European Journal of Developing Country Studies, Vol.

10 2011
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Coping Strategies of Mothers having Children with Special Needs
*e+an E, Na-a'y .+/ed 0oa'ad ( )+D
,e1turer of pediatri1 Nursing , 2a1ulty of Nursing
0ansoura 3niversity , Egypt

Abstract
2a/ilies 'it+ a 1+ild '+o +as spe1ial +ealt+ 1are needs e4perien1e life
differently t+an ot+er fa/ilies. 0ot+ers appear to 1arry t+e larger -urden of 1are
and /ay feel a need to -e 'it+ t+eir 1+ild at all ti/es and e4perien1e stress
related to 1oping 'it+ t+e +eavy load of 1are giving. t+e 1urrent des1riptive
resear1+ design is ai/ed to identify e4isting 1oping strategies of /ot+ers '+o
+ave 1+ildren 'it+ spe1ial needs and deter/ine '+et+er t+ere is a relations+ip
-et'een t+e 1oping strategies and t+e /ot+ers5 de/ograp+i1 varia-les. 0ot+er6s
1oping strategies 'ere assessed using t+e 2a/ily Crisis 7riented )ersonal
Evaluation S1ale (2#C7)ES. 8+e study 1on1luded t+at t+ere is signifi1an1e
relations+ip -et'een age and -ot+ refra/ing and passive appraisal, as 'ell as
-et'een -irt+ order and /o-ili9ing fa/ily to a1:uire and a11ept +elp. 8+e study
re1o//ended t+at future resear1+ s+ould -e done on larger populations and
additional resear1+ /ig+t address t+e 1oping strategies of ot+er fa/ily /e/-ers,
su1+ as si-lings and t+e e4tended fa/ily.
Key Wards : Coping strategies, /ot+ers, 1+ildren, spe1ial needs, 2a/ily
Crisis 7riented )ersonal Evaluation S1ale (2#C7)ES.
1. Introduction
2or /ost parents, t+e -irt+ of t+eir 1+ild is a ;oyous ti/e. <o'ever, nearly => of
parents re1eive distressing ne's a-out t+eir 1+ild5s +ealt+. In fa1t, a-out every
$.% /inutes a parent is told t+at t+eir 1+ild +as a serious 1+roni1 /edi1al illness,
+ealt+ defe1t, disa-ility, sensory i/pair/ent, or /ental retardation . 2or t+ese
parents, t+e ti/e of t+eir 1+ild5s -irt+ /ay -e1o/e /i4ed 'it+ stress and despair
((arnett ?et al ,200$.
)arenting is a +ig+ly stressful ;o-, and -e1o/ing a parent of a 1+ild 'it+
disa-ility is one of t+e /ost stressful life events t+at 1an o11ur. 2a/ilies 'it+ a
1+ild '+o +as spe1ial +ealt+ 1are needs e4perien1e life differently t+an ot+er
fa/ilies. 0ot+ers are usually t+e pri/ary 1aregivers of t+ese 1+ildren -e1ause
/ost of t+e/ re/ain in t+e fa/ily environ/ent during t+eir treat/ent and t+ey
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appear to 1arry t+e larger -urden of 1are and t+ey /ay feel a need to -e 'it+
t+eir 1+ild at all ti/es so t+ey e4perien1e stress related to 1oping 'it+ t+e +eavy
load of 1are giving (8+o/pson, 2000 ? Ja/es ? .s+'ill, 200& ? )eters ?
Ja1@son,200A .
C+ild 'it+ spe1ial needs is diffi1ult to define, -e1ause t+ere is no single
definition or 1lassifi1ation syste/ t+at is used .2or /any years a nu/-er of
ter/s +ave -een used to 1lassify and des1ri-e 1+ildren 'it+ spe1ial +ealt+ 1are
needs. 8+ese ter/s in1lude 1+roni1 illness, 1ongenital disa-ility, develop/ental
delay, develop/ental disa-ility, disa-ility, +andi1ap, i/pair/ent, and
te1+nology#dependent 1+ild(Stein, S+en@/an ?Begener, 200$.0ore re1ently
t+ere +as -een i/petus to develop a definition of 1+ildren 'it+ spe1ial +ealt+
1are needs to -e used .8o date, 1+ildren 'it+ spe1ial +ealt+ 1are needs, as
defined -y t+e federal 0aternal and C+ild <ealt+ (ureau are C1+ildren '+o +ave
or are at in1reased ris@ for a 1+roni1 p+ysi1al, -e+avioral, develop/ental, or
e/otional 1ondition and '+o also re:uire +ealt+ related servi1es of a type or
-eyond t+at re:uired -y 1+ildren in general. 8+e ter/s D1+ild 'it+ spe1ial needsE
and Cdisa-ilityE are utili9ed inter1+angea-lyC( <o1@en-erry ? Bilson, 200& ?
0iller, Fe1s@y ? .r/strong, 200= ? 0sall, .very ? 8re/ont, 200$ ? (eers,
Ge/eny ?S+erritt, 200$ .
Disa-ility is des1ri-ed as any restri1tion or la1@ of a-ility to perfor/ an a1tivity
in a /anner or 'it+in a range 1onsidered nor/al for +u/an -eings. 8+ere is a
large and gro'ing nu/-er of persons 'it+ p+ysi1al, /ental, or sensory
disa-ilities in t+e 'orld today. <o'ever, t+e in1iden1e and 1auses of disa-ilities
vary t+roug+out t+e 'orld a11ording to age ,level of e1ono/i1 develop/ental,
a11ess to +ealt+ 1are, edu1ational, environ/ental, and ot+er fa1tors( <ar'ood,
Sayer ?<irs1feld,200=.8+e esti/ated ratio of disa-led persons ranges -et'een
%.2#1".2> in t+e 'orld populations. In developing 1ountries, up to %> of t+e
1+ildren are -orn disa-led or -e1a/e disa-led during t+eir 1+ild+ood .Disa-ility
is related to t+e population6s +ealt+ :uality as 'ell as t+e individual6s +ealt+
pro-le/. 8+e type and 1auses of disa-ilities s+ould -e deter/ined to dete1t t+e
pre1autions '+i1+ prevent disa-ility and planning approa1+es for re+a-ilitation
for t+e disa-led . 0any fa1tors are responsi-le for t+e rising nu/-ers of disa-led
1+ildren .,a1@ of o4ygen in t+e fetus during -irt+ due to torsion of t+e u/-ili1al
and dysto1ia, various diseases in t+e postnatal period, +eredity and geneti1
defe1ts are t+e /ost 1o//on fa1tors of disa-ilities (Don-a@ ? et al,200! ?
Coo@e , 200%.
0ot+ers 1an never fully prepare t+e/selves for t+e ne's t+at t+eir 1+ild is
different. B+et+er t+e diagnosis of a disa-ility is s+ortly after -irt+ or later on in
life, fa/ily drea/s and e4pe1tations suddenly 1+ange. 0ot+ers /ay +ave to fa1e
i//ediate de1isions a-out t+eir 1+ild5s /edi1al 1are and treat/ent (Case#
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S/it+,200=. 0ore ever, /ot+ers of 1+ildren 'it+ disa-ilities 1ope 'it+ t+e
sa/e responsi-ilities and pressures t+at ot+er /ot+ers fa1eH +o'ever, t+ese
/ot+ers reported +ig+er a/ounts of stress and t+ey e4perien1e greater de/ands
/ade -y 1aring for a 1+ild 'it+ spe1ial needs. 8+is sense of stress /ay -e
asso1iated 'it+ a 1+ild5s 1+ara1teristi1s, greater finan1ial and 1are#giving
de/ands, feelings of -eing unprepared for t+e tas@s of parenting, and a sense of
loneliness and isolation (Sullivan#(olyai, Sadler ? Gnafl, 200$ ? 7ru1+e ? et
al,2012.
Coping involves psy1+ologi1al resour1es and 1oping strategies t+at +elp to
eli/inate, /odify, or /anage a stressful event or 1risis situation . <aving a 1+ild
'it+ spe1ial needs 1reates a 1risis event, +o' /ot+ers respond to t+e stresses of
raising t+eir 1+ild 'it+ spe1ial needs depends on a 'ide variety of fa1tors
influen1ing t+eir a-ility to 1ope, su1+ as t+eir interpretation of t+e 1risis event,
t+e fa/ily5s sour1es of support, 1o//unity resour1es, and fa/ily stru1ture .8+e
personality 1+ara1teristi1s of t+e fa/ily /e/-ers, t+eir finan1ial status,
edu1ational level, pro-le/#solving s@ills, and spirituality all influen1e a fa/ily5s
a-ility to 1ope. Strong /arital relations+ip and so1ial support also +elp
deter/ine /ot+er ad;ust/ent (E/erson,200$ ? 2a9il, Balla1e ? Sing+, 200=.
8+e goal of 1oping strategies is to strengt+en or /aintain fa/ily resour1es ,
redu1e t+e sour1e of stress or negative e/otions , and a1+ieve a -alan1e in
fa/ily fun1tioning . Strategies dire1tly ai/ed at 1oping 'it+ t+e sour1e of stress,
su1+ as pro-le/ solving and see@ing infor/ation are /ore adaptive strategies
t+an t+ose efforts to deny or /ini/i9e t+e situation ((ailey ? S/it+, 2000.
0ore ever ,t+e literature on t+e adaptation of fa/ilies of 1+ildren 'it+ spe1ial
needs repeatedly indi1ates t+at it is i/portant for servi1e providers to understand
fa/ily -elief syste/s, -ot+ in a general sense and entity. Fesear1+ers do1u/ent
t+e i/portan1e of understanding fa/ilies5 'orldvie's , values and spiritual
-eliefs and day#to#day priorities and 1on1erns (Ging ? et al ,200A.
(e1ause ea1+ fa/ily syste/ is uni:ue, ea1+ fa/ily /ay +ave different 1oping
strategies. So, professionals need to @no' t+at '+at 1oping strategies are
+elping ea1+ fa/ily. 7ne s+ould not assu/e t+at any one spe1ifi1 strategy 'or@s
'ell for all fa/ilies. )rofessionals s+ould identify fa/ily sour1es of support and
pro/ote t+e utili9ation of -ot+ for/al and infor/al support syste/s.
2urt+er/ore ,nurses '+o 'or@ 'it+ /ot+ers '+o +ave 1+ildren 'it+ spe1ial
needs /ust understand +o' to assist t+e /ot+ers in 1oping 'it+ t+eir stressors.
In order to a11o/plis+ t+is, nurses 1an +elp /ot+ers reali9e t+eir a-ilities and
strengt+s, identify pro-le/s, develop pro-le/#solving strategies, and identify
ne' 1oping strategies(<o1@en-erry ? Bilson, 200& ? Boodgate, .lea+ ?
Se11ol,200".8+e professional#parent relations+ip is also very i/portant. B+ile
professionals /ay suggest 'ays to +elp a 1+ild 'it+ disa-ilities and offer
infor/ation regarding t+e 1+ild5s disa-ility, /ot+ers are t+e real e4perts on t+eir
1+ild5s li@eIdisli@es and +o' t+ey 1o//uni1ate .0ot+ers and professionals need
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to 'or@ toget+er 1on1erning t+eir 1+ild5s level of 1are, as 'ell as individual and
fa/ily needs. )rofessionals s+ould also dire1t t+eir attention to'ards '+at is
+elping t+e /ot+ers 1ope 'it+ t+e added stressors of raising a 1+ild 'it+ spe1ial
needs(Siv-erg,2002? Ging,et al,200A.
2. Significance of the proble
8+e statisti1al reports of 0inistry of <ealt+ in Gingdo/ of Saudi .ra-ia ( 2011
stated t+at, t+e total nu/-er of +andi1ap 'as &20000 and t+is nu/-er a11ount
for => of total population of Saudi .ra-ia. In relation to 1+ildren it 'as reported
t+at , -irt+ rate is =00000 # %00000 per year , a-out =00 # %00 of t+e/ is
+andi1ap and t+ey a11ount a-out !.$> of all 1+ildren in Saudi .ra-ia .
$. Ai of the Study
8+e ai/s of t+is des1riptive study 'ere to identify t+e 1oping strategies of
/ot+ers '+o +ave 1+ildren 'it+ spe1ial needs and deter/ine '+et+er t+ere is a
relations+ip -et'een t+e 1oping strategies and t+e /ot+ers5 de/ograp+i1
varia-les.



=. Methodology
4.1 !esearch design:
8+e 1urrent resear1+ design 'as a des1riptive design ai/ed to identify t+e
1oping strategies of /ot+ers '+o +ave 1+ildren 'it+ spe1ial needs and
deter/ine '+et+er t+ere is a relations+ip -et'een t+e 1oping strategies and t+e
/ot+ers5 de/ograp+i1 varia-les.
4.2 Setting:
8+e study 'as 1ondu1ted at 7ut#)atient Clini1s in .sser Central <ospital, .-+a ,
Saudi Gingdo/.
4.3 Sub"ects:
8+e study involved 1=! /ot+ers +aving 1+ildren 'it+ different types of
disa-ilities or spe1ial needs. 8+e data 1olle1ted during t+ree /ont+s started fro/
2e-ruary to .pril 2012. 8+e /ot+ers 'it+ t+eir 1+ildren 'as attending out#
patient 1lini1s in t'o days only per 'ee@ (0onday J 8uesday for follo' up .
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4.4 Instruent
8+e data 'as 1olle1ted using t+e follo'ing toolsK#
#A$ #8+e stru1tured :uestionnaire s+eet 'as developed -y t+e resear1+er. It 'as
'ritten in si/ple .ra-i1 language. 8+e :uestionnaire 'as 1on1erned 'it+
gat+ering data related toK
1# 0ot+ers5 de/ograp+i1 1+ara1teristi1s t+at in1lude age, /arital status,
edu1ational level, nu/-er of 1+ildren, se4 and -irt+ order of t+e 1+ild
'it+ spe1ial needs, fa/ily /ont+ly in1o/e, and t+e nature of t+e 1+ild5s
disa-ility.
2# .n additional open#ended :uestion 'as added to as@ t+e /ot+ers to
furt+er state '+at 'as /ost +elpful in 1oping 'it+ t+eir 1+ild5s disa-ility
(i.e., see@ing spiritual support, /aintaining a positive attitude, see@ing
+elp fro/ fa/ily /e/-ers, see@ing +elp fro/ friends, 1o//unity
resour1es, a1:uiring additional infor/ation, professionals support and
ot+ers t+ings .
#%$ & 0ot+er6s 1oping strategies 'ere assessed using t+e 2a/ily Crisis 7riented
)ersonal Evaluation S1ale (2#C7)ES developed -y #McCubbin' (lson' and
)arsen '*+,*$. 8+is %#point li@ert, self#report s1ale 'as designed to indi1ate t+e
point at '+i1+ a person agrees or disagrees 'it+ ea1+ state/ent (1L strongly
disagree and %L strongly agree. 8+e 2#C7)ES 1ontains $0#ite/s t+at -een
divided into five 1oping pattern su-s1alesK a1:uiring so1ial support, refra/ing,
see@ing spiritual support, /o-ili9ing fa/ily to a1:uire and a11ept +elp, and
passive appraisal #McCubbin et al.' *++*$. 8+e 2#C7)ES (1A"1 'as initially
tested on a sa/ple population of 2&=0 +us-ands, 'ives, and adoles1ents '+o
'ere graduate and undergraduate students . Fesear1+ers +ave used t+e 2#C7)ES
in a variety of 1ir1u/stan1es, so/e of '+i1+ in1ludeK parents 1oping 'it+
1+ildren '+o +ave learning disa-ilities, /ental retardation, or p+ysi1al
disa-ilitiesH 1aregivers of .l9+ei/er5s patientsH or fa/ilies 1oping 'it+ /a;or
illnesses, in;uries, or diagnoses. 2#C7)ES +as -een s+o'n to +ave +ig+
1onstru1t validity and relia-ility.
4.5 -efinition of variables:&
Ac.uiring social support is t+e fa/ily5s a-ility to a1tively engage in a1:uiring
support fro/ relatives, friends, neig+-ors, and e4tended fa/ily (e.g., s+aring our
diffi1ulties 'it+ relative.
!efraing assesses t+e fa/ily5s 1apa-ility to redefine stressful events in order
to /a@e t+e/ /ore /anagea-le (e.g., @no'ing t+at 'e +ave t+e strengt+ 'it+in
our fa/ily to solve our pro-le/s.
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See/ing spiritual support is finding 1o/fort in a +ig+er -elief syste/ (e.g.,
parti1ipating in religious or spiritual a1tivities.
Mobili0ing faily to ac.uire and accept help is t+e fa/ily5s a-ility to see@
out 1o//unity resour1es and a11ept +elp fro/ ot+ers (e.g., see@ing assistan1e
fro/ 1o//unity agen1ies and progra/s designed to +elp fa/ilies in situation.
1assive appraisal is t+e fa/ily5s a-ility to a11ept pro-le/ati1 issues t+at
/ini/i9es rea1tivity (e.g., -elieving if 'e 'ait long enoug+, t+e pro-le/ 'ill go
a'ay.
4.6 Methods:
7ffi1ial per/ission to 1ondu1t t+e study 'as ta@en fro/ t+e +ospitals
responsi-le aut+orities after e4planation of t+e ai/s of t+e study.
Self#ad/inistered stru1tured :uestionnaire s+eet 'as developed -y resear1+er.
2a/ily Crisis 7riented )ersonal Evaluation S1ale (2#C7)ES, 'as translated
into .ra-i1 -y resear1+er.
. ;ury of % e4perts in t+e field of nursing 'as done to as1ertain t+e 1ontent
validity of t+e tool, ne1essary /odifi1ations 'ere 1arried out a11ordingly.
. pilot study 'as 1arried out on 10 /ot+ers +aving 1+ildren 'it+ spe1ial needs
to ensure t+e 1larity and appli1a-ility of t+e tools.
2a/ily Crisis 7riented )ersonal Evaluation S1ale (2#C7)ES, 'as tested for its
relia-ility. 8est and retest relia-ility 'as 1o/puted using a s/all sa/ple of
/ot+ers +aving 1+ildren 'it+ spe1ial needs (10 and it 'as satisfa1tory for
resear1+ purposes (r L 0.A0.
Data 'as 1olle1ted during a1tual visits to t+e previously /entioned setting. .
self#report :uestionnaire ta@es 1%#20 /inute to -e 1o/pleted. 8+e resear1+er
ta@e ver-al 1onsent fro/ t+e parti1ipants after e4planation of t+e purpose of t+e
study.
%. !esults
2re:uen1ies and per1entages of t+e de/ograp+i1 varia-les 'ill -e presented.
Des1riptive statisti1s 'ill -e reported on ea1+ of t+e five su-s1ales, as 'ell as
t+e results of t+e open#ended :uestion. In addition, t+is se1tion 'ill also dis1uss
any signifi1an1e found -et'een de/ograp+i1 varia-les and 1oping strategies .
8a-le 1 s+o's t+at, /ore t+an one t+ird ($1.%> of studied /ot+ers ,t+eir age
'ere /ore t+an forty years and t+e +ig+est per1ent (=&.A> of t+e/ +ad /iddle
level of edu1ation. In relation to /arital status, t+e /a;ority(A1.1%> of studied
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/ot+ers 'ere /arried. Con1erning nu/-er of 1+ildren , /ore t+an t'o t+irds
(!".%> of /ot+ers +ad four or /ore 1+ildren and (%.%> of t+e/ +ad one 1+ild.
In relation to -irt+ order of t+e 1+ild 'it+ spe1ial needs, t+e ran@ing of (=0.=>
of t+e/ 'ere t+e fourt+ or /ore . .s regards t+e se4 of t+e 1+ild 'it+ spe1ial
needs, /ore t+an +alf of t+e/ (%1.=> 'ere /ale. Fegarding /ont+ly in1o/e,
/ore t+an +alf (%2.&> of studied /ot+ers , t+eir in1o/e 'ere suffi1ient '+ile
t+e in1o/e of ( =&.$> 'ere not suffi1ient.
8a-le 2 indi1ates t+at , =0.=> of studied /ot+ers, t+e nature of t+eir 1+ildren
disa-ility 'ere 1ognitive disa-ility (/ainly Do'n6s syndro/e '+ile (2.1> of
t+e/ +ad psy1+ologi1al disa-ility. In addition, ($2.2> of t+e/ +ad p+ysi1al
disa-ility and t+e rest (2%.$> of t+e/ +ad -ot+ p+ysi1al and 1ognitive disa-ility.
8a-le $, it is o-served fro/ t+is ta-le t+at, t+e /ost 1oping strategies used -y
/ot+ers 'as a1:uiring so1ial support follo'ed -y refra/ing.
8a-le = s+o's t+at, t+e /ost of /ot+ers (=$.2> using /ore t+an one 'ay in
1oping 'it+ t+e 1+ild6s disa-ility follo'ed -y see@ing spiritual support (1=.=>
and t+e least 'ay 'as see@ing +elp and support fro/ t+eir friends (0.&>.
8a-le % 1larifies t+at, t+ere is signifi1an1e relations+ip -et'een age and
refra/ing and passive appraisal, as 'ell as -et'een -irt+ order and /o-ili9ing
fa/ily to a1:uire and a11ept +elp. 0oreover, t+ere is signifi1an1e relations+ip
-et'een in1o/e and refra/ing and /o-ili9ing fa/ily to a1:uire and a11ept +elp.
0ean'+ile, t+ere is no signifi1an1e relations+ip -et'een /arital status, level of
edu1ation, nu/-er of 1+ildren, se4 of t+e 1+ild and five su-s1ales of 1oping
strategies.
2. -iscussion
B+en one -e1o/es a parent it is al'ays ne1essary to ad;ust to a ne' 'ay of life
and all parents 'is+ for a +ealt+y -a-y, -ut so/e parents t+oug+ not -y
t+eir 1+oi1e are gifted 'it+ 1+ild 'it+ spe1ial needs. So/e are a-le to 1ope up
'it+ su1+ a situation and so/e e4perien1e psy1+ologi1al stress. )arenting t+ose
1+ild is not an easy tas@. <aving a 1+ild 'it+ spe1ial needs pla1es strain on t+e
'+ole fa/ily (Nissel ?et al ,200$. )arents +aving a 1+ild 'it+ spe1ial needs
e4perien1e a variety of Mpsy1+ologi1al stress5 related to t+e 1+ild5s disa-ility.
)arents espe1ially /ot+ers need every +elp and en1ourage/ent possi-le in t+eir
diffi1ult tas@, '+i1+ is, indeed, easier for t+e/ '+ile t+e 1+ild is still a -a-y. .n
an4ious love, on t+e part of t+e /ot+er, /ay do /u1+ to e4a1er-ate t+e
defe1tive5s disa-ility (Gu/ar,200".
2ollo'ing t+e diagnosis of a 1+roni1 +ealt+ 1ondition in a 1+ild, 1+anges o11ur
in t+e fa/ily6s day to day routines, plans for t+e future, feelings and /eaning
a-out self ( Guster ? et al , 200=. 8+e 1+ild 'it+ spe1ial needs and +is or +er
fa/ily are -ot+ affe1ted -y t+e 1+ild6s 1ondition and 'ay of living. Ea1+
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/e/-er of t+e fa/ily e4perien1es effe1ts related to t+e 1+ild6s spe1ial needs.
2a/ily /e/-ers6 e4perien1es and t+eir responses to t+e 1+ild6s illness influen1e
ea1+ ot+er dire1tly (Gyle,200". 0ot+ers '+o +ave 1+ildren 'it+ spe1ial needs
report +ig+er a/ounts of stress 1o/pared to /ot+ers '+o do not +ave 1+ildren
'it+ spe1ial needs. . /ot+er5s a-ility to adapt to stressful situations depends
upon a nu/-er of varia-les, in1luding an individual5s psy1+ologi1al strengt+s,
individual and fa/ily resour1es, and t+e type of 1oping strategies utili9ed
(.+/ann,200!.8+e ai/s of t+is study 'ere to identify t+e 1oping strategies of
/ot+ers '+o +ave 1+ildren 'it+ spe1ial needs and deter/ine '+et+er t+ere is a
relations+ip -et'een t+e 1oping strategies and t+e /ot+ers5 de/ograp+i1
varia-les.
In relation to 1+ara1teristi1s of t+e studied /ot+ers, t+e findings of t+e present
study s+o'ed t+at, /ore t+an t'o t+irds (!$.&> of studied /ot+ers ,t+eir age
'ere /ore t+an t+irty years and /ore t+an t'o t+irds (!".%> of /ot+ers +ad
four or /ore 1+ildren, t+e ran@ing of (=0.= > of t+e 1+ild 'it+ spe1ial needs
'ere t+e fourt+ or /ore. In addition, (=0.=> of studied /ot+ers, t+e nature of
t+eir 1+ildren disa-ility 'ere 1ognitive disa-ility (/ainly Do'n6s
syndro/e.8+ese results supported -y Nia9i ?et al,(1AA% '+o 1ondu1ted a
study in Fiyad+ to deter/ine t+e in1iden1e and distri-ution of Do'n5s
syndro/e -irt+s during a A#year period fro/ July 1A"2 to June 1AA1, found t+at
an in1iden1e of Do'n5s syndro/e 'as 1 in %%= live -irt+s (1." per 1,000. .
trend to'ards an in1reased in1iden1e of Do'n5s syndro/e 'it+ advan1ed
/aternal age or in1reased /aternal parity 'as found. Si/ilarly, t+is result is in
agree/ent 'it+ 2aud,(200! '+o stated t+at, Do'n syndro/e (DS is a 1o//on
disorder t+at o11urs in appro4i/ately 1K!00 ne'-ornsH +o'ever, t+is in1iden1e
greatly in1reases a/ong 1+ildren -orn to /ot+ers over $% years of age. .ffe1ted
1+ildren al/ost al'ays +ave /ental retardation . 0oreover, Fiper, (200& '+o
reported t+at Do'n syndro/e is t+e /ost 1o//on 1+ro/oso/al 1ause of
intelle1tual disa-ilities and t+e in1iden1e of it re/ains steady, o11urring on1e in
every "00J 1,000 live -irt+s.
.s regarding level of edu1ation, t+e results of t+e present study revealed t+at,
t+e /a;ority of t+e /ot+er ( &1.2> 'ere edu1ated .No signifi1an1e 'as found
regarding /ot+er6s 1oping strategies and t+eir level of edu1ation. 8+ese results
are 1ontradi1ted 'it+ Gu/ar, (200" '+o stated t+at, /ot+ers 'it+ +ig+er
edu1ational status +ad lo' psy1+ologi1al stress and +ig+ 1oping strategy s1ores.
0ost of t+e /ot+ers '+o are edu1ated see@ professional +elp for 1oping.
Edu1ated /ot+ers are also a-le to provide appropriate and ti/ely treat/ent for
various pro-le/s of t+e 1+ild. 8+e /ot+ers 'ere a'are of attending se/inars
and 'or@s+ops to en+an1e t+eir 1oping strategies and to deal 'it+ t+e pro-le/s
of t+e 1+ild su11essfully. 2urt+er, t+e edu1ated /ot+ers are /ore e4posed to t+e
prevailing fa1ilities t+at 'ill i/prove t+eir 1+ild5s 1ondition and en+an1e t+e
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strategies t+at t+ey 1an adopt to 1ope effe1tively 'it+ t+e psy1+ologi1al stress
and t+ey +ave fre:uent 1onta1ts 'it+ t+e e4perts and professionals.
2urt+er/ore, /ore t+an +alf of /ot+ers( %2.&>> '+o +ad suffi1ient in1o/e
<o'ever, a signifi1ant relations+ip 'as found -et'een fa/ily in1o/e and
refra/ing as 'ell as fa/ily in1o/e and see@ing spiritual support and /o-ili9ing
fa/ily to a1:uire and a11ept +elp . 0ot+ers '+o +ad a +ig+er in1o/e utili9ed
refra/ing and see@ing spiritual support 1oping strategies to a greater e4tent t+an
t+ose '+o +ad insuffi1ient in1o/e. 7ne possi-le reason for t+is /ay -e t+at
/ot+ers '+o +ave a +ig+er in1o/e /ay also +ave /ore resour1es availa-le to
t+e/, '+i1+ +elps /a@e t+e situation less stressful.
In t+e open#ended :uestion, /ot+ers +ad listed a variety of +elpful 1oping
strategies. 8+e results found t+at t+e /a;ority of /ot+ers (=$.2> listed t+at
using /ore t+an one 1oping /et+ods is /ore -enefi1ial in dealing 'it+ t+eir
1+ildren6s disa-ility. 8+is result supported -y (arentt,et al,(200$ '+o stated t+at
+aving a 'ide variety of strategies is /ore +elpful t+an +aving only one or t'o.
8+e results of t+e 1urrent study revealed t+at, t+e /ost 1oping strategies used -y
/ot+ers 'as a1:uiring so1ial support follo'ed -y refra/ing. 8+is finding is
1ongruent 'it+ 8otis@a ? et al , (2011 '+o reported t+at '+en 1aregivers are
supported, t+ey are -etter a-le to 1ope 'it+ t+e 1+allenges of providing 1are for
a 1+ild 'it+ spe1ial needs. In addition, t+is result is agree/ent 'it+
)rit9laff,(2001 '+o 1ondu1ted a study to e4a/ine t+e 1oping strategies of t+e
parents '+o +ave 1+ildren 'it+ disa-ilities, found t+at, t+e t'o /ost fre:uently
utili9ed 1oping strategies 'ere a1:uiring so1ial support and refra/ing. See@ing
spiritual support 'as t+e least utili9ed. 8+is result is not 1orrespondent 'it+
.yrault, (2001 '+o stated that so/e /ot+ers avoid t+eir relatives and friends,
fearing t+at t+ey /ay not understand t+eir 1+ildren5s needs and spend /u1+ of
t+eir ti/e 1aring for t+eir 1+ildren, ta@ing t+e/ for assess/ent, t+erapy or
/edi1al treat/ent . .s a result, t+eir so1ial life is interrupted and t+eir :uality of
life in t+is do/ain de1reases. Si/ilarly, t+is is 1onfir/ed -y ,i#8sang ?
,eung ,(200$ '+o reported t+at '+ile it ta@es ti/e for /ot+ers to a11ept t+eir
1+ildren, as t+e 1+ildren gro', /ot+ers /ig+t feel pressure fro/ so1iety,
espe1ially on t+e o11asions '+en t+eir 1+ildren e4+i-it unpredi1ta-le
/is-e+avior in pu-li1, su1+ as s1rea/ing. In order to avoid t+ese
e/-arrass/ents, /ot+ers so/eti/es refrain fro/ so1ial a1tivities. 8+us, t+ey
li/it t+eir so1ial net'or@s. 0oreover, t+is result 'as supported 'it+ C+ur1+ill ?
et al,(2010 '+o 1ondu1ted a study on12A parents of 1+ildren 'it+ spe1ial +ealt+
1are needs (CS<CN to des1ri-e and :uantify 1oping s@ills and prevalen1e of
depressive sy/pto/s in t+ose parents and des1ri-e t+e asso1iation of 1oping
s@ills 'it+ parental depressive sy/pto/s, severity of 1+ild5s 1ondition and
fa/ily de/ograp+i1 1+ara1teristi1s, t+ey found t+at ,t+e /ost 1oping strategy
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used -y parents 'as refra/ing follo'ed -y a1:uiring so1ial support and t+e least
one 'as see@ing spiritual support.
In general, parents of 1+ildren 'it+ disa-ilities are /ore 'it+dra'n fro/ so1iety.
<o'ever, previous reports +ave o-served t+at so/e parents a1tively parti1ipate
in parental self#+elp support groups. 8+ese parents tend to -e edu1ated, 'it+
+ig+er intelle1tual fun1tion, sta-le fa/ily -a1@grounds, no finan1ial diffi1ulties,
outgoing, 1onfident, effi1ient, and /otivated. )arents5 attitudes, rat+er t+an t+eir
1+ildren5s level of disa-ilities, see/ to -e t+e /ain deter/inant for a1tive so1ial
parti1ipation (.t@in, 2000H ,i#8sang, Nau ? Nuen, 2001.
&. Conclusion
8+e present study 1on1luded t+at, t+e /ost of /ot+ers reported t+at , using /ore
t+an one 1oping /et+ods is /ore -enefi1ial in dealing 'it+ t+eir 1+ildren 'it+
spe1ial needs. 8+e /ost used 1oping strategies 'as a1:uiring so1ial support
follo'ed -y refra/ing. 2urt+er/ore, t+ere is signifi1an1e relations+ip -et'een
age and -ot+ refra/ing and passive appraisal, as 'ell as -et'een -irt+ order and
/o-ili9ing fa/ily to a1:uire and a11ept +elp. 0oreover, t+ere is signifi1an1e
relations+ip -et'een in1o/e and -ot+ refra/ing and /o-ili9ing fa/ily to
a1:uire and a11ept +elp. 0ean'+ile, t+ere is no signifi1an1e relations+ip
-et'een /arital status, level of edu1ation, nu/-er of 1+ildren, se4 of t+e 1+ild
and five su-s1ales of 1oping strategies.
". !ecoendations
2uture resear1+ s+ould -e done on larger populations .
.dditional resear1+ /ig+t address t+e 1oping strategies of ot+er fa/ily /e/-ers,
su1+ as si-lings and t+e e4tended fa/ily.
E4a/ining parental 1oping strategies at different stages of develop/ent.

2urt+er resear1+ s+ould fo1us on 1o/parative study -et'een 1oping strategies
used -y /ot+ers versus t+ose used -y fat+ers.

)ersonal intervie's 1ould -e 1ondu1ted to avoid su-;e1tivity.

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Ventilator#.ssisted C+ildren. Journal of )ediatri1 Nursing, 1A( = K2&!#2"&.
Note
8a-le 1K )er1entage distri-ution of /ot+ers a11ording to t+eir 1+ara1teristi1s.
Demographic variables Frequency Percent
Age
# ,ess t+an 20 years
2$ 1%."
# 2ro/ 20 years to 2= years 11 &.%
# 2ro/ 2% years to 2A years 1A 1$.0
# 2ro/ $0 years to $= years 2= 1!.=
# 2ro/ $% years to $A years 2$ 1%."
# 0ore t+an =0 years =! $1.%
O T SD =.0$ T 1."1
Marital status
# 0arried
1$$ A1.1
# Divor1ed ! =.1
# Bido' & =."
)evel of education
# Illiterate
=2 2"."
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# 0iddle level of edu1ation &0 =&.A
# <ig+ level of edu1ation $= 2$.$
Nuber of children
# 7ne
" %.%
# 8'o 20 1$.&
# 8+ree 1" 12.$
# 2our or /ore 100 !".%
%irth order of the child with special
needs
# 2irst
$= 2$.$
# Se1ond $= 2$.$
# 8+ird 1A 1$.0
# 2ourt+ or /ore %A =0.=
Se3 of the child with special needs
# 0ale
&1 =".!
# 2e/ale &% %1.=
Incoe
# E4tre/ely not suffi1ient
2A 1A.A
# Not suffi1ient =0 2&.=
# Suffi1ient !! =%.2
# E4tre/ely suffi1ient 11 &.%
4otal 1=! 100.0
8a-le 2K )er1entage distri-ution of type of spe1ial needs.
Type of disability Frequency Percent
# )+ysi1al =& $2.2
# Cognitive %A =0.=
# )sy1+ologi1al or e/otional $ 2.1
# Co/-ination $& 2%.$
8otal 1=! 100.0

8a-le $ K Des1riptive statisti1s of five su-s1ales of 1oping strategies.

Five subscales of coping
strategies

Mean

Std.
Deviation

Maximum

Minimum

# .1:uiring so1ial
support
$$.0 A.=
"%.00 1%.00
# Fefra/ing
$0.% !.1
=0.00 12.00
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# See@ing spiritual
support
1!.A $.0
20.00 %.00
# 0o-ili9ing fa/ily to
a1:uire and a11ept
+elp
1%." $.!
20.00 &.00
# )assive appraisal
12.$ $.2
20.00 =.00

8a-le =K )er1entage distri-ution of t+e /ost -enefi1ial 'ay in 1oping 'it+ t+e
1+ild6s disa-ility (open end :uestion .
Items Frequency Percent
# See@ing spiritual support 21 1=.=
# 0aintaining a positive attitude A !.2
# See@ing +elp and support fro/
fa/ily
1! 11.0
# See@ing +elp and support fro/
friends
1 0.&
# )rofessionals support 1& 11.!
# .1:uiring additional infor/ation % $.=
# Co//unity resour1es 1= A.!
# 7t+ers ( /ore t+an one 'ay !$ =$.2
8otal 1=! 100.0

8a-le (% Felations+ip -et'een de/ograp+i1 1+ara1teristi1s and five su-s1ales
of 1oping strategies

C+ara1teristi1s
.1:uiring
so1ial
support
Fefra/ing See@ing
spiritual
support
0o-ili9ing
fa/ily to
a1:uire and
a11ept +elp
)assive
appraisal
# .ge #.0%$
.%22
1!=(U
0="
.1%%
.0!2
#.0%%
.%10
.1"2(U
02"
# 0arital
status
1=!
#.1$%
1=!
#.1%%
.0$"
!=&
#.0%2
.%$%
.010
.A0%
# ,evel of
edu1ation
#.02"
.&$&
.1%%
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** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).