Coping strategies in mothers of children with intellectual
disabilities showing multiple forms of challenging
behaviour: associations with maternal mental health
Author
Adams, D, Rose, J, Jackson, N, Karakatsani, E, Oliver, C
Published
2018
Journal Title
Behavioural and Cognitive Psychotherapy
Version
Accepted Manuscript (AM)
DOI
https://doi.org/10.1017/S1352465817000704
Copyright Statement
© 2017 British Association for Behavioural and Cognitive Psychotherapies. This is the author-
manuscript version of this paper. Reproduced in accordance with the copyright policy of the
publisher. Please refer to the journal's website for access to the definitive, published version.
Downloaded from
http://hdl.handle.net/10072/368768
Griffith Research Online
https://research-repository.griffith.edu.au
1
Left running head: D. Adams et al.
Right running head: Challenging behaviour and coping styles
Coping strategies in mothers of children with intellectual disabilities showing multiple forms
of challenging behaviour: Associations with maternal mental health
Adams, D.
1,2
, Rose, J.
3
Jackson, N.
2
, Karakatsani, E.
2
, & Oliver, C.
2
1
Autism Centre of Excellence, School of Education and Professional Studies, Griffith
University, QLD, Australia
2
Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of
Birmingham, UK
2
School of Psychology, University of Birmingham, UK
Correspondence regarding this article should be addressed to:
Dr Dawn Adams, Autism Centre of Excellence, School of Education and Professional
Studies, Griffith University, Mount Gravatt, Brisbane, Queensland 4122, Australia
Email: Papers@DawnAdams.co.uk
Keywords: parental cognitions, coping strategies, intellectual disabilities, challenging
behaviour
2
Background
It is well documented that mothers of children with intellectual disabilities experienced
elevated mental health difficulties and that these are exacerbated by the presence of
challenging behaviour. However, comparatively little is known about the effect of specific
coping strategies for managing such behaviours.
Aims
This paper aims to document coping strategies used by mothers of children showing multiple
forms of challenging behaviour and to explore how these relate to positive and negative
maternal mental health.
Method
Eighty-nine mothers of children with intellectual disabilities completed questionnaires
assessing maternal mental health (Hospital Anxiety and Depression Scale, Positive and
Negative Affect Scale) and maternal coping strategies (Brief COPE).
Results
Coping strategies were not associated with child age or ability, but were associated with
maternal mental health. Higher levels of problem-focused and positive-coping strategies
were associated with higher positive affect. Although active-avoidance coping was the least
frequently reported, it was associated with higher levels of negative affect and increased
anxiety and depression. Moderated mediation analyses identified that active-avoidance
coping mediated the relationship between the number of forms of challenging behaviour and
poor maternal mental health, but only in mothers with lower levels of problem-focused
coping.
Conclusions
Active-avoidance coping is associated with poorer negative mental health in mothers of
children with intellectual disabilities who have average to low levels of problem-focused
3
coping. This is reflective of that noted within a range of populations, highlighting it as a key
area for intervention.
Keywords: mothers, parental cognitions, coping strategies, intellectual disabilities,
challenging behaviour
Introduction
It is widely accepted that caregivers of children with an intellectual disability are at increased
risk of experiencing mental health difficulties compared to parents of typically developing
children (Singer, 2006). However, as literature within this area has expanded and developed
it has become increasingly apparent that this relationship between parenting a child with an
intellectual disability and poorer mental health is more complex than initially described.
Child factors (e.g., age, ability, challenging behaviour) have been explored with varying
results.
A number of studies have focused upon the relationship between challenging
behaviour and maternal mental health and have documented a strong association between the
presence and the extent (e.g., frequency, severity) of challenging behaviour and elevated
levels of maternal stress and mental health difficulties (e.g., Hastings, 2002; Tomanik, Harris
& Hawkins, 2004; Mash, 1990). However, the variability in how parents respond to the
challenges of raising a child with an intellectual disability and challenging behaviour
suggests that there may be a range of parental factors (e.g., socio-economic status; Giallo &
Gavidia-Payne, 2006) and cognitive or psychological processes influencing the relationship
(Horsley & Oliver, 2015), either by mediation or moderation. These have also begun to be
explored in the positive psychology literature, exploring the underlying cognitive factors
contributing to the variability in positive well-being in parents raising children with
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intellectual disabilities (Beighton & Wills, 2016). Models such as the Model of Parent-Child
Interactive Stress (Mash & Johnston, 1990), aim to explain this variability through inter-
linking factors that combine or interact to contribute to stress in parents and families.
Coping strategies have repeatedly been suggested as one of the key mechanisms by
which parents adapt to the process and stresses associated with raising a child with a
disability (Smith, Seltzer, Tager-Flusberg, Greenberg & Carter, 2008) and therefore influence
their mental health and well-being. Hastings, Kovshoff, Brown, Ward, Espinosa and
Remington (2005) reported the results of a multidimensional coping inventory, the Brief
COPE, in mothers and fathers of children with autism, and their study explored the
relationship between coping strategies and parental well-being. Factor-analyses of the 28
items from the Brief COPE identified four factors; active-avoidance coping (nine items),
Problem-focused coping (seven items), Positive coping (six items) and religious/denial
coping (four items). There was no effect of child age on coping strategies reported but there
was an effect of parent gender, with mothers reporting more active-avoidance and problem-
focused coping strategies than fathers. Mothers who showed more active-avoidance coping
strategies reported more symptoms of anxiety and depression. Religious/denial coping was
associated with depression in mothers and depression and anxiety in fathers. Finally, parents
who adopted more positive coping strategies reported lower levels of depression. In a
longitudinal study, Benson (2010) also used the Brief COPE in a sample of 113 mothers of
children with autism. Although using a different factor structure, he found a similar profile of
results; higher use of avoidant strategies (distraction and disengagement) increased parental
distress but problem-focused coping strategies (engagement and cognitive reframing) had
minimal impact on reducing maternal distress. Benson also noted that maternal well-being
and positive health were associated with higher levels of cognitive reframing and lower levels
of disengagement coping strategies. However, neither of these studies explored the impact of
