’s experience of running a parents’ group at Zhi Ling Special School for Mentally Handicapped Children in Guangzhou, southern China. Originally the group was designed to provide parenting skills training for people with children attending the school. Somewhat unexpectedly, given the common belief that Chinese people are unwilling to show strong emotions in front of strangers (11, the group became an arena for the parents to share their long-masked grief at having given birth to a handicapped child and their worries and uncertainties about their childrens’ future.

They talked about their children’s strange behaviour, the lack of understanding and help from spouses and families, the social rejection of the community, the scarcity of community resources and the stigma attendant on the family.

The parents’ stress was manifest as they shared these issues. Many of them were very emotional and tearful. These were parents who, by definition, had received some help as their children were attending the school. The plight of others, in receipt of no assistance at all, can only be imagined.

THE SITUATION IN GUANGZHOU

According to the 1987 National Sample Survey Of Disabled People and Affected Households in the

People’s Republic of China, 3.95% of the population of Guangdong Province have a disability. Amongst these, 23.06% have a learning disability, of whom 53% were children under 15. In Guangzhou city there were approx. 25,600 people with a learning disability, 13,650 of whom were under 15.

Despite the very large numbers of learning disabled

children, there were only three special schools (including Zhi Ling school) and eight special classes providing less than 300 school places catering to their needs in Guangzhou in 199 1.

Zhi Ling School

Zhi Ling School opened in 1985, at which time it was the first special school in Guangzhou, and the first non-government run special school in China. According to the pamphlet A Brief Introduction To Guangzhou Zhi Ling School published in 1988, the three guiding principles of the school are as follows:

(1) “Helping people to develop their full potential and capacity”. This is taken as the highest ideal of the school. The aim is to enable those with a learning disability to develop greater competence to meet various life demands, and to ensure the right of the mentally handicapped to receive education.

(2) “Developing the spiritual civilization of social- ism”. This idea, one of the government’s commonest slogans, is interpreted within the school to mean the enhancement of understanding between mentally handicapped and non-handicapped people, in the hope that this will assist in the integration of the mentally handicapped into the community.

(3) “Children are our gods”. This slogan reflects the child-centred approach adopted by the school in providing its services, and the effort made to accommodate the interests of the children.

Thus the school tries to adopt a humanistic approach to the children and emphasizes normalization principles. Currently, there are 208 children receiving services from the school. The majority of them are designated as mild and moderately handicapped. Of

SW 37,2--J 267

26X VEK~NICA PEARSON and TIM W. L. CHAN

these 208, 158 receive schooling. 113 of whom are residential students who return home at the weekend. The other 50 children arc enrolled in an out-reach counselling service.

PARENTING STRESS AND SOCIAL SUPPORT

In a community where the understanding of learning disability is minimal and the resources for people so affected scarce, parents play a crucial role in the provision of care to their handicapped children. Yet the stress factors involved in such a situation are clearly very great. Social support is usually perceived as a mechanism to cope with stress. It was this relationship that the present study wished to explore.

The concept of stress is elusive and there is no single agreed definition [2]. The authors adopted the position that stress is a function of the relationship between the individual and the environment. It is a product of the subjectively defined demands of a situation and the capacity of an individual or group to respond to these demands. Stress exists when the subjectively experienced demands are inconsistent with the response demands [3].

Abidin’s concept of parenting stress was used to operationalize the construct [4]. Parenting stress is the result of the interaction between both the child’s and the parents’ characteristics. In the case of children with a learning disability. their condition almost inevitably causes problems for the parents. Stress is generated in the parents when their capacity to fulfil their parental role is exceeded by the demands made on them by their child.

The present study also attempted to measure parental life stress. Life stress may be seen as an external intervening factor that intensifies parenting stress. Stressful circumstances that are often beyond the control of the parents. for instance the death of a relative, loss of a job. severe financial worries are taken into account.

Social support is another term that lacks a consen- sus definition. In the present study, we have chosen to approach social support through both its origins and its content. Lieberman [6] has made it clear that social support is indexed by the source of support, (such as parents, other relatives, friends, neighbours etc.), as well as the type of support offered. The content of social support is generally considered to have three aspects [779]. These are instrumental, emotional and information/referral support.

Individuals receive support through social networks, which may be either formal or informal systems [IO]. Social networks for families with mentally handicapped children include family household members, extended kin and relatives, neighbours, friends and representatives of social services and educational systems [I 1, 121. In this study, social support will be measured by the extent to which subjects experienced themselves being supported by

others. and perceived that those in their networks were available when called upon.

Experience at Zhi Ling school indicated that it was mothers rather than fathers who carried the main responsibility for child care. Mothers also had the most contact with the school. For these reasons, it was decided that the study should focus on mothers rather than on both parents. Three hypotheses were tested.

(I) Mothers of children with a learning disability experience greater parenting stress than mothers of non-handicapped children.

(2) Mothers of children with a learning disability receive less support from their significant others than mothers of non-handicapped children.

(3) A negative relationship exists between the level of stress and the amount of social support for both groups of mothers.

METHODOLOGY

Two samples were drawn to explore the relationship between the parenting stress of and social support for mothers of children with a learning disability. The target sample was the mothers of mentally handicapped children at Zhi Ling school. Simple random sampling was used to draw 100 mothers from the total population of children receiving services from the school (208). These mothers were then sent a letter inviting them to come for an interview. Quota sampling was used to draw 75 mothers of non-handicapped children as a control group. Five schools in Guangzhou were approached and asked if they were willing to participate. Ques- tionnaires were distributed to the mothers by teachers after they had received a briefing from the second author. The smaller sample was due to resource restraints and the difficulty of gaining access to this population. Mothers in both groups were matched proportionately according to whether their children were in kindergarten, primary or secondary classes. Responses were measured by a structured questionnaire that differed between the two groups only in so far as the introduction was concerned. In all, 83 completed questionnaires were received from the mothers in the target group and 60 from mothers in the control group.

Mothers in both groups were told that the study was to gain greater knowledge and understanding about the stress of being a parent and the kind of help parents received. Within the context of the Chinese situation it was not felt advisable to imply that this would necessarily lead to action on the part of the authorities.

The questionnaire was divided into three main sections. The first adopted the Parenting Stress Index [4] to measure the parenting stress of mothers in both groups. A Chinese translation of the instrument has been made by Y. C. Chan and has been validated for use in a Chinese population (Hong Kong) [13]. The

Parenting stress and social support in China 269

index is based on the assumption that stressors or sources of stress are additive and multi-dimensional both as to source and as to kind. Three major domains for parenting stress were identified: child characteristics, mother characteristics and situa- tional/demographic life stress.

The instrument obtained reasonable reliability and validity. Alpha reliability coefficients were deter- mined for each sub-scale, each domain and the total score. These coefficients were sufficiently large to indicate a high degree of internal consistency for these measures.

The stability of the instrument was supported by the test-retest reliabilities obtained from four different studies, some of them using an earlier version of the scale [4, 14-161. The construct and concurrent validity was found to be high in several studies [17-191. Y. C. Chan’s version adapted for a Chinese population also has high reliability and validity. The Cronbach’s alpha score, not including the optional Life Stress Scale, was 0.92. The cor- responding Guttman’s split-half was 0.87. The correlation between the two domain scales, (child and parent) yielded a high level of significance (r = 0.5299, P = O.OOO), implying that the validity of the instrument was high. In the present study, minor changes in wording were made to suit the Guangzhou context.

A Significant Others’ Scale (SOS) was employed to measure the different functional resources of social support that may be provided by a number of significant role relationships within an individual’s social network [20]. The scale contained ten items that reflected either emotional support or instrumental support that a person was able to receive from different potential relationships.

A list of potential role relationships was given to the respondents. These included family, friends, work, professional contacts, and ‘others’. The scale has been demonstrated to have acceptable validity. In a 6 month test-retest the correlation ranged from 0.73 to 0.83 for summary qualitative measures and 0.65 for quantitative measures [20]. The scale was also found to distinguish significantly between depressed and non-depressed respondents. The scale was translated into standard Chinese by graduate students of Hong Kong University. Comments from Zhi Ling teachers and the results of a pilot study demonstrated that the Chinese version was a reliable and accurate translation.

All data collected were checked and coded for data processing and statistical analysis. SPSS-PC was employed for this purpose. The following analyses were made:

(1) univariate analysis was used to analyse the personal variables of both the mothers and the children of the target and control groups. The aim was to give a clear demographic and socio-economic profile;

(2) comparisons of mean differences for interval scales and nominal scales between the target and control groups were made with ANOVA;

(3) the x2 test was employed to compare mean differences between nominal scales of the samples. One way analysis with Tukey was used for differenti- ating homogeneity between nominal scales with over two values;

(4) correlation ratio (r~‘) was used to locate the magnitude of association between nominal and interval scales;

(5) multivariate-regression or a test of correlation was used to identify the relationships and/or strengths of predictability between interval scales;

(6) the instruments used were tested for reliability.

RESULTS

Demographic projiles of the respondents

The age of the respondents ranged from 28 to 56 years. The mean age of the target group was 41.13 while that of the control group was 39.28. There was no statistical difference between the two groups. All respondents were married with the exception of two, one separated and the other widowed. The number of children for all respondents ranged from 1 to 4. The mean number of children of mothers in the target group was 1.73, and in the control group was 1.45. The difference, tested by ANOVA, was significant (P = 0.012 < 0.05).

Family size was defined as the total number of people related by blood living under the same roof. The mean family size for the target group was 4.06 and 3.87 for the control group. No statistical difference was found. This was also the case for employment and family income. 97.6% of the target group and 98.3% of the control group were gainfully employed.

However, there was a statistical difference between the two groups in educational level (P = 0.0440 < 0.05). 76.7% of mothers of non-handicapped children had received education at the senior secondary level or above. This was true of only 55.4% of the mothers in the target group.

There were marked differences in the sex distribution of the children in the study. In the target group, 60.2% were male and 39.8% female, while in the control group, 41.7% were male and 58.3% were female. The reasons for the difference in the sex distribution of children in Zhi Ling school will be discussed later. In relation to the control group, there is no obvious demographic difference in the total population. It may be that female students were more punctilious about encouraging their mothers to complete and return the questionnaire. There was no significant difference between the two groups in terms of age. Approximately half of the children (48.2%) in the target group lived at the school during the week.

270 Vmohi(.A PEARSON and TIM W. L. CHAN

Stress und support rntwsures of the respondents

Both the parenting stress and life stress scores of the mothers of handicapped children were greater than those of the mothers in the control group. The mean scores of parenting stress were statistically significant at the 0.05 level (P = 0.945). There was no statistically significant difference between the mean scores of life stress.

Both the child’s and parent’s domain mean scores for the target group were greater than those for the control group. The former was statistically significant at the 0.05 level (P = 0.000). and the latter was significant at the 0.05 level (P = 0.000). A closer examination of the sub-scales showed that all the means of the target group were larger than the control group. Nearly all of the sub-scales showed statistically significant differences between the groups. The exceptions were the Attachment sub- scale (P = 0.205 > 0.05) and the Reinforce Parent sub-scale (P = 0.473 > 0.05).

It was apparent that the mothers in the target group scored less in social support from their significant others. in comparison with mothers in the control group. A statistically significant difference was found at the 0.05 level (P = 0.008). They also received less emotional and instrumental support. However, these differences were only significant for emotional support (P = 0.008 < 0.05).

Ditferences in sources of support were found between the target and the control group in all categories except ‘professional’ and ‘others’, which in the Guangzhou context means government othcials and cadres in the Ministry of Civil Affairs. Control group mothers perceived themselves as receiving more support than was the case for target group mothers. Statistically significant differences were found in the categories of parents (P = 0.004 < 0.05), children (P = 0.001 < 0.05). best friends (P = 0.000 < 0.05) and colleagues (P = 0.000 < 0.05).

Husbands provided the major support to the mothers in both groups. Mothers received least support from professionals and government officials. They were also likely to receive more help from their own parents and siblings than from their husband’s parents and siblings.

Correlates of’ the stress and support measures

The total score, child domain and parent domain of the parenting stress scale have a positive and moderate strength correlation with the residential condition of the handicapped children (q = 0.291, P = 0.008; q = 0.257. P = 0.019; q = 0.267, P = 0.15). Thus mothers of handicapped children living at Zhi Ling experienced less stress in comparison with mothers of handicapped children living at home.

The correlations between total score and parent domain of the parenting stress scale and the educational level of the target group are statistically significant (P = 0.048 < 0.05: P = 0.001 < 0.05). A

multiple range test indicates that the strongest correlation between parent domain and the educational level of mothers in the target group is between: university level and junior secondary level; university level and senior secondary level; and technical insti- tution and junior secondary level. Essentially. mothers with higher levels of education experience less stress than mothers with less education. A similar relationship was found for the mothers in the control group.

A stepwise multiple regression analysis of the income, mother’s age. children’s age. and numbers in the family of the control group shows that income alone, negatively and moderately explains the total stress score on the parenting stress scale (0 or r = -0.34341. P = 0.0077 < 0.05). In relation to the target group, family income alone. positively and moderately explains the life stress scores of the mothers (ii or r = 0.22677. P < 0.05).

It was found that the strength of the correlation of the parent domain with total stress (r = 0.9213; r = 0.9335) was stronger than that of child domain (r = 0.8738; I’ : 0.8088) for both groups. All the relationships between domain stress and total stress in both groups were significant. The child’s adapta- bility had the strongest significant correlation with the total stress score of the mothers in the target group (r -0.7713. P = ~0.001). The picture was slightly ditferent fat- the mothers in the control group. For them, social isolation was the strongest significant correlated variable with the total stress score.

Parenting stress. (including the total stress, child domain and parent domain) and social support has a negative and very weak correlation (r = -0.14106 to r = -0.08094). but the relationship is not statistically significant in either group. Life stress and social support. however. vjaries in predictive magnitude in the two groups.

DlSCCSSIOh

The mothers

Some of the findings in the demographic profile were consistent with similar studies. Some [2l. 221 have shown that low maternal intelligence was most predictive of low IQ score in children. The present study demonstrated that mothers in the target group tended to have less education than mothers in the control group. However, little education does not necessarily mean one has low intelligence in the Chinese context. Conventionally, women tend to receive less education in China. Furthermore, edu-

cation was disrupted during the period of the Cul- tural Revolution, particularly between 1966 and 1970. For these factors to be significant, it would have to be proven that mothers in the two groups consist- ently had differential access to educational opportu- nities.

Another point where there is consistency between overseas studies and the present one is that mothers


of mentally handicapped children have a lower socio- economic status [23]. It was found that the average

household income of the target group was about 20% lower than that of the control group.

Differences in comparison with other studies from outside China were also found. It tends to be assumed that mothers of handicapped children are wholly engaged in caring for their handicapped child and are therefore less likely to take up full time employment. This was not the case in Guangzhou. State policy emphasizes that all citizens should work in order to contribute to the development of a modern socialist society [24]. Mothers are also encouraged to engage in production. On a more pragmatic level, families may only be able to manage financially if both parents work. About 50% of the children lived at the school during the working week. From personal observation, it seems that the care of the others fell primarily on grandmothers.

A number of studies have shown that handicapped children had a deleterious effect on the parents’ marital relationship and increased the divorce rate [25-271. In the present study none of the respondents were divorced. This characteristic is indicative of a particular social condition in China.

Although the number of divorces has risen in recent years, divorce remains less common in China [28]. Divorce is still regarded as a social disgrace, particularly for rural women [29]. Furthermore, divorce violates socialist morality [28], so that the State, not only by law but also through administrative discipline, discourages divorce. In 1987 out of 1,027,OOO applications for divorce only 56.6% were approved [30]. It would not be wise to assume that a lack of divorce equals marital harmony. In the parenting stress index, mothers in the control group had a significantly lower score on the measure of marital disharmony.

The children

Boys were heavily over-represented in the target group sample. It has been found that boys are somewhat more likely than girls to be mentally retarded [23]. There may be other contributory factors in China. Infanticide, especially of handicapped and female infants is not uncommon in China [31]. A female, handicapped infant would be in double jeop- ardy. Furthermore, sons have a higher status than daughters in Chinese culture. Parents are more willing to pay expensive school fees for their sons to obtain formal education and training than for their daughters.

Stress und socinl support measures

The first hypothesis of this study has been confirmed by the findings. Mothers of mentally handicapped children were found to have significantly extra stress than mothers of non-handicapped children. According to Abidin [4], parents scoring over 260 on the total stress measurement of the parenting

stress index should be referred for professional con- sultation. It was found that 91.6% of the mothers in the target group exceeded this score.

More suprisingly, it was found that the parenting stress of the mothers in the control group was also relatively high. Over 49% of them scored more than 260. There are three possible explanations. First is that parenthood is a difficult task within the social context of Guangzhou. The second is that the norms of parenting stress are higher in Guangzhou, in which case the scale needs to be adjusted for use there. The third is that the scale is biased towards finding high levels of stress. Further investigation in this area is needed.

The second hypothesis was also proven. Mothers in the target group were found to receive significantly less support from their significant others than mothers in the control group. The result again was consistent with other studies that have found that families with handicapped children were relatively

isolated [32]. The present study also found that mothers of

children with a learning disability received significantly less emotional support than mothers in the control group. Social acceptance of the mentally handicapped tends to be low among Chinese popu- lations [33]. Consequently, mothers of handicapped children received less social recognition and empathy. Time may also be an issue here. Our mothers nearly all worked full-time. Once home, much of their energy probably went into caring for the family, especially the child with a learning disability. They may have had little time or emotional resources left over for developing relationships, other than with their most immediate family members. This may explain why the husband played a significant role in providing support as the most accessible person, with a responsibility for showing some concern for his wife.

The amount of support provided by friends and colleagues was found to be significantly different between the control and target groups. Extended family provided more support to the mothers in the target group than work colleagues or friends. ‘Blood is thicker than water’ and perhaps extended family tend to be more accepting of the difficulties of the mothers of handicapped children. The issue of stigma may also be involved here, with families reluctant to acknowledge to outsiders that they have a handicapped child. In-laws were less supportive than natal family members. Traditionally, daughters-in-law tend to be blamed if there is anything wrong with a baby, or if the child is a girl rather than a boy. Thus support and acceptance are less likely to be forthcoming from a mother-in-law in comparison with a mother.

Mothers in the target group received least support from professionals and government officials. A variety of reasons, which are not mutually exclusive, may account for this. Professionals may not recognize the needs of the mothers. They may focus solely on the

272 VERONICA PEARSON and TIM W. L. CHAN

needs of the handicapped children, not accepting that it is their responsibility to provide support to the mothers. Mothers may consider that professionals are remote, with a tendency to blame parents and consequently best avoided.

Correlates qf stress and support measures

Whether or not the child was receiving residential care from Zhi Ling school was significantly related to the parenting stress of target group mothers. Such care provided them with a respite and the hope that something constructive was being offered to their child.

The lower the education level, the higher the experienced stress. Presumably a poorer education does not equip the mother with the skills she needs to cope and resolve the difficulties presented by the needs of a handicapped child. Using a x’ test of significance, no significant difference was found between educational level and income (sign F = 0.6778 > 0.05). Thus a low educational level tends to go hand in hand with a low income and the two together may have a multiplier effect on stress.

Low income had a positive relationship with and moderately explained the life stress of mothers in the control group, (r = 0.2296, P = 0.018). Unexpect- edly, income had no statistical relationship with parenting stress in the target group. Possibly, over the years of meeting the child’s needs, the family had found ways to make their budget accommodate any extra expenses incurred by having a handicapped child. Life stress emerged dramatically and suddenly. Finances needed to cover the event might not be easily available, causing stress to the respondents.

The correlation of the total parenting stress score with its domain scores (child characteristics and parent characteristics), indicated a stronger correlation between the parent domain and parenting stress. This suggests that characteristics of the parents played a more important role in contributing to the stress of the mother, in comparison with the characteristics of the child. Thus perceived stress is a product of the interaction between the child’s behaviour and needs and the mother’s resources to cope with them.

The correlation of the total parenting stress score with sub-scale variables showed that the child’s adap- tability as perceived by the mother has the strongest correlation with parenting stress. This is consistent with the findings in Kazak and Marvin’s study. They commented that “handicapped children are observed by their mothers as being less adaptive to their physical and social environments” [32].

The present study also showed that mothers tended to receive more instrumental than emotional help. Social workers in the West tend to emphasize strongly the importance of emotional support. Instru- mental support, however, has also been shown to be of great value to mothers of children with a learning disability. Hewett [34], Carr [35] and Wilkin [36]

highlighted the practical day to day problems encountered by families with handicapped children and the need to develop services to assist them. Hewett

noted that:

the tendency to characterize parents of handicapped children as guilt ridden, anxiety laden, over-protective and rejecting beings is unfortunate. .Their common characteristics appear much more to be the need for money and information. Counselling without these latter is of little value [37].

The third hypothesis of the present study was not supported. No significant correlation was found between total parenting stress and social support. However, we found a negative relationship which indicates that the more support all mothers received the less stress they experienced. The only exception to this was the life stress measures for the target group. What factors might account for this finding?

First, according to Cohen and Willis [38], social support provides two major effects-- the main erect and the buffering effect. The former is concerned with the overall well being of a person. The latter means the support that protects one from the potentially pathogenic influence of stressful life events only. Since social support has multi-faceted effects, it is possible that the main effect of the social support identified in the present study improved total well- being, instead of forming a buffer to combat parenting stress. Social support may be a catalyst that activates one’s well being to strengthen defences against the attack of unpleasant experiences. As the direct buffering effect of social support was less dominant, no significant relationship between social support with parenting stress could be located.

One contributing factor to the sense of total well- being could be that, unlike most mothers in Western countries, virtually all mothers in both our samples were in full time employment. In the classic study by Brown and Harris [39] employment outside the home

for married women with children was found to be a protective factor against stress and depression. Not only does it reduce contact with children. but it lessens social isolation, may improve self image, and imposes a normal structure on lift into which the child has to fit, rather than the child becoming the predominant focus for the mother’s daily activity.

Second, Henderson [40] and Henderson 41 a/. [4l] identified that the perceived adequacy of available support is more important than availability per se.

The present study measured perceived support, while the actual experience and relevance of the support provided to mothers of handicapped children was not measured. It could be that regardless of the amount of support mothers of handicapped children received. the quality of support was below that which would yield any buffering effect in combating parenting stress.

Both Barrera [42] and McFarlane [43] encountered the same phenomenon and failed to identify any buffering effect in assessing satisfaction with opportu-


nities to give support. Clearly, further work in this area needs to distinguish between satisfaction with how much support one has and with the perceived quality of available support (holding amount constant).

IMPLICATIONS AND CONCLUSIONS

This study has demonstrated that mothers of children with a learning disability experience high levels of parenting stress that largely go unacknowledged. These stress levels were more dependent on the characteristics of the parent than those of the child. Obviously, the optimum development of the child is affected if the mother’s level of stress is such that it interferes with her parenting abilities. In China, as elsewhere, the lesson to be learned about helping children with a learning disability is that the focus of attention needs to shift from an almost total concern with the child, to the child in relation to his environment. Immediate concerns are more with instrumental support in the form, for instance, of cash help for special needs or medical treatment and practical caring support, like respite care.

A significant finding of this study was that residential care for the child significantly reduced parental stress. However, such a residential alternative may not necessarily be in the child’s best interests as it removes him or her from a normal family environment. Zhi Ling clearly is an invaluable resource to the families who have access to it. But there is still a need for a wide variety of flexible domiciliary, out-reach and day services to provide parents with a choice of

resources. Evidence suggests that available professional re-

sources are neither sufficient not fully utilized. Both parents and those entrusted with helping them har- boured biases about each other. Parents need to accept that they are entitled to make demands on professional staff. The staff, in turn, should realize that their responsibility does not stop with the child but extends to the child-in-the-family. The school is in a good position to provide adequate information to the parents concerning mental retardation, cover- ing the characteristics of children with learning disabilities, and the available resources and treatment for these children. It could put parents in touch with resources, and run training programmes to develop parents’ skills in managing their children. The school could also take a leading role in public education programmes aimed at reducing the level of stigma associated with mental handicap. As yet, school authorities do not see this as part of their formalized objectives.

We tend to see social support as a uniform ‘good thing’. In China, the majority of lay people know little about learning disabilities and harbour many traditional and negative beliefs. Thus, support from significant others may be based on misconceptions and misinformation that serves to bring more trouble

to the mother. Zhi Ling staff report that parents frequently come under a great deal of pressure from family members or concerned friends to take their children to visit traditional medical practitioners for herbal treatments, massage, or qi gong. Such treatments tend to be costly and apparently ineffective. Either resisting these suggestions or complying with them tends to increase parents’ sense of frustration and futility.

Zhi Ling is a pioneer in providing formal education services for children with a learning disability in China. Generally, Chinese society remains ignorant about and negative in its attitudes towards, such children. Consequently, a mode of intervention re- liant on empowerment and self-help is probably not the most relevant for China at its current level. Initially at least, services may need to be led by workers rather than consumers. Neely [44] identified four major intervention areas relevant for parents with learning disabled children; information giving; training in parenting; co-ordination; and counselling. This would seem to be an appropriate model for Zhi Ling to adopt.

Despite suffering such severe stress levels, the mothers with children at Zhi Ling school are the fortunate ones. We can only imagine the condition of the vast majority of parents of children with a learning disability in China, who receive no help of any kind.

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REFERENCES

Pearson V. Western theory, Eastern practice; social group work in Hong Kong. Sociul Work With Groups 14, (2) 45558, 1991. Cox S. Social support as a moderator of life stress. Psychosomat. Med. 38, 300-314, 1987. Strauss M. A. Stress and physical child abuse. Child Abuse and Neglect 4, 75-88, 1980. Abidin R. R. Parenting Stress Index. Paediatric Psy- chology Press, Virginia, 1983. Turner R. J. and Avison W. R. Assessing risk factors for problem parenting; the significance of social support. J. Marriage Family November, 881--X92, 1985. Lieberman M. A. The effects of social support on response to stress. In Handbook on S~rexs: Theorerical and Clinical Aspects (Edited by Goldberger L. and Breznitz S.). Free Press, London 1982. Lee G. R. Effects of social networks on the family. In Conlemporary Theories Aboui the Funi!,, (Edited by Burr W. R. et al.). Vol. I. Free Press, New York, 1979. Dean A. and Lin N. The stress buffering role of social support: problems and prospects for systematic investi- aation. J. new. menl. Dix. 165, 403417. 1977. Unger D. G. An ecological approach to the family: the role of social networks, social stress and mother-child interaction. Unpublished master’s thesis, Merrill Palmer Institute, Detroit, 1979. Froland C. et al. (Eds) Networks and Human Sercices. Sage, Beverley Hills, 1981. Barnes J. Social Network.~. Addison-Wesley, Reading, MA, 1972. Schilling R. F. and Schinke S. P. Maltreatment and mental retardation. In The Future qfMenta1 Retardation Through the 80s (Edited by Berg J. M.). University Park Press, Baltimore, 1984.

274 VERONICA PEARSON and TIM W. L. CHAN

13. Chan Y. C. A study of mothers abusing their children: their stress and the amount of social support received. Unpublished M.Soc. Sci. dissertation, University of Hong Kong, 1990.

14. Burke W. T. The development of a technique for assessing the stresses experienced by parents of young children. Unpublished doctoral dissertation, University of Virginia, Institute of Clinical Psychology, 1978.

15. Zakreski J. R. Prematurity and the single parent: effects of cumulative stress on child development. Unpublished doctoral dissertation, University of Virginia, Institute of Clinical Psychology, 1973.

28. Cheng X. N. Perspectives on Divorce. Northern Women and Children’s Publisher, Jinin, 1988. (In Chinese.)

29. Au K. L. The promotion of women’s rights in China: the work of the Guangzhou Women’s Federation. Un- published master of social work dissertation, University of Hong Kong, 1989.

30. Leung J. C. B. Farni1.v Mediation with Chinese Charac- teristics: a Hybrid of Formal and Informal Service in China. Monograph Series on Social Welfare in China, University of Hong Kong, Department of Social Work, Hong Kong, 1991.

16. Hamilton E. B. The relationship of maternal patterns of stress, coping and support to quality of early infant mother attachment. Unpublished doctoral dissertation. University of Virginia, Institute of Clinical Psychology. 1980.

31. China Society 3 July, 1990. 32. Kazak A. E. and Marvin R. S. Differences, difficulties

and adaptation: stress and social networks in families with a handicapped child. Family Relutions 33, 67 77, 1984.

17. Lafiosca T. The relationship of parent stress to anxiety. approval, motivation and children’s behaviour problems. Unpublished doctoral dissertation, University of Virginia, Institute of Clinical Psychology, 1981.

18. Lafferty W., Cote J., Chafe P., Keller L. and Robertson H. The use of the Parenting Stress Index (PSI) for the evaluation of a Systematic Training for Effective Par- enting (STEP) programme. Unpublished paper, Beech- grove Regional Children’s Centre, Toronto, Canada, 1980.

33. Chan K. C. Chinese parent’s perception of mental retardation and expectations of service provision: the case of Guangzhou Zhi Ling Special School. Unpub- lished master of social work dissertation, University of Hong Kong, 1988.

19. Casey B. Recurrent, serious otitis media: its impact on the cognitive performance and social adjustment of pre-school children. Unpublished doctoral dissertation, University of Virginia. Institute of Clinical Psychology, 1983.

34. Hewett S. The Family und rhe Handicapped Child: A SIU~V of Cerebral Palsied Children in Their Homes. Allen & Unwin, London, 1970.

35. Carr J. The effect of the severely subnormal on their family. In Mental Deficiency: The Changing Outlook (Edited by Clarke A. M. and Clarke A. D. B.). 3rd edn. Methuen, London, 1974.

20. Power M. J., Champion L. A. and Aris S. J. The development of a measure of social support; the Signifi- cant Others (SOS) scale. Br. J. clin. P.qrhol. 27, 349-358. 1988.

21. Garber H. and Heber R. The efficacy of early intervention with family rehabilitation. In Psychosocicd Injurnce in Retarded Pe~fbrmuncr (Edited by Begab M. ci ~1.). University Park, Baltimore. 1981,

22. Ramey C. and Smith B. Assessing the intellectual consequences of early intervention with high risk infants. Am. J. nienr. D&c. 81, 315-324, 1977.

23. Zigler E. Men& Rrlurdution. Cambridge University Press, Cambridge, 1976.

36. Wilkin D. Curing For The Meniully Handicapped Child. Croom Helm, London. 1979.

37. Russell P. The parents’ perspective of family needs and how to meet them. In Purenrs Prqfessionals and Men- tully Hundicupped People (Edited by McConachi H. and Mittler P.), p. 50. Croom Helm, London, 1986.

38. Cohen S. and Willis S. T. Stress, social support and the buffering hypothesis. PsychoI. Bull. 98, 310-357. 1985.

39. Brown G. W. and Harris T. 0. Sociul Origin., o/ Depression: A Study of Psychiulric Disorder in Women. Tavistock, London, 1978.

24. Dixon J. E. The Chinese WeJfure .r)‘.stem 1949-1979. Praeger. New York. 1981.

25. Friedrich W. N. and Friedrich W. L. Psychosocial assets of parents of handicapped and non-handicapped children. Am. J. nienr. O&c. 85, 551 ~553, 1981.

26. Holroyd J. The questionnaire on resource and stress: an instrument to measure family response to a handicapped family member. J. Communiry P.~ychol. 2, 92-94. 1974.

40. Henderson S. Social relationships, adversity and neuro- sis: an analysis of prospective observations. Br. J. P,Tychitit. 138, 39L 398. 1981.

41. Henderson S.. Byrne D. G., Duncan-Jones P.. Scott R. and Adock S. Social relationships, adversity and neuro- sis: a study of associations in a general population sample. Br. J. P.~~,chicr/. 136, 554~-583, 1980.

42. Barrera M. Social support in the adjustment of preg- nant adolescents: assessment issues. In Soc,iul Ne/wrk.v cmd So&d Support (Edited by Gottlieb B. H.). Sage. Beverley Hills. 198 I.

43. McFarlane A. H.. Norman G. R., Steiner 0. L. and Roy R. G. The process of social stress: stable. reciprocal and mediating relationships. J. HI/h. .soc Behat,. 24, 160~173. 1983.

27. Price-Bonham S. and Addison S. Families and mentally 44. Neely M. A. Counselling cmd Guidunce Pruc~t~c,es Wrrh retarded children: emphasis on the father. Family Co- Specicrl Educcrlion Sludent.y. The Dorsey Press. Home- ord. 27, (3). 221-230, 1978. vvood. IL. 1982.

Documents

The relationship between parenting stress and social support in mothers of children with learning disabilities: A Chinese experience