Presented at ISEC 2000

Personality Characteristics of Greek Mothers of Children with Special Needs who are Involved in Special Needs Support Centres

E. Makri-Botsari - University of Athens, Greece

Contributions from: F. Polychroni - University of Wales, Athens Campus, Greece, E. Megari, Municipality of Aighio, Greece.

Abstract

It is generally accepted that the support of the family is critical to the effective intervention of a child with special needs (SEN). The quality of this support highly depends on the personality characteristics and the mental health of the parents. It has also been argued that, because of the increased pressure and the strain of having to care for a child with SEN, the opportunity to learn from and share problems with other families and to seek emotional support at times of crises through the means of parent support groups, is very beneficial. This empirical study focuses on the mothers' personality since they are usually the ones who are primarily involved with the day to day care of their child with SEN and, as a result, they are more directly affected by their child's disability. The aim was to examine (a) the self-esteem, the coping mechanisms and the depression of mothers of children with SEN, and (b) whether participation in and satisfaction from such organized support groups, socio-economic status, size of family and father's involvement have any effect on the above personality characteristics.

INTRODUCTION

The study of the development and the adjustment of children with disabilities has been largely focused on the characteristics of the children themselves. This approach has ignored the family systems perspective, which takes into consideration the family's direct and indirect effects on the child's adjustment and progress. Even more, rather than emphasizing the unidirectional influence of parents on children or children on parents, child functioning is now seen more in the context of the family as a system where there is a mutual influence of family and child leading to child outcome (Martin, 1987; Hinde & Stevenson-Hinde, 1988; Halverson & Wampler, 1993). The application of a conceptual framework that emphasizes the context of the family as critical among the various systems in which the disabled children develop, such as the school and the community, will facilitate the understanding of disabilities and improve the possible negative family influences on the child's development.

Bringing up a child with developmental disabilities can be particularly disruptive for the family system. On the one hand, parents are expected to deal with the situation effectively and support their child alongside professionals. On the other hand, caring for a disabled child can be extremely demanding despite its rewards (Beresford, 1994). The specific problems associated with disabled children may adversely affect the family's adjustment and in turn decrease the levels of parental support. The effects of the disability on the family are evident in several areas such as increased cost, limited time and psychological strain. The way that parents deal with the problems related to the special needs of their child is critical for the effective support of the disabled child.

The majority of the empirical evidence in this area consists of studies on the psychological well being and adjustment of the disabled child in the educational settings and, later in the society. In comparison, fewer studies have been carried out investigating the effects of a child's disability on the family in terms of the psychological impact and the stress on the parents (Ferguson & Watt, 1980; Carr, 1985). Finally, the link between psychological aspect of the parents such as self-esteem, depression and coping strategies has received considerably less attention, especially in cases where parents were involved in parental groups.

The purpose of the present study was to investigate whether participation in parent support groups and sharing the care of the disabled child affect the levels of self-esteem and depression of mothers of disabled children, as well as the coping strategies that they use in order to deal with the strain of disability. The emotional reactions and the psychological health of mothers have been traditionally investigated in the special needs literature regarding infants or very young children and older children and adolescents have largely been ignored. Nevertheless, disabled children stay at home and continue to be cared for by parents well beyond school-age days so it is expected that the pressure on the family is considerably higher.

The review will encompass three linked areas. Firstly, the effects of the disability on the family's -especially the mother's- psychological adjustment will be presented. Secondly, the issue of participation in parent support groups will be discussed. Then, the review will describe the different coping strategies that parents employ in order to deal with the problems they face.

Effects of disability on the family

All parents and especially mothers develop anticipation regarding their infant. They have plans and project their expectations into the future. As a result of the diagnosis, the parents realize that their children may not fulfill their expectations and the "life plan" can be irrevocably changed (Robin & Josse, 1986).

The effects of disability on the family have been documented through empirical studies, which compared families with a disabled child with families with healthy children and through qualitative studies where parents -in most cases the samples consisted of mothers- discussed their feelings and their problems. Problems refer specifically to anxiety and stress, marital adjustment and family cohesion in general, depression and low levels of confidence as well as maladaptive coping styles.

The effects on the family of bringing up a child with a developmental disability such as autism or Down syndrome can often be overwhelming. The exceptional pressures that parents and the whole family system face start very early from the birth or the time of diagnosis (if these are different) of the child with disabilities. The birth of a child with liabilities or a high-risk child is a stressful event that often leads the mother to inadequate coping styles, difficulties in relationships and reduced social contact (Brooks-Gun & Lewis, 1982). The adaptation process that parents go through following the diagnosis of learning disabilities in one of their children, is long and difficult and has often been compared to a bereavement process (Hornby, 1994; Miller, et al., 1994; Gath, 1985). The key difference is that the child with learning disabilities continues to live with the family and the parents continue to provide care for him/her. The parental stages of adaptation to the diagnosis of learning disability consist of shock, denial, anger, sadness, detachment, reorganization and adaptation (in order of occurrence). Given time and support parents and other family members will progress from the initial stages of shock and denial to the adaptation to their child's disability (Manthorpe, 1995). However, it has been argued that not everyone is progressing at the same pace and there are people who often regress at a previous stage or different members of the family may be at different stages of adapting at the same time (McCormack, 1992).

Parental stress can also be linked with the presence of a disability in the family. This relates to the limited time and the social restriction described above. Research has been conducted with children with Down syndrome and children with autism where the effects on parents -usually mothers- were contrasted with families with healthy children. Results indicated that families in the first situation reported more problems (Sanders & Morgan, 1997; Cuskelly et al., 1998). High levels of parental stress and psychological ill-health are known to lead to decreased interaction between the parent and the child, and as a result less support for the child (Field, 1980; Lewis & Sullivan, 1996). Since engaging in high levels of interaction and actively participating in the education of the disabled child is highly correlated with the child's progress, the latter is irrevocably damaged.

The bulk of evidence converged that living with a disabled child causes a great deal of problems both for the family as a system, its members separately and their interaction. However, certain findings presented a reverse picture. Specifically, in some studies, mothers of severely disadvantaged children did not necessarily report greater levels of stress than those of "normal" children (Holroyd & McArthur, 1976; Bradshaw, 1980; Carr 1985) or indeed in others a positive impact of children with an intellectual disability on the family was reported (Stainton & Besser, 1998).

Parent support groups

Learning disability associations throughout Europe and USA and the community (MENCAP, The National Autistic Society) run parent groups. These involve parent meetings with professionals, at varying intervals from weekly to monthly in a variety of settings such as hospitals, universities and schools. The models have been described elsewhere (Callias, 1980). Parents are taught to assess their children, identify problems, set targets and are taught principles of behaviour modification. When at home, they work towards specific objectives and report on their children's progress at the next meeting. The aim is to include both parents but in practice mothers are usually the majority. Attendance in parent groups is reported between 72 and 82 per cent (Holland & Hattersley, 1980; Firth, 1982).

Family support is conceptualized from a social model of disability involving a consideration of the wider context in which the families live. There are a wide variety of schemes aimed at supporting parents and families of people with disabilities (Mittler & Mittler, 1994).

Through the participation in support groups, it is expected that parents (a) systematically learn new behavioural methods from trained professionals (b) release some of the pressure that they experience by sharing their feelings with others in a similar position and, (c) exchange information about their children.

Participation in parent groups can be evaluated through the use of questionnaires circulated to parents after the end of the training. Respondents are very positive, mainly emphasizing that the approach has helped them to see their child in a more positive light, and to be more objective and constructive. In addition, it enabled them to feel more confident and cope with the problems associated with learning disabilities (Holland & Hattersley, 1980; Firth, 1982). Many family support initiatives have addressed the lack of resources in families of children with special needs to cope with the increased stress they face from day to day. In terms of the effect of family support programs on family stress, some evidence exists showing increased factual knowledge about the disability, increased knowledge about stress and stress management but no reduction in overall stress (Peck, 1998).

Given the different criteria used to assess the success of the programs it is often difficult to reach a conclusion. Perhaps parents are grateful for any type of help and teaching provided and do not assess the effectiveness of the program with objective criteria such as skills' improvement in their children.

Some drawbacks of parent groups according to Carr (1985) may be summarized as follows:

1. The importance of including both parents in the teaching sessions is emphasized but almost all projects had difficulty in including the fathers

2. Difficulties are highlighted when the children of the parents present diverse problems, abilities and are of different age. It was argued that parents of the younger and the more able children were benefited more. Those with children with more difficulties feel discouraged and embarrassed and may be unwilling to attend further meetings

3. Other problems arise when new skills that the parents learn bring them in conflict with other professionals (i.e. teachers) who may not be aware of such new methods

From this review it emerged that children cared for at home constitute a demanding situation for the parents and especially for the mothers who are the primary carers. Within a transactional model the difficulties of the children can adversely affect the parents' and especially the mothers' mental health, increase stress, lower self-esteem and increase levels of depression. As an effect, the study of family variables has become increasingly critical in understanding outcomes typically considered program driven. The coping styles that mothers use are often maladaptive and, given that the child stays and continues to receive care in the family long after the normal school years, it becomes increasingly difficult for mothers to redress the balance. The problems faced are often aggravated if no support is provided. One could expect that that in a normal family less care is needed when the child becomes an adolescent and is prepared for employment status. The opposite stands for families with a disabled child. Identification of the problems that the mothers face is needed in order to provide the appropriate support through formal and informal services. Only then will it be possible to enable families to adjust with disability.

Coping strategies

In the 1990s a shift was observed from a pathological model of disability to an emphasis on employing "coping strategies" (Russell, 1994). Families differ greatly in their reactions, coping styles and resources. According to McConachie (1994), the coping styles of families differ in that different families can perceive the challenges they face in a different way.

Many factors were identified as assisting the adaptation to the child of a disability. Some of them are the early provision of information by the professionals, the quality of relationships with the professionals and the involvement of parents in decisions about their child (Grant et al., 1998; Barr, 1997; McCormack, 1992).

Visits by a trained professional ("home visitor") provide the parents with support and encourage them to lead ordinary lives and develop relationships with the local community. Parents who were provided with support at the initial stages after the diagnosis seemed to be more confident and optimistic and had higher expectations for their children than those who did not receive similar support.

After the initial shock and disbelief when the child is identified with a disability, comes anger, sadness and finally parents enter the coping stage. According to the theory of coping, there are three coping dimensions: task-oriented, emotion oriented and avoidance oriented (Endler & Parker, 1990a, 1990b). Task-oriented coping is defined as active, problem oriented efforts to change the situation or the problem. Emotion-oriented coping is the tendency to focus on negative affective reactions. Finally, avoidance-oriented coping is defined as a reluctance to confront a stressful situation. This is subdivided in two subscales, distraction and social diversion. The second and the third coping style are considered maladaptive since they do not help the individual address the problematic situation effectively. The emotion-oriented coping style includes a tendency to be highly self-focused and engage in excessive self-blame and wish fulfillment. Individuals who use this type of coping, experience their emotions with great intensity and often feel unable to regulate their negative emotions. As a result, there is a greater likelihood that they present depressive symptoms in conjunction with negative cognitive operations, self-consciousness and dysfunctional attitudes (Billing & Moos, 1984; Folkman et al., 1986). Finally, people who are more negative about regulating their negative mood have a tendency to avoid rather than approach problems (Catanzaro & Greenwood, 1994).

The life stress that the parents and especially the mothers of children with disabilities face has already been discussed. Feelings of disappointment and distorted cognitive mechanisms prevent them from functioning normally and can often be linked to low self-esteem and depression (Patterson, 1992; Beresford, 1995). Counselling of families suffering from the stress of having disabled children indicate that the focus on the parents attributions may have the best chance of altering the family dynamics. Typically these programs consist of discussions with parents aimed at dealing with the cognitive attributional style of parents. It is common that parents refuse to face the reality of their child's problem and cope with anxiety and guilt by denying the presence of the disability. Moreover, levels of guilt and self-blame are high. Counselling helps to reduce self-blame and guilt in parents as well as restructure negative attributions and reduce depression (Nixon & Singer, 1993).

Participating in parent groups can act as an effective coping strategy for the problems that parents face due to their child's disability. It is assumed that through parent groups and the support of trained professionals, parents are better equipped to help their child and simultaneously cope with their own difficulties. Moreover, it has been established that coping variables can emerge as significant predictors of maternal and paternal involvement as well as a mediator variable between family functioning and parental involvement.

METHOD

Sample

The sample of the study consisted of 69 mothers of children with special needs selected from two Special Needs Centres in Greece. The centres catered for children from 5 to 18 years with developmental disabilities (autism, Asperge syndrome), mild learning difficulties and severe learning difficulties with mobility problems. Both centres were running parent groups where, under the guidance of a psychologist and a social worker (for the first and second centre respectively) parents met weekly in groups of 4-8 to discuss matters of their children's progress and to learn techniques in order to cope with their children's disability. Although the aim of the study was to include both parents, that was proved impossible since it was mainly the mothers who participated in the parents groups. After permission from the centres' directors, the mothers were approached by the researcher, they were informed about the scope of the investigation and decided to meet at a later convenient time for them. The questionnaires were filled in individually by the mothers and were returned to the centre at the following parent meeting.

Measures

Self-esteem

Self-esteem was assessed using the Rosenberg Self-Esteem Scale (Rosenberg, 1965). Each of the ten items in this instrument is intended to measure global self-esteem in the way described by Rosenberg. The respondent is asked to rate each statement from 1 to 4 (e.g. Generally, I am satisfied with myself). High scoring implies high self-esteem while low scoring implies low self-esteem.

For Rosenberg, when a person is characterized as having high self-esteem, this implies that he has self-respect and considers himself a person of worth. Rosenberg claimed that we should acknowledge the individual's general sense of self-worth in addition to one's self-perceptions across the specific domains of one's life. Rosenberg has argued that, in all likelihood, the various discrete elements of the self are weighted, hierarchized and combined according to an extremely complex equation of which the individual is probably unaware. Accordingly, he has taken the direct approach to item writing, assuming that each individual, in developing his or her self-esteem, has consciously and/or unconsciously taken into account and weighted a unique set of varying personal importance.

Depression

For the assessment of depression of the mothers of the sample we used the depression subscale of Goldberg's General Health Questionnaire - GHQ28 (Goldberg & Williams, 1988), as adapted for use with Greek population by Moudzoukis et al. (1990). This questionnaire is widely used for the identification of the mild forms of psychopathology in the general population. It consists of 28 questions investigating the general mental and psychosomatic state of the individuals in the weeks previous to the questionnaire. It focuses on two important categories of psychological states: (a) the person's inability to continue his/her normal way of living and (b) the onset of factors that are responsible for the problems.

Apart from the overall scoring, the questionnaire provides individual scoring and information on four subscales: somatic symptoms, stress and insomnia, social malfunctioning and depression. The respondent is asked to pinpoint whether he/she presents a symptom or behavior (e.g. Do you feel that you are always under pressure?) over the previous weeks and to what degree: "never", "not more than usual", "a little more than usual" or "a lot more than usual".

Coping

To assess the coping strategies used by the sample of the study we employed the coping measure of Folkman and Lazarus (1980), as adapted for use with Greek population by Besevegis and Karadimas (1997). This questionnaire assesses five types of coping strategies used by individuals to deal with a stressful problem.

The five types of coping strategies are: (a) Positive approach - this strategy involves attempts of the individual to reassess the stressful situation in a positive way (e.g. I tried to see the positive side of the situation). (b) Search for social support - this scale involves items that refer to the individual looking for support in his/her social surroundings in order to deal with these problems (e.g. I talked to someone to help me realize more of my situation). (c) Wishful thinking/dreaming - this strategy consists of items that assess the tendency of the individual to overcome problems by wishing for a miracle or dreaming of how the situation would be if something like that hadn't happened (e.g. I wish this situation would disappear). (d) Avoidance - this subscale assesses the individual's tendency to reevaluate the situation by minimizing or ignoring its true importance (e.g. I tried to forget by working or being involved with something else). (e) Assertive handling of the problem - this subscale assesses the individual's effort to find a solution by dealing directly and assertively with the situation or the person who is perhaps responsible for it (e.g. I expressed my anger to the person who was responsible of the problem).

The respondent is asked to state how often he/she uses a particular coping strategy when dealing with a stressful problem: "never", "rarely", "sometimes" or "often".

RESULTS

In Table 1 the number of mothers are presented by level of participation in organized support groups and level of sharing with others the care of the child with special needs.

Table 1 Number of mothers by level of participation in organized support groups and level of sharing the care of the SEN child with others

As Table 1 shows, the majority of mothers did not participate in parent groups in the centres of the sample.

The mean scores and standard deviations of the mothers' self-esteem by level of participation in organized support groups and level of sharing the care of the SEN child with others are presented in Table 2.

Table 2 Self-esteem mean scores and standard deviations by level of participation in organized support groups and level of sharing the care of the SEN child with others

Table 2 shows that the self-esteem mean scores are above the midpoint of the scale ( =2.86>2.50). However, there are differences associated with both level of participation in organized support groups and level of sharing with others the care of the child with special needs.

The results of the two-way ANOVA of the self-esteem scores are presented in Table 3. The eta statistic, whose squared value indicates the proportion of variance explained by each factor and the interaction term, was used as index of the effect sizes. The proportion of variance in the dependent variable accounted for by level of participation in organized support groups, level of sharing with others the care of the child with special needs and their interaction, the adjusted R², was used as index of the model goodness-of-fit.

Table 3 Two-way ANOVA of the mothers' self-esteem scores by level of participation in organized support groups and level of sharing the care of the SEN child with others

According to Table 2, the mothers' self-esteem was lower both when mothers did not participate in organized support groups and when they were not sharing the care of their child with others ( =2.66). The self-esteem appeared higher when mothers had both types of help available ( =3.31). The ANOVA revealed highly significant main effects for both the independent variables of sharing [F(1,65)=23.128, p<.001] and participation [F(1,65)=9.399, p.<.003], but no interaction effects. The proportion of variance in the self-esteem scores explained by sharing with others the care of the child with special needs was = 26.2%, while the respective proportion for participating in organized support groups was =12.6%. Thus, it appears that sharing with others the care of the child with special needs has a stronger effect on mother's self-esteem than her participation in organized support groups. The total variance in the self-esteem scores explained by the differences in the levels of participating in organized support groups and sharing with others the care of the child with special needs, the adjusted R², was 33.1%.

These additive and very systematic effects are also evident in the profile plot (Figure 1) of the means in Table 2. These findings imply that both variables combine to produce a mother's level of self-esteem and that one does not offset or compensate for the other.

Figure 1 also illustrates that the mothers with the highest self-esteem were those who both participated in organized support groups and shared with others the care of their child. These are the mothers scoring in the =3.31 range on self-esteem. The mothers with the lowest self-esteem are those who displayed the opposite pattern, non-participation in organized support groups coupled with non-sharing with others the care of her child with special needs. These are the mothers scoring in the =2.66 range on self-esteem. The difference between these two groups is marked, indicating the impact that both these predictors have on the mothers' self-esteem.

In Table 4 mothers' depression mean scores and standard deviations are presented by level of participation in organized support groups and level of sharing with others the care of the child with special needs.

Table 4 Depression mean scores and standard deviations by level of participation in organized support groups and level of sharing the care of the SEN child with others

On the whole, depression levels were average. Taking into account that 12 is a cutoff score for a diagnosis of depression, it can be said that the sample was not expected to be clinically depressed, however they did present some depressive symptoms. In terms of the two independent variables, participation in organized support groups and sharing the care of the SEN child with others have a positive effect in the mothers' level of depression. Depression levels were lower for those mothers who received help at home for their child and participated in support groups ( =2.33). Higher depression levels were observed for mothers who did not have any of this support ( =10.49).

These effects are also evident in the results of the two-way ANOVA of the depression scores by level of participation in organized support groups and level of sharing with others the care of the child with special needs, presented in Table 5. Main effects were found for both independent variables [participation in support groups: F(1,65) = 16.477, p.<.001, sharing with others the care of the child with special needs: F(1,65) = 23.250, p.<.001], but no interaction effects were detected.

Table 5 Two-way ANOVA of the depression scores by level of participation in organized support groups and level of sharing the care of the SEN child with others

The total variance in the depression scores explained by the differences in the levels of participating in organized support groups and sharing the care of the SEN child with others, the adjusted R², was 47.4%.

Tables 6-10 present the mean frequencies and standard deviations of the five types of coping mechanisms examined in the study by level of participating in organized support groups and level of sharing the care of the SEN child with others.

Table 6 Mean frequencies and standard deviations of the positive approach coping mechanism by level of participation in organized support groups and level of sharing the care of the SEN child with others

The mothers who received counselling and had some help for their child were more likely to use the positive approach type of coping ( =27.44) whilst those who had neither of these types of support were the least likely to be positive about their situation ( =22.76).

Table 7 Mean frequencies and standard deviations of the search for social support coping mechanism by level of participation in organized support groups and level of sharing the care of the SEN child with others

Table 7 shows that higher means for search for social support were achieved by the mothers who shared their care of their child with others but did not receive any counselling ( =13.33) and the lowest means were achieved by those who participated in support groups but did not share their care of their child with others in the family ( =11.00).

Table 8 Mean frequencies and standard deviations of the wishful thinking coping mechanism by level of participation in organized support groups and level of sharing the care of the SEN child with others

As Table 8 shows, there were no particular differences in wishing coping strategy in terms of counselling and support group participation. It is interesting to note that the group who least used this strategy, in other words wishing that the problems would disappear, were those who had both types of support.

Table 9 Mean frequencies and standard deviations of the avoidance coping mechanism by level of participation in organized support groups and level of sharing the care of the SEN child with others

Table 9 shows that the second negative coping strategy, i.e. avoidance, was most frequently used by those mothers who had both types of support.

Table 10 Mean frequencies and standard deviations of the assertive solution of problem coping mechanism by level of participation in organized support groups and level of sharing the care of the SEN child with others

The mothers who received help for their situation both through counselling and sharing the care of their child were those who were equipped to deal more assertively with the situation ( =8.67). No participation in parent groups resulted in the lowest scoring for those who had someone to help them for the care of their child ( =5.83).

Table 11 presents the results of the two-way ANOVAs for the mean scores of the coping strategies.

Table 11 Two-way ANOVAs of the frequencies of the coping mechanisms by level of participation in organized support groups and level of sharing the care of the SEN child with others

It can be seen that sharing with others the care of the child with special needs has a significant main effect on two out of the five coping mechanisms examined here: positive approach [F (1,65)=19.456, p.<.001] and search for social support [F(1,65)= 4,966, p<.05]. This finding implies that when mothers received some kind of help in the caring of their child they were more likely to use a positive approach in order to cope with their stressful situation and also look for support in their social settings. No significant differences in their coping strategies were found in terms of their participation in organized support groups. Moreover, an interaction effect (sharing x participation) was found for the dependent variables of avoidance [F(1,65)=11.172, p<.001] and assertive solution of the problem [F(1,65)=16.577, p.<001].

DISCUSSION

The present study revealed that both types of support, counselling and help for the care of the child, when they take place simultaneously, enhance the self-esteem of the mothers. The demands of having a disabled child in the family are significantly reduced when mothers share the pressure of caring for their child throughout the day with another person. As supported in the literature, one of the most important consequences of having a disabled child in the family is the constant responsibility and the overwhelming amount of time devoted to his/her care (Dupont, 1980; Brooks-Gun & Lewis, 1982; Russell, 1994). Lack of -or small steps of- improvement can lead to anxiety and reduced social contact. Self-esteem has been known to be related to these factors. The findings of this study revealed that mothers who had the opportunity to be involved in a group with other parents in a similar situation and received the help of someone for the care of their child seemed to report higher levels of self-esteem.

Depression may be an additional factor linked with the parents' feelings of anxiety and stress about the current situation as well as the future of the disabled child. Coupled with the mothers' limited time and the inability of employment due to restricted hours this can often lead to a negative self-image, general ill-health and even depression. The mothers of the present study reported on average moderate levels of depression. Although they were not expected to compose a clinically depressed sample they did present certain depressive symptoms. Increased stresses and the strains of care may have resulted in this. The hypothesis that participation in organized parent groups and sharing the care of the child can alleviate a degree of stress that the mothers feel was confirmed in this study, since the group who received this type of help was found to respond better and present lower levels of depression.

In terms of the frequency that the mothers used both positive and negative types of coping strategies in order to deal with their problems, the findings showed that indeed mothers who were involved in an organized social interaction with other parents with similar problems and had the opportunity to devote some time on matters other than their children's care with the help of someone else in the family taking over the care of the child, employed positive coping techniques more frequently. For example they were involved in positive thinking, were looking for social support and were able to act on the source of stress. It has to be stressed that the way that the parents react to the stressful situation -whether for example they are task oriented (positive style) or emotion oriented (maladaptive)-, and how they perceive the challenges they face can be linked with the child's physical and emotional well-being (Fehrenbach & Peterson, 1989). Moreover, it has been illustrated that there were significant differences in terms of coping styles between the group who received some help and the group who had no help. The tendency to confront the stressful situation directly, by being focused on the problem and not being engaged in excessive self-blame and wish fulfillment enables the individual to regulate negative emotions, engage in positive cognitive thinking, present fewer negative symptoms and finally hold more positive attitudes (Billing &Moos, 1984; Folkman et al., 1986; Catanzaro & Greenwood, 1994).

A number of studies in the UK have indicated the pressures that parents face due to the needs of their disabled children. Limited time and social restriction is a constraint since most children with disabilities cannot be left alone for a few minutes during the day (Russell, 1994). Dupont (1980) found that in a population sample of thirty-nine learning disabled children, families were spending an average of seven hours in the care and training of the children. In an early study, Wilkin (1979) revealed that there was little help from relatives, friends or neighbours for the day-to-day care of the severely disabled child. As a result there was a lack of a social support network. That is aggravated when there is evidence of poor housing, low income and one-parent families. Social restriction is intensified when the child is cared for at home rather than in special centres.

An additional factor that may cause high levels of anxiety for the parents is home intervention. Studies have showed that the quality of parental participation in their child's education in addition to or in conjunction with the professionals -especially in cases of disability- facilitates and balances the work of the professionals and also reinforces a positive image for the disabled individual. However, parents are expected to find the time to work with their special children in a way that is not expected for their ordinary children (Buckley, 1994). This can be a cause of anxiety for some of them especially if they have other siblings to care for and their time is limited. This is consistent with the findings of this study which indicated that relieving the mother from the care of her child for some hours every day reduces depression and increases self-esteem.

Despite thei supportive role, parent support groups have often been seen as sources of stress and negative feelings from the part of the parents. For mothers, the combination of different roles such as therapist and teacher to their disabled child and wife and mother to their other children may prevent them from being themselves and can often lead to psychopathology (Carr, 1985). The question is whether a small improvement in the child outweighs the psychological cost to the family. Another stressor associated with parental involvement is that parents often feel that they are looked down by professionals, that their efforts are undervalued and their needs are not recognized (Berry et al., 1981; Gascoigne, 1996). The pressure of the professionals to involve the parents in the education of their children may turn out to be in conflict with the interests of the rest of the family. The need arises to help parents in a way that is acceptable to them, because efforts may be wasted otherwise. This study has indicated the positive effect of the parent groups on the mothers' self-esteem, depression levels and coping strategies but aso found that the most significant variable was support from someone at home. A more in-depth investigation of the support the mothers received at the centres wuld reveal more interesting information.

Another significant finding which has many implications for the research in this area is the increasing responsibilities taken on by mothers. They are expected to have the main and sometimes the sole responsibility for the child with disabilities. Caring tends to be perceived as the mothers' primary responsibility. This pattern is reinforced by the "male incompetence" myth (Blain, 1994) which argues that men are less able to provide care and excuses them from learning the necessary skills. Studies have shown that mothers are unsupported by other members of the family. Moreover, even in cases where other members of the family contributed to the domestic tasks, the disabled child was considered the responsibility of the mother. This "burden" of caring on the mother's shoulders is aggravated when SEN services concentrate on the mother and the child and indirectly ignore the contribution of fathers. The absence of fathers from the support groups was noted in this study as well. Perhaps more emphasis should be given on the significance of including the fathers in the helping process.

Traditionally, mothers have been the main focus of family research either by providing information for their children with disabilities or discussing the effects of the disability on their personality and behaviour. The main body of research on the area of interaction between parents and children with learning disabilities focuses on mother-child interaction. Less attention has been given to fathers mainly due to the difficulty in access and co-operation that was reported in many studies. Findings suggest that those of fathers who had supportive parents themselves were more likely to have positive feelings and do more with their child (Waisbren, 1980). In another early study, where fathers of learning disabled children were compared with fathers of healthy children the first presented higher levels of depression, less enjoyment of both their disabled child and their other children, lower self-esteem and sense of paternal competence and "a pattern of neurotic-like constriction" expressed in increased levels of stress (Cummings, 1976).

An intervening variable that may redress the balance between the lowered self-esteem and the high levels of stress is mother's employment. Research indicates that women's employment -if so desired- is correlated with a positive self-image and feelings of worthiness (Martin & Roberts, 1984). Mothers who were employed in a paid job had less psychological problems than those who wanted to work and did not (Bradshaw, 1980). However, caring for a disabled child decreases maternal employment rates since the number of hours that it is possible for a mother to work are restricted (Smyth & Robus, 1989). Moreover, mothers of children with disabilities do not increase their working hours as their children grow up (Baldwin, 1985). Findings from a study by Beresford (1994) suggest that employment rates of parents of disabled children are lower than in the general population.

The majority of the mothers in this sample were unemployed. Although the reasons why this occurred were investigated, it is evident that lack of opportunity to work can result in extreme personal and financial hardship (Glendenning, 1992). Parents are exposed to increased risk of stress and symptoms such as depression. Employment can offer mothers and parents in general, an opportunity to escape monotonous household routine and make them move away from their image as parents of disabled children (Beresford, 1994). It has also been found that employment can reduce the levels of stress, ill-health and depression among mothers of children with disabilities (Bradshaw & Lawton, 1978; Sloper & Turner, 1993; Sloper et al., 1991) and lead to self-fulfillment (Lewis et al., 1996). It is important to emphasize though that the beneficial effects of mother's employment were only important in cases where the mothers were satisfied with their employment status (Bradshaw & Lawton, 1978).

In conclusion, the life stress that parents, and in general everyone involved in the day-to-day care of a learning disabled child can often be overwhelming as already discussed. Caring for children with severe impairments often implies help with self-care (toileting, washing, dressing, feeding, watching over) lasting longer than their non-disabled peers. Other special needs may involve special dieting, medication, and physiotherapy. Given these sources of additional stress it is not surprising that the literature has shown increased levels of mental and physical health problems among parents of disabled children (Beresford, 1996).

It has been shown that group counselling programmes that aim at dealing with the cognitive attributional style of the parents and increase the social contacts among parents who face similar stressful situations at home can help alleviate some of this stress, raise self-esteem, reduce depressive symptoms and help parents learn to use positive coping techniques. In addition, receiving some help with their children at home can lift considerable weight off the mothers' shoulders who are traditionally the main carers and can enable them to be involved in social interactions, or engage in part-time employment which in turn improve their self-image (Martin & Roberts, 1984; Beresford, 1994).

That sharing the care of the child at home leads to improved self-esteem, lower levels of depression and more positive coping strategies, this has certain implications for policy and practice for the provision of special needs support in Greece. The development of services to support families with a disabled child has to take place in order to provide a framework through which the parents can use the coping strategies they find work best for them. According to the model of stress developed by Lazarus and Folkman (1984) the process of coping mediates the effects of stress on an individual's well being. Given that the support needs for parent and child are inextricably linked, services have to made available that focus not only on the child but on the parent as well. Lessening the care burden would allow more quality time between parent and child and child-care provision would allow the parent to return to work and feel less isolated and unsupported. Finally, counselling services should focus on the individual ways of coping with the stress of having a disabled child in the family and seek to build on parents' strengths as well as their preferred ways of coping. After all, it is the needs of the parents that have to be addressed in these types of programs since they are the ones who are involved in the care of their children in the long term. All such interventions should ideally involve the whole family and not only the mothers.

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Index