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Family environment and parental stress in families of children affected by organic or psychological conditions


Background. The present research was carried out by the Family Psychology Service of the "Eugenio Medea" Institute - Association La Nostra Famiglia (Bosisio Parini). The Association provides services for the diagnosis, treatment and rehabilitation of children with disabilities and counseling for their families.

The evaluation and management of children with disabilities focus not only on the pathology but also on the contexts in which they live - mainly with their families.

In 1998, a Family Psychology Service was set up which, besides other areas of investigation, focuses particularly on family dynamics (Maino, Fara, 2005).

On the assumption that, for a family intervention to be successful in terms of invested resources and results, it is first necessary to evaluate the family functioning, its weaknesses and its strengths, the Family Psychology Service has been using a family dynamics evaluation protocol, including clinical interviews and self-reports such as the Parenting Stress Index (Abidin, 1983) and some subscales of the Family Environment Scale (Moos, Insel & Humphrey, 1974). This protocol measures the family climate (atmosphere) and the parental stress, against the child's problems and the parenting role.

 Purpose. The present work is the outcome of an analysis of the self-reports collected by practitioners during the assessment of the family dynamics. Its goals include: 

  • The detection of significant differences, if any, in the perception of parental stress and family atmosphere in families of children affected by a different pathology diagnosed according to the ICD-10 criteria.
  • To investigate the possible relationships between family climate and parental stress.

A total of 498 protocols were collected. This report, however, includes only the results obtained from a comparison between the self-reports of 130 parents of children with autism and 110 parents of children with emotional disorder (anxiety and depression).

The two groups of parents do not differ on socio-demographic variables (i.e. family structure, number of children, education and occupation), but they do differ in terms of age (parents of children with autism: 39.29 years vs. parents of children with emotional disorder: 41.39 years) and years of marriage (parents of children with autism: 10.75 years vs. parents of children with emotional disorder: 13.31 years).

An age-related difference was also found in the children of both groups: children with autism are younger (mean age 5.38 years) than children with emotional disorder (mean age 8.80 years). Furthermore, children with autism are mainly males (56 males vs. 9 females), while males and females are equally distributed in the group with emotional disorder (26 males vs. 24 females).

An analysis of variance and a step-wise multiple regression analysis were carried out.

 Main results and implications. The main results of the analysis of variance include the perception of less conflict (p = .001) and a greater cohesion (p =.015) and communication (p = .008) in the families of children with autism vs. families of children with emotional disorder. 

A comparison of the factors linked to parental stress shows that children's behaviors such as distractibility, lack of listening, difficulties in remaining concentrated and completing tasks (p =. 001) as well as intellectual and emotional features that were different from parental expectations, are perceived as a source of stress by parents of children with autism to a greater extent than by parents of children with emotional disorder (p = .003).

In contrast, a source of stress for parents of children with emotional disorder is the sad mood and the frequent and unexplained mood changes of these children (p = .001). These parents also show a greater tendency towards depression (p =. 024).

With regard to family climate, the multiple regression analysis shows the same model for both groups: the greater communication and family cohesion (which mutually influence each other), the lower the conflict in the family.

However, based on the results of the analysis of variance, this model seems to show different functioning levels: the group of parents with children with autism show higher functioning.

Among the most significant results, the multiple regression analysis shows that, in both groups of parents an increase in parental stress due to the lack of recognition of their parenting role and the lack of material and emotional support by the spouse, is matched by an increase in family conflict and a decrease in family cohesion and communication.

These results have some interesting implications for clinical practice. They seem to point to the need for a two-fold intervention strategy. On the one hand, this intervention should help parents of children with autism to understand better and manage the features and the behaviors of their children, while it should improve the family climate and appraise the parents' specific characteristics in families of children with emotional disorder. On the other hand, it is important to devise an intervention strategy enabling the parents to provide mutual support in order to preserve a good family climate.

Key references

Abidin, R. R. (1983). Parenting Stress Index, Third Edition Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.

Maino, E. & Fara, D. (2005). Un servizio di psicologia della famiglia in una struttura sanitaria per l'età evolutiva. In M. Cusinato & M. Panzeri (Eds.), Interventi e valutazione nel lavoro con le famiglie (pp. 81-99). Bologna: Il Mulino.

Moos, R. H., Insel, P. M., & Humphrey B. (1974). Combined Manual for Family, Work and Group Environment Scales. Palo Alto, CA: Consulting Psychologist Press.

Contacts: Eleonora Maino, IRCCS "E. Medea" - Associazione "La Nostra Famiglia", Via don Luigi Monza, 20 - 23842 Bosisio Parini (LC), E-mail: eleonora.maino@unipd.it, Phone 031/877518.

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