British Journal of

Learning Disabilities
The Official Journal of the British Institute of Learning Disabilities

ORIGINAL ARTICLE

Supporting parents:
development of a tool to
measure self-efficacy of
parents with learning
disabilities
Linda Bloomfield and Sally Kendall, Centre for Research in Primary and Community Care,
University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK (E-mail: l.j.bloomfield@herts.ac.uk) and
Sandra Fortuna, CHT (LD) Psychological Therapies, St. Peters House, 2 Brickett Rd, St. Albans,
AL1 3JW, UK

Accessible summary • Many parents with learning disabilities have their children removed and put into
care.
• Parents with learning disabilities often need support to manage their children and
to be good parents.
• This article is about how we worked with parents to find a way of seeing whether
the support given to them is helpful.
• If parenting support is seen to be helpful, more funding may be available for
future support.

Summary There has been a steady increase over the last 20 years in the number of parents with
learning disabilities who are referred to social workers and community health
practitioners. It is a common experience for parents with learning disabilities to have
their child removed from the home and placed permanently in care, and although
they are often judged as inadequate parents, it is known that they can be good
enough parents when provided with parenting support. This article reports the
development of a tool to measure the self-efficacy of parents with learning
disabilities, which will help to evaluate parenting initiatives specifically aimed at
this parent group. A tool to measure parenting self-efficacy (TOPSE) has been
adapted to be accessible to parents with learning disabilities. Eighteen parents took
part in the study to complete and comment on the tool with the help of a researcher
from the community learning disabilities team. This tool, which consists of 45 self-
efficacy statements, now needs to be tested on a larger sample of parents with
learning disabilities.

Keywords Learning disabilities, parenting, self-efficacy, tool development

ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309 doi:10.1111/j.1468-3156.2009.00607.x
304 L. Bloomfield et al.
Background
It is difficult to accurately assess the number of parents with
learning disabilities in the United Kingdom partly because
of a lack of common definitions, poor records and the
invisibility of many parents to official agencies; however,
the number of referrals of these parents to social workers
and community health practitioners has steadily increased
over the last 20 years and is rising (Booth et al. 2005,
Department of Health, 2001). McGaw has suggested that
around 250 000 parents with learning disabilities are known
to health and social services (McGaw 1997), and more recent
figures from the first national survey of adults with learning
disabilities in the United Kingdom found that 1 in 15 of the
2898 adults interviewed had children (Emerson et al. 2005).
Many parents are identified to services only if they are in
a crisis, while those who are coping with parenthood may
remain unknown to the professional services (Woodhouse
et al. 2001). An internationally consistent pattern would
seem to be that without additional support, parents with
learning disabilities have difficulty looking after their
children and that two of every five children are removed
from the family home (Booth et al. 2005). Parents with
learning disabilities appear to be over-represented in care
proceedings and are significantly more likely to have their
children placed permanently into care than any other group
(Booth et al. 2005).
When children are removed from the care of their parents,
there are usually additional difficulties, such as mental
health and/or physical health problems, domestic violence,
substance abuse, isolation from family and friends, poverty
and inadequate housing (Brophy 2006; Cleaver & Nicholson
2007) Parental level of intellectual ability by itself is not
correlated with deliberate abuse of children (Tymchuk 1992)
or with risk of child protection concerns (Department of
Health & Department for Education and Skills, 2007). Most
concerns about children’s welfare where parents have
learning disabilities relate to neglect or emotional abuse.
This neglect occurs because of lack of education coupled
with unavailability of supportive services (Cleaver & Nich-
olson 2007). Furthermore, McGaw et al. (Department of
Health & Department for Education and Skills, 2007) found
that high risk of child protection concerns are related to
factors such as parental childhood trauma, parents’ physical
disability, having a child with special educational needs and
also having a partner with a higher IQ, associated with
higher risk of harm or care proceedings. Protective factors
include having access to adequate resources and support
and appropriate parenting models in the parents’ own
childhood (Tymchuk 1992; Woodhouse et al. 2001).
Traditionally, the views and experiences of parents with
learning disabilities have not been sought, despite concerns
about their parenting abilities (Tarleton & Ward 2007).
While it is a common experience for parents who have
ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309
learning disabilities to be judged as inadequate (McConnell
et al. 2002), it is known that these parents are ‘good enough
parents’ especially when given enough support (Murphy &
Feldman 2002; Swain & Cameron 2003). National policy in
England is committed to supporting parents with learning
disabilities to ensure their children gain maximum life
chance benefits wherever possible (Department of Health,
2001) and states that ‘people with learning disabilities have
the choice to have relationships, become parents and
continue to be parents, and are supported to do so’ (p.90).
The task of being a parent is often a stressful and
difficult one and may be more so for parents with learning
disabilities who have restricted social networks. Addi-
tional parenting difficulties may contribute to perceptions
of low self-efficacy in managing their children. A large
proportion of these parents do not have access to adequate
rearing models or opportunity to establish secure attach-
ments. Many parents have themselves been looked after by
local authorities, a factor known to affect the quality of
parent–child interactions (Cotson et al. 2001). Frequent
histories of trauma, abuse or neglect (McGaw & Sturmey
1994; Sinason 1992) and a lack of support networks and
socio-economic difficulties may also contribute to percep-
tions of low self-efficacy (McGaw 1996; McGaw & Sturmey
1994).
One way of improving the outcome for these parents is to
help them build positive social networks and to encourage
them to learn parenting skills through group and individual
parenting programmes (Murphy & Feldman 2002). While
parenting support appears to safeguard children and
enhance the quality of family life (Tarleton & Ward 2007),
education for parents with learning disabilities is generally
enacted only where parenting difficulties have been noted.
Systematic parenting training for all parents and prospec-
tive parents would help to reduce the impact of parenting
inadequacies on children (Sheerin 1998). Parenting pro-
grammes provide opportunities for parents to raise their
expectations as a result of mastering positive behaviours, by
observing other parents’ success and through encourage-
ment and role modelling from programme facilitators and
other parents.
Despite the fact that parents with learning disabilities
take part in parenting programmes, there is a paucity of
tools to measure outcomes, and we have found none for
completion by parents themselves. TOPSE, a tool to
measure parenting self-efficacy, is currently used to eval-
uate the effectiveness of a range of parenting programmes
and has demonstrated an increase in parenting self-efficacy
following participation in a programme (Bloomfield &
Kendall 2007). TOPSE was developed using a self-efficacy
framework (Bandura 1982, 1989) that grounded the study
theoretically, thus enabling further development and
refinement within this construct (Kendall & Bloomfield
2005). Self-efficacy, derived from social learning theory

(Bandura 1982, 1989), refers to a perception of a person’s
ability to perform competently and effectively in a partic-
ular task or setting and that the behaviour will lead to a
desired outcome. It is known that self-efficacy beliefs are
amongst the best predictors of success and performance in
many contexts (Haidt & Robin 1999). Sources of self-
efficacy include a person’s experiences of successes and
failures, vicarious experience and learning through role
modelling. In the domain of parenting support, practitio-
ners can implement and evaluate their practice through the
application of self-efficacy theory.
During the piloting of TOPSE, it was recognised that the
tool may not suitable for parents who have been identified
as having learning disabilities. Because of their intellectual
disability, these parents are limited in their ability to use
tools designed to evaluate mainstream parenting initiatives,
and the tool has not been validated for parents with low
literacy skills and comprehension difficulties. A revised
version of TOPSE specifically for use with parents who have
learning disabilities could provide some indications of these
parents’ perceived competence in their parenting role and
possible performance outcomes after attending a parenting
programme.
Aim
To adapt a tool to measure parenting self-efficacy for
parents who have learning disabilities, which will help to
evaluate parenting initiatives specifically aimed at this
parent group.
The study
Stage 1
A feasibility study to investigate whether a tool to measure
parenting self-efficacy (TOPSE) could be adapted for
parents with mild to moderate learning disabilities.
The multidisciplinary research team included a clinical
psychologist, speech and language therapist, health care
assistant and assistant psychologist, all working in the field
of learning disabilities, a professor of nursing, health visitor,
manager of a family support centre and a health psychol-
ogist/research fellow. A parent with mild learning disabil-
ities was also included on the research team.
Participants
Parents who were on the learning disability register in
Hertfordshire and had been identified as having mild to
moderate learning disabilities were potential participants.
Parents with at least one child under the age of ten and
whose first language was English met the inclusion
criteria. Families involved in child protection issues were
ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309
Self-efficacy of parents with learning disabilities 305
excluded from the study. Ethics approval was obtained
from Hertfordshire Research Ethics Committee. A major
concern was how to obtain informed consent and how to
provide study information in a way that was accessible to
the participants.
Methods
Consent was obtained in three ways:
1. Parents were identified as potential participants
through social workers and community nurses working
in the Community Learning Disability Teams (CLDTs). The
community nurse or social worker had a preliminary
conversation with the parent to ask whether they might
like to participate in the study to develop a questionnaire
around parenting. It was explained that parent participa-
tion would be to answer a questionnaire with the help of a
research assistant who was a health care worker in the
CLDTs.
2. The research assistant made contact with consenting
parents to arrange to meet with the parent either in their
home or at the CLDT. The purpose of this meeting was to
fully explain the study, to give the parent a study informa-
tion sheet and consent form and to agree a time for an
interview to take place 1–2 weeks later. Parents were asked
to think about whether they would like to take part and
provided with contact details of members of the research
team if they had any concerns or wished to ask for further
information. Written consent would be sought on the day of
the interview, and parents were reassured that they could
withdraw at any time.
3. On the day of the interview, the research assistant
explained the purpose of the study again and allowed
plenty of time for questions about the parent’s involvement.
It was clearly stated that the information provided while
answering the questionnaire would not be used to assess the
parent in any way. Signed informed consent was obtained
by the research assistant before the interview.
The consent form and the information sheet were written
in accessible language to allow the participants to reread
them at any time. Flesch–Kincaid readability statistics
indicated a reading age of 6.2 for these documents. A
pictorial version was produced for parents, who were
unable to read, using Widgit symbols, recommended by the
British Institute for Learning Disabilities (BILD).
Particular consideration was given to participants
understanding their right to withdraw from the study at
any time and that their informed consent was given. It
was understood that a parent with learning disabilities
may be less confident to say ‘no’ to participation, also the
limitations of confidentiality in cases of disclosures that
have to be acted upon, and these issues were addressed
both in the written information sheet and verbally by the
researcher.
306 L. Bloomfield et al.
Using the scale below, please enter in the boxes how much you agree with each
statement. The scale ranges from 0 (I completely disagree) to 10 (I completely agree).
You may use any number between 0 and 10. Please answer all statements.
0 1 2 3 4 5 6 7 8 9
Completely Moderately agree Completely
disagree agree
* I am able to show affection towards my child.
* I can recognise when my child is happy or sad.
* I am confident my child can come to me if they’re unhappy.
* When my child is sad I understand why.
* I have a good relationship with my child.
* I find it hard to cuddle my child.
The interview
At the start of the interview, the research assistant again
discussed and assured confidentiality and the participant’s
right to withdraw from the study at any stage. She
explained that the parent was not being assessed in any
way and that there were no right or wrong answers on the
questionnaire. The researcher had been provided with
training on how to complete the observation questionnaire.
Parents completed TOPSE with as much help from the
researcher as needed. TOPSE comprises 48 statements, six
statements in each of eight scales (Fig. 1). Each scale
addresses a different dimension of parenting. For each scale
on the questionnaire, the researcher read out the six
statements and asked the participant to say how much they
agreed with each statement. She explained or rephrased any
statements where needed, constantly seeking understand-
ing from the participant. On completion of all six statements
of a scale, the researcher recorded her observations on a
standard questionnaire, which addressed how much help
was needed, time taken to complete each statement, appro-
priateness of content and whether the participant seemed
offended or unwilling to respond to any statements.
Before moving onto the next scale, the researcher checked
that the participant wished to continue and reinforced that
there were no correct or wrong answers. At the end of the
interview, the researcher sought confirmation that the
participant consented for their questionnaire to be used in
Table 1 Mean number of statements requiring some or much help (n = 9)
Scale1 Scale2 Scale3
Help with reading 2.63 2.50 2.25
Help by prompting 2.13 1.38 1.13
Help by adapting 1.75 2.38 1.88
ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309
10
Figure 1 TOPSE: scale to measure emotion and
affection.
the study. She allowed time for participants to convey any
concerns or difficulties about the content or other aspects of
the questionnaire and recorded further observations and
parents’ comments about their perceived understanding
and difficulty experienced. The researcher understood that
parents may wish to appear competent to save face and
constantly conveyed reassurance that the questions may be
difficult to understand and that parents’ participation
would help the research team to modify the tool and make
it easier to complete.
Results
Nine parents completed TOPSE in the way described. Two
parents were fathers, and all were of White British ethnicity.
The length of time taken to complete the scales was
19–88 min (mean = 50). The analysis was based on the
researcher’s observations as to the amount of help needed to
complete the self-efficacy statements. How much help needed
for reading the statement, adapting the statement for under-
standing and prompting for a response were recorded on the
observation form as either none, some or much. The amount
of help needed on all three dimensions ranged considerably
amongst parents from no help on any statements to much
help on all statements within each section (Table 1).
The researcher recorded whether parents seemed unwill-
ing to respond to any statements and whether there were
any statements that seemed to offend the parent. There were
Scale4 Scale5 Scale6 Scale7 Scale8
2.25 3.50 3.88 1.71 3.14
1.88 3.38 4.38 1.71 4.00
2.13 4.13 4.88 1.14 4.43

no parents who seemed offended by, or unwilling to
respond to, any statements.
There was a tendency for parents to score higher than
parents in the general population who took part in the
research to test TOPSE (Bloomfield & Kendall 2007). The
median scores out of a possible 60 for each of the eight
scales were 59.5, 60, 60, 58, 60, 34.5, 59 and 57 compared to
53, 48, 43, 32, 36, 35, 45 and 51 baseline scores for the original
study, respectively.
Many statements were perceived to be confusing for some
parents, and there were several statements that were confus-
ing for almost all parents. In particular, negatively phrased
statements and those with unfamiliar wording caused the
most difficulty. Statements containing words such as ‘recog-
nise’, ‘confident’, ‘patiently’, ‘potential’, ‘boundaries’, ‘con-
flict’ and ‘reasoning’ were difficult for many parents to both
read and comprehend. Of concern to nearly all parents were
the statements such as ‘I am able to help my child reach their
full potential’ and ‘I am able to put myself in my child’s shoes’.
Further observation and parent feedback indicated that
the use of a numeric Likert scale was also confusing for
these parents, that sentences were often too long and that
the print size was too small.
The TOPSE scores together with a content analysis of
parent feedback and researcher’s recorded observations
were used to ascertain the feasibility of revising TOPSE for
parents with learning disabilities and to inform the
subsequent adaptation of the tool for this parent group.
Stage 2
Revising and testing the TOPSE
The feasibility study determined that TOPSE could be
revised and simplified to evaluate parenting interventions
with parents who have learning disabilities. Using evidence
from the feasibility study and parent feedback, a simplified
version of TOPSE was developed to be accessible to parents
with learning disabilities.
Tool development
The research team met regularly to discuss revisions and
were guided by the speech and language therapist and
recommendations from Makaton (makaton.org). While
every effort was made to retain the meaning of the original
statement, it was recognised that for some statements this
was limited, and a ‘best fit’ was agreed, e.g. ‘understanding
how my child feels’ does not precisely reflect ‘putting
myself in my child’ shoes’.
Statements were rephrased for clarity and understanding.
The language used has been simplified, and most state-
ments begin with ‘I know’ or ‘I can’. Statements that were
found to be difficult to comprehend possibly because of
ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309
Self-efficacy of parents with learning disabilities 307
their abstract content have been reworded and shortened to
reflect a more concrete meaning, and all negative statements
have been rephrased as positive statements. The presenta-
tion of the questionnaire has been simplified including the
use of a five-point rating scale with faces to denote
agreement to replace the 10-point Likert scale.
Statements beginning ‘I am able’ now begin ‘I can’:
I am able to show affection towards my child (original
statement)
I can show my child I love them (revised statement)
Simplifying the wording
I am able to help my child reach their full potential (original
statement)
I can help my child do the best they can (revised statement)
Changing an abstract concept into a concrete statement
I am able to put myself in my child’s shoes (original
statement)
I can understand how my child feels (revised statement)
Changing the order of words so that ‘I’ is the subject
Playing with my child comes easily to me (original
statement)
I find it easy to play with my child (revised statement)
The revised parenting self-efficacy tool is shown (Fig. 2).
Testing the revised tool
Participants. As for the feasibility stage, parents who were
on the learning disability register in Hertfordshire and had
been identified as having mild to moderate learning
disabilities were potential participants. The same inclusion
criteria were applied, and similar rigorous methods of
recruiting and obtaining consent were used.
Parents completed the revised questionnaire with as
much help as needed from the research assistant, who
recorded her observations on the same standard question-
naire as in the feasibility study. The amount of help needed
with reading, adapting the statement and prompting for a
response were recorded on the observation form as before.
Results
Eleven parents completed the revised questionnaire. Two
parents took part in both stages of the study, while the
remainder were recruited for this second stage. Two parents
were fathers, and all were White British ethnicity.
The length of time taken to complete the scales was
between 5 and 36 min (mean = 17) compared with
308 L. Bloomfield et al.
19–88 min (mean = 50) to complete TOPSE. Less help was
needed than to complete TOPSE (Table 2). One parent
needed help reading every statement on all scales, and three
parents needed no help at all.
All statements seemed appropriate in terms of parenting
issues, and no parent was unwilling to respond to any of the
questions. As in the feasibility study, parents also tended to
score highly. The median scores out of a possible 30 for each
of the eight scales were 28, 28, 28, 28, 26, 28, 29 and 27.
One statement was confusing for five parents (45%) and
another for four parents (36%). Three statements were
confusing for three parents (27%). Further discussions
within the team concluded that these statements should be
removed as continued revisions would alter the meaning
beyond an acceptable level.
I can change so that my child behaves better (n = 5)
I can find new ways of looking after my child (n = 4)
I can see changes in my child as they grow up (n = 3)
I can decide what to do for myself without listening to other
people (n = 3)
I do not worry how other parents are doing (n = 3)
Discussion
The outcome of this study is a revised parenting self-efficacy
questionnaire for use with parents who have learning
Table 2 Mean number of statements requiring some or much help (n = 11)
Scale1 Scale2 Scale3
Help with reading 1.6 1.2 1.4
Help by prompting 0.3 0 0.2
Help by adapting 0.3 0.2 0.2
ª 2010 Blackwell Publishing Ltd, British Journal of Learning Disabilities, 38, 303–309
Figure 2 Revised tool: scale to measure emotion
and affection.
disabilities. This tool may have wider relevance also to
parents with low literacy skills. A tool to measure parenting
self-efficacy of parents with learning disabilities will
enable an evaluation of parenting initiatives with this group
of parents and will potentially increase resources for future
support.
It was noted that no parent during either stage of the
study used the Widgit symbol version of the information
sheet and consent form. This was an important observation
in terms of revising the TOPSE as we had considered
developing a symbol version if this had seemed appropri-
ate. As all parents who took part in this study had been
identified as having mild to moderate learning disabilities,
rather than severe learning disabilities, this may account
for a preference for written rather than symbolic informa-
tion.
Parents scored highly on both versions of TOPSE, and
these scores were higher than the baseline scores of parents
in the wider population (Bloomfield & Kendall 2007).
Discussions with professionals in the learning disability
field suggest that, in their experience, these parents may rate
themselves more highly if they want to show they are good
parents and are perhaps fearful that if they admit to
parenting difficulties their children may be taken into care
by local authorities. This is also supported by quotes from
parents in the ‘Good Practice Guidance on Working with
Parents with a Learning Disability’ (Department of Health &
Department for Education and Skills, 2007). This tendency
to rate themselves highly may limit the use of an evaluation
Scale4 Scale5 Scale6 Scale7 Scale8
1.6 1.3 1.6 1.0 1.1
0.1 0.1 0.9 0.2 0.6
0.3 0.4 0.3 0.2 0.9

tool with these parents. However, the study was concerned
with the revision of a tool rather than its use in practice
where parents will complete the tool before and following a
parenting intervention. Parenting interventions provide an
opportunity and environment for a trusting relationship
between parent and practitioner to develop, which may
facilitate parents to be less cautious in their responses.
A limitation of this study was that we were unable to
recruit sufficient parents to fully test the tool and to
generalise our findings. There were several factors that
contributed to the problems with recruitment. It was not
always easy to identify parents who were eligible to take
part as professionals may be reluctant or not have sufficient
skills to label parents as ‘learning disabled’ and parents are
often not known to Specialist Learning Disability Services
unless problems have been identified (Woodhouse et al.
2001). Parents who are known to these services very often
have children under child protection, and these parents
were not eligible to take part in the study. Examples from
practice from professionals in learning disability services
indicate that parents with learning disabilities can also be a
transient population especially when they have previous
experiences of child protection procedures.
Because of a personal history of care, stigma and perhaps
a difficult history of contact with professionals, some
parents may be wary of the research and not wish to be
identified. It is sometimes hard to provide reassurance of
confidentiality to these parents who because of intellectual
difficulties may not understand consent implications. Par-
ents may also have realistic concerns about confidentiality
and how their scores will be used because of their own and
others past negative experiences of professional practice
(Tarleton et al. 2006). Because of issues around the capacity
of these parents to give informed consent, we employed
rigorous recruitment and consenting procedures as des-
cribed in the method. There was also at times a need to
reassure professionals who perhaps felt protective towards
their clients as to how the research findings would be used.
Although we were unable to test the revised tool on a
large sample, it was developed from TOPSE that is a reliable
and validated tool. Further testing needs to be conducted to
make this tool widely available to practitioners working
with parents who have learning disabilities.
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