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Parental stress, coping strategies and social support in families of children

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Article in Child Care in Practice · October 2015

DOI: 10.1080/13575279.2015.1064357

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 Child Care in Practice

ISSN: 1357-5279 (Print) 1476-489X (Online) Journal homepage: http://www.tandfonline.com/loi/cccp20

Parental stress, coping strategies and social

support in families of children with a disability

Francesca Cuzzocrea, Anna Maria Murdaca, Sebastiano Costa, Pina Filippello

& Rosalba Larcan

To cite this article: Francesca Cuzzocrea, Anna Maria Murdaca, Sebastiano Costa,
Pina Filippello & Rosalba Larcan (2015): Parental stress, coping strategies and
social support in families of children with a disability, Child Care in Practice, DOI:
10.1080/13575279.2015.1064357

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 CHILD CARE IN PRACTICE, 2015
http://dx.doi.org/10.1080/13575279.2015.1064357

Parental stress, coping strategies and social support in

families of children with a disability
Francesca Cuzzocrea , Anna Maria Murdaca , Sebastiano Costa , Pina Filippello
and Rosalba Larcan
Department of Human and Social Sciences, University of Messina, Via Tommaso Cannizzaro, 278 Messina, Italy

ABSTRACT KEYWORDS
The aim of this research was to compare parental stress, coping Disability; parenting; services;
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strategies and social support perceived in families of children support systems; family
with low functioning autism (n = 8), high functioning autism
(n = 10), Down syndrome (n = 12) and parents of typically
developing children (n = 20). Specifically, the objective was to
investigate which variables (coping strategies and perception of
social support available) might better predict different stress
outcomes in the four groups. Parents were asked to fill in three
questionnaires: Parent Stress Index, Coping Orientation to
Problems Experienced and Social Support Questionnaire.
Significant differences among groups in all of the variables
considered were found. These results suggest the advisability of
fostering functional coping strategies and social support
received in families of children with disabilities, and especially in
those with children with low functioning autism.

Introduction
One of the most common models used to understand the parental situation when a child
is born with a disability is the ABC-X model (Hill, 1949). Although his ABC-X formu-
lation has been expanded (Boss, 2002; Burr et al., 1994; McCubbin & Patterson, 1981;
Patterson, 1988), it has withstood careful assessment and is still the basis for analysing
family stress and coping (Boss, 2002, 2006). The ABC-X formula, in fact, is the basis
of most family stress models, leading Hill to be called the father of family stress
theory (Boss, 2002). This model accounts for what parents experience and feel in stressful
situations, and also considers what people do to cope in these situations. In the model, A
is the stressor or stressful event, X is the outcome (or sometimes the crisis, when nega-
tive), and B and C are variables involved in the coping of the event. Specifically, B is the
support system available, either internally (e.g. knowledge or experience) or externally
(e.g. extended family or services). The perception of the event or the meaning the
family gives to the event or situation as they live with it is represented by C. The
main idea is that the X factor is influenced by several other moderating phenomena.
Stress or crisis is not seen as inherent in the event itself, but conceptually as a function
of the response of the disturbed family to the stressor (Boss, 2002, 2006; Burr, 1973; Hill,

CONTACT Francesca Cuzzocrea fcuzzocrea@unime.it

© 2015 The Child Care in Practice Group
 2 F. CUZZOCREA ET AL.

1949). This component highlights the importance of cognitive factors in stressful situ-
ations. According to this model, in families with a child with disability, parental stress
is related to the severity of the child’s impairments (Hastings, 2003). Parents of children
with autism experience higher levels of parental distress than parents of non-disabled
children (Hastings, Kovshoff, Brown, et al., 2005) and parents of children with other
disabilities (Cuzzocrea, Larcan, Baiocco, & Costa, 2011; Larcan & Cuzzocrea, 2011). In
particular, parents of children with autism not only report higher levels of stress but
are also at high risk of depression (Dunn, Burbine, Bowers, & Tantleff-Dunn, 2001).
They often feel incompetent as parents, are frustrated and tend to isolate themselves
(Dunn et al., 2001).
However, these outcomes are influenced by the other two components of Hill’s model
(B and C) that may be considered as risk or protective factors for parents of children with
disabilities. Greater stress levels seem to be associated with the use of dysfunctional
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coping styles, while stressful events may be perceived as less severe through effective
coping skills (Lazarus, 1996). Coping strategies can be divided into internal and external
(McCubbin & Patterson, 1981): internal coping strategies seem to be influenced by the
perception of the disability and by parents’ beliefs (Hastings, Kovshoff, Brown, et al.,
2005; Hastings, Kovshoff, Ward, et al., 2005). Gray (2006) has found that internal
coping strategies are increasingly used by parents of children with autism over time.
In fact, young parents seem to use more problem-focused coping strategies; while
older ones prefer emotion-focused coping activities (such as praying, expressing feelings,
etc.) (Gray, 2006). It is likely that when children grow up, parents’ hopes about their
recovery decrease and so the second kind of coping strategies becomes more frequent
(Lazarus, 1996; Gray, 2006).
The availability of social support, as an external strategy, is a very important poten-
tial resource for parents, especially those of children with intellectual disabilities. Several
studies indicate social support as a coping mechanism that may act as a buffer against
stress (Bailey, Wolfe, & Wolfe, 1994) and could be useful to improve parents’ compe-
tence in order to foster an adequate development of social skills (Cuzzocrea, Larcan,
Costa, & Gazzano, 2014; Larcan, Cuzzocrea, & Oliva, 2008). Several researchers have
analysed various dimensions of social support for such parents. For example, spousal
support and marital satisfaction are associated with lower stress levels in parents of
children with intellectual disabilities (Santamaria, Cuzzocrea, Gugliandolo, & Larcan,
2012). Other researchers have investigated the role of support that seems to help
parents to cope better with the stressful situations (Hastings, Thomas, & Delwiche,
2002).
The effects of professional support and services on parental stress are not clear due to
conflicting results: some studies have found that this kind of support is evaluated positively
by parents and is correlated with lower stress levels (Chan & Sigafoos, 2001). Other authors,
instead, highlight that professional support and services are sometimes unable to provide
for the individual and specific needs of each family and can therefore be experienced by
parents as an additional source of stress (Jones & Passey, 2004; White & Hastings, 2004).
In families of children with developmental disabilities, social support also has an
important influence on family functioning: in fact, some authors have found that
support from a spouse and friends is significantly associated with the level of satisfaction
with family functioning, with better personal and marital adaptation, and with life
 CHILD CARE IN PRACTICE 3

satisfaction (Higgins, Bailey, & Pearce, 2005). This strategy also seems to protect parents
from mental health issues (White & Hastings, 2004), and is inversely associated with
depression and anxiety (Gray, 2006).
The last component of Hill’s model (C) is related to cognitive factors and parental per-
ceptions. Many studies have also found that internal parental locus of control is associated
with reduced stress in families with a disabled child (Cuzzocrea, Larcan, & Westh, 2013).
In contrast, an external locus of control may increase parental distress. Specifically,
because of the unpredictability of such a disability, parents of children with autism may
experience a feeling of hopelessness and therefore become more sensitive to stressful
events (Dunn et al., 2001; Jones & Passey, 2004). The possibility of modifying cognitive
appraisal and negative beliefs may have consequences on stress and an unhealthy
reduction of emotion (Filippello, Harrington, Buzzai, Sorrenti, & Costa, 2014; Lazarus,
1996; Spada, Nikčević, Moneta, & Wells, 2008).
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Parental stress, coping strategies and social support in families of children with a dis-
ability is an important topic in light of the increased knowledge that parents with disabled
children have higher levels of stress (Davis & Carter 2008) and lower levels of social
support than parents of children with typical development (Glidden & Schoolcraft
2007). For this reason, we are interested in investigating the relationship between parental
stress, coping strategies and perceived social support in families with disabled and non-
disabled children. Differences in stress levels among parents of children with different
kinds of disabilities are expected from this research because, in accordance with the
ABC-X model, in families with a child with disability parental stress (X) is related to
the severity of the child’s impairments (A). The aim of the present research is to
compare coping strategies, levels of stress and social support perceived in parents of
children with low and high functioning autism and parents of children with Down syn-
drome. The same variables were also measured in parents of non-disabled children. In
particular, we wished to verify whether the presence of a disabled children and the kind
of disability could differently influence the parental stress, coping strategies and social
support perceived from parents. In fact, in accordance with the ABC-X model, the stressful
events (A; child disability) influence coping strategies and the social support perceived by
parents.
Specifically, the first research question was to verify whether there are significant
differences in the levels of stress, coping style and types of support used in four groups:
parents of children with high functioning autism; parents of children with low functioning
autism; parents of children with Down syndrome; and parents of typically developing
children.
The second research question was to investigate which variable (coping strategies and
source of support received) may better predict stress outcomes in the four groups. Specifi-
cally, the aim of this research question is to verify which coping strategies (control for
either coping strategy) is more predictive of parental stress and also is to verify which
type of support (control for either type of support) is more predictive of parental stress
A two-tailed test of probability was used. In according with the ABC-X model, in fact,
the X factor (parental stress) is influenced by the interaction of other variables (A, B,
C), and understanding the different predictors for each group could be useful to define
practical interventions.
 4 F. CUZZOCREA ET AL.

Methodology
Participants
The sample was made up of 50 couples with children with developmental disabilities. Our
convenience sample was recruited by contacting rehabilitation centres in Messina. The
mothers’ mean age was 40.1 years (standard deviation [SD] = 4.8) and the fathers’ was
43.8 (SD = 5.5). Their children included 22 females and 28 males: the average age was
7.82 years (SD = 3.33). To control for the effect of family structure, all of the parents
refer to the two biological parents of the children. This approach was used because recruit-
ing other family structures would have created sub-groups which were too small to be ana-
lysed. According to precedent diagnoses in hospital, participants were divided into groups:
20 parents (average age = 40.5; SD = 4.8) of children with high functioning autism, 16
parents (average age = 41.13; SD = 5.1) of children with low functioning autism and 24
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parents (average age = 43.7; SD = 6.2) of children with Down syndrome. Subsequently,
40 parents (average age = 41.9; SD = 5.4) of typically developing children were also
selected, matching to parents of disabled children according to their socio-economic
level. Socio-economic status was based on the education of the father and the mother.
Parent educational status is considered one of the most stable aspects of socio-economic
status because it is typically established at an early age and tends to remain the same over
time (Sirin, 2005). All of the disabled children had been involved in a rehabilitation pro-
gramme. All participants were volunteers. Seventy-five couples were contacted and 53
responded positively (response rate 71%); and three couples failed to complete the
entire questionnaire.

Instruments and procedure

After presenting the aim of the research to each couple, parents completed the submitted
questionnaires separately. The order was balanced within couples and within groups.
In order to investigate the level of parental stress, each parent completed the Italian
format of Parent Stress Index/SF (PSI-SF) (Guarino, Di Blasio, D’Alessio, Camisasca, &
Serantoni, 2007), a brief version of the Parenting Stress Index (PSI) (Abidin, 1995). The
PSI-SF is a self-report measure and consists of 36 items, from the original 120-item
PSI. Parents have to indicate their level of agreement about the statements on a five-
point scale. The PSI-SF includes three sub-scales. Parental Distress (12 items) investigates
the perception of parents about stress related to their role; and Parent–Child Dysfunc-
tional Interactions (12 items) investigates the perception of parental stress related to inter-
action with their children. The last scale analyses parental stress related to the children’s
difficulties (Difficult Child; 12 items). It can also be used to evaluate the total level of stress
perceived by the parents. High scores underline the high stress level perceived. The
reliability of the overall PSI-SF in this study is α = 0.91 and the reliability (Cronbach α)
of each sub-scale is good with a range from α = 0.76 to α = 0.90.
The coping strategies used by parents were evaluated by the Italian version of Coping
Orientation to Problems Experienced-NVI (COPE) questionnaire (Sica et al., 2008). It
consists of 60 items evaluated on a four-point scale: parents have to indicate how often
they use a specific coping strategy in stressful situations. The COPE focused on five strat-
egies: Social Support investigates the frequency of use of a quest for understanding, for
 CHILD CARE IN PRACTICE 5

information and emotional release; Avoidance Strategies is a heterogeneous scale that

includes denial, substance use and mental detachment; Positive Attitude is related to
acceptance and positive reinterpretation of events; Problem-solving investigates the use
of active strategies and planning; and, finally, Turning to Religion includes relying on reli-
gion and lack of humour. Higher scores indicate more frequent use of this coping strategy.
The reliability of all COPE sub-scales is good (range from α = 0.72 to α = 0.86).
The social support perceived by parents was evaluated by the Social Support Question-
naire (SSQ) (Sarason, Levine, Basham, & Sarason, 1983). This is a 27-item questionnaire:
each question describes everyday situations and consists of two parts—in the first, parents
were asked to list the persons (maximum nine individuals) who may give them support in
these situations; and in the second part they have to indicate how much they are satisfied
with the support received, on a six-point rating scale (from “very satisfied” to “very dissa-
tisfied”). A total number score (number of support persons) and a total satisfaction score
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may be calculated. However, in order to analyse the different sources of social support, the
number of familial (Support from Family), friends (Support from Friends) and other
persons (Support from others, e.g. institutions, employer, religious figures, etc.) indicated
by parents was calculated. The reliability of the total number score in this study is α = 0.97.

Results
Data analysis
The Statistical Package for Social Science was used to analyse the data. Non-parametric
statistics were used to compare scores obtained by parents on the PSI, COPE and SSQ.
To analyse possible differences among groups, the Kruskal–Wallis test (Kruskal &
Wallis, 1952), based on the χ2 statistic, and the Jonckheere–Terpstra test (Jonckheere,
1954) were used. In order to verify statistical differences between simple comparisons,
the Mann–Whitney U test (Mann & Whitney, 1947) was applied. The Wilcoxon signed
ranks test (Wilcoxon, 1945) is calculated to verify statistical differences in simple compari-
sons within the scales of each questionnaire.
Multiple regression analysis determined the extent of the relationship between potential
predictor variables (coping strategy and social support) and relevant dependent variables
(parental stress). To better compare the results, all data were transformed into sin–1
(Freeman & Tukey, 1950).

Differences between groups in parental stress

Table 1 presents the mean and SD of PSI, COPE and SSQ scores obtained by parents of
children with high and low functioning autism, with Down syndrome and with non-dis-
abled children.
Comparing parents’ results for the PSI questionnaire, the Kruskal–Wallis test and the
Jonckheere–Terpstra test showed significant differences between groups in parental total
stress and in all sub-scales (Table 1).
To verify statistical differences between groups, the Mann–Whitney U test was applied,
and the results are summarised in Table 2.
Parents of children with autistic spectrum disorder reported the highest levels of stress
compared with the other two groups of parents. Comparing parents of children with low
 6 F. CUZZOCREA ET AL.

Table 1. Means and standard deviation of parenting stress, coping and social support scores by
category of parents.
Parents of children with
Down Typically Jonckheere–
ASD – LF ASD – HF syndrome developing χ2 Terpstra test
Parenting stress PD 0.69 (0.23) 0.68 (0.13) 0.61 (0.21) 0.58 (0.10) 12.99*** –3.01**
P-CDI 0.72 (0.21) 0.69 (0.15) 0.59 (0.18) 0.54 (0.10) 20.29*** –4.15***
DC 0.84 (0.21) 0.78 (0.15) 0.61 (0.20) 0.62 (0.10) 30.83*** –4.44***
PSI-TOT 0.79 (0.22) 0.69 (0.16) 0.64 (0.23) 0.61 (0.14) 16.95*** –3.06**
Coping SS 0.72 (0.29) 0.67 (0.26) 0.65 (0.19) 0.75 (0.18) 2.62 1.27
AS 0.49 (0.19) 0.40 (0.17) 0.39 (0.17) 0.33 (0.17) 9.33* 2.27*
PA 0.88 (0.24) 0.77 (0.20) 0.86 (0.22) 0.81 (0.17) 2.98 0.17
PS 0.81 (0.20) 0.79 (0.23) 0.79 (0.21) 0.76 (0.20) 0.52 0.47
TR 0.87 (0.13) 0.91 (0.18) 10.01 (0.24) 10.08 (0.23) 12.81** 3.43***
Social support From family 0.31 (0.13) 0.32 (0.10) 0.35 (0.15) 0.39 (0.08) 7.11 2.53*
From friends 0.20 (0.11) 0.25 (0.14) 0.29 (0.15) 0.29 (0.15) 4.32 1.35
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From others 0.03 (0.01) 0.04 (0.03) 0.06 (0.08) 0.04 (0.02) 7.66 –0.24
Support satisfaction 1.02 (0.34) 1.1 (0.21) 1.12 (0.35) 1.15 (0.19) 1.04 0.92
Note: ASD, autistic spectrum disorder; LF, low functioning; HF, high functioning. Parenting Stress: PD, Parental Distress;
P-CDI, Parent-Child Dysfunctional Interaction; DC, Difficult Child coping: SS, Social Support; AS, Avoidance Strategies;
PS, Positive Attitude; PS, Problem-solving; TR, Turning to Religion. ***p < 0.001; **p < 0.01; *p < 0.05.

functioning autism and parents with non-disabled children, significant differences in par-
ental total stress were found. In particular, parents of children with low functioning autism
reported higher levels of parenting stress, of dysfunctional interactions with their children
and of child difficulties than parents of typically developing children.
Similar results were found when comparing total stress of parents of children with high
functioning autism and of parents of non-disabled children. In this case too, parents
reported being more stressed than parents of typically developing children by their par-
ental role, the interaction with their children and as a result of their children’s difficulties.
No significant statistical differences between parents of children with Down syndrome and
non-disabled children were found.
Comparing parents of children with high and low functioning autism, analyses showed
significant differences only in total stress; with parents of children with low functioning
autism being more stressed than parents of children with high functioning autism.
Parents of a child with low functioning autism are more stressed than those of a child
with Down syndrome. More specifically, in families of a child with autistic spectrum dis-
order, the parental distress did not differ from that perceived by parents of a child with
Down syndrome. Parents of a child with high functioning autistic spectrum disorder
and of children with low functioning autism were more stressed by dysfunctional inter-
action with their children than parents of a child with Down syndrome. Child difficulties
seem to be greater for parents of a child with high functioning and with low functioning
autism than for parents of a child with Down syndrome.

Differences within groups in parental stress

Within-group comparisons have shown that parents of a child with low and high autistic
spectrum disorder did not show statistical differences between parent–child interaction
and parent distress. For these families the principal source of stress is the child’s difficul-
ties. In fact, parents of a child with low functioning autism were more stressed by
Downloaded by [Francesca Cuzzocrea] at 20:47 23 November 2015

Table 2. Mann–Whitney test for parental stress, coping and social support by category of parents.
ASD (LF) vs. Down ASD (LF) vs. typically ASD (HF) vs. Down ASD (HF) vs. typically Down syndrome vs.
ASD (LF) vs. ASD (HF) syndrome developing syndrome developing typically developing
Parenting PD Z: –0.67, CI: 0.51–0.53 Z: –1.79, CI: 0.06–0.07 Z: –2.87**, CI: 0.00–0.00 Z: –1.88, CI: 0.07–0.08 Z: –3.04**, CI: 0.00–0.00 Z: –0.06, CI: 0.94–0.95
stress P-CDI Z: –0.67, CI: 0.50–0.52 Z: –2.14*, CI: 0.03–0.04 Z: –3.42**, CI: 0.00–0.00 Z: –2.11*, CI: 0.03–0.04 Z: –3.86***, CI: 0.00–0.00 Z: –1.15, CI: 0.24–0.26
DC Z: –1.63, CI: 0.10–0.12 Z: –3.49***, CI: 0.00–0.00 Z: –4.48***, CI: 0.00–0.00 Z: –2.95**, CI: 0.00–0.00 Z: –4.08***, CI: 0.00–0.00 Z: –0.04, CI: 0.97–0.98
PSI Z: –2.00*, CI: 0.04–0.05 Z: –2.53**, CI: 0.35–0.37 Z: –4.07***, CI: 0.03–0.04 Z: –0.94, CI: 0.01–0.01 Z: –2.17*, CI: 0.00–0.00 Z: –0.80, CI: 0.41–0.43
Coping SS Z: –0.27, CI: 0.79–0.80 Z: –0.30, CI: 0.75–0.77 Z: –0.90, CI: 0.37–0.39 Z: –0.33, CI: 0.75–0.77 Z: –0.89, CI: 0.36–0.38 Z: –1.58, CI: 0.11–0.12
AS Z: –1.61, CI: 0.10–0.12 Z: –1.75, CI: 0.92–0.93 Z: –2.82**, CI: 0.16–0.18 Z: –0.10, CI: 0.07–0.08 Z: –1.39, CI: 0.00–0.01 Z: –1.55, CI: 0.11–0.13
PA Z: –1.29, CI: 0.19–0.21 Z: –0.05, CI: 0.14–0.15 Z: –0.91, CI: 0.45–0.47 Z: –1.44, CI: 0.96–0.97 Z: –0.76, CI: 0.36–0.38 Z: –0.99, CI: 0.31–0.33
PS Z: –0.38, CI: 0.71–0.73 Z: –0.46, CI: 0.91–0.92 Z: –0.73, CI: 0.78–0.80 Z: –0.11, CI: 0.65–0.67 Z: –0.27, CI: 0.47–0.49 Z: –0.25, CI: 0.80–0.81
TR Z: –0.16, CI: 0.87–0.89 Z: –1.57, CI: 0.20–0.22 Z: –3.20**, CI: 0.01–0.01 Z: 1.27, CI: 0.11–0.12 Z: –2.62*, CI: 0.00–0.00 Z: –1.38, CI: 0.16–0.17
Social Support Z: –0.06, CI: 0.95–0.96 Z: –0.37, CI: 0.59–0.61 Z: 1.85, CI: 0.01–0.02 Z: –0.54, CI: 0.71–0.73 Z: –2.42*, CI: 0.06–0.07 Z: –1.53, CI: 0.12–0.13
support from family
Support Z: –0.81, CI: 0.42–0.44 Z: –1.73, CI: 0.49–0.51 Z: –2.05*, CI: 0.45–0.47 Z: –0.67, CI: 0.09–0.10 Z: –0.74, CI: 0.03–0.04 Z: –0.13, CI: 0.90–0.91
from friends
Support Z: –0.47, CI: 0.71–0.73 Z: –0.69, CI: 0.77–0.79 Z: –0.20, CI: 0.78–0.80 Z: –0.30, CI: 0.45–0.47 Z: –0.36, CI: 0.77–0.79 Z: –0.71, CI: 0.45–0.47
from others
Support Z: –0.19, CI: 0.85–0.86 Z: –0.75, CI: 0.78–0.80 Z: –0.98, CI: 0.60–0.62 Z: –0.26, CI: 0.45–0.47 Z: –0.52 , CI: 0.33–0.35 Z: –0.38, CI: 0.70–0.71

CHILD CARE IN PRACTICE

satisfaction
(total)
Note: ASD, autistic spectrum disorder; LF, low functioning; HF, high functioning; CI, 95% confidence interval. Parenting Stress: PD, Parental Distress; P-CDI, Parent-Child Dysfunctional Interaction;
DC, Difficult Child coping: SS, Social Support; AS, Avoidance Strategies; PA, Positive Attitude; PS, Problem-solving; TR, Turning to Religion. ***p < 0.001; **p < 0.01; *p < 0.05.

7
 8 F. CUZZOCREA ET AL.

children’s difficulties than their role and than by the interaction with their children.
Parents with a child with high functioning autism also had higher scores in the child dif-
ficulties scale than in parental distress and than in parent–child dysfunctional interaction
scales.
In families with children with Down syndrome, no statistical differences within the PSI
sub-scales were found.
Parents of typically developing children showed a higher stress level due to their role
than with interaction with their children. For these families, children’s difficulties are a
greater source of stress than the parent–child dysfunctional interactions. No statistical
differences between child difficulties and parent distress were found.

Differences between groups in coping strategies

In Table 1, the mean and SD of COPE scores obtained by parents of children with high
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and low functioning autism, with Down syndrome and with non-disabled children are
illustrated. The Kruskal–Wallis test revealed significant differences among groups in
avoidance strategies and turning to religion, confirmed also by the Jonckheere–Terpstra
test. No significant differences among groups in the other scales were found (Table 1).
Parents of children with low functioning autism showed higher levels in avoidance
strategies and lower levels in turning to religion than parents of typically developing chil-
dren (see Table 2).
Other differences among groups in the COPE sub-scales were not significant, except for
parents of children with high functioning autism who had lower levels in turning to reli-
gion than parents of typically developing children.

Differences within groups in coping strategies

Within each group of parents there were some differences in the most frequently used
coping strategies. Friedman rank tests indicated significant differences among the relative
use of five coping strategies in all groups (high functioning: χ2(4) = 37.04, p < 0.001; low
functioning: χ2(4) = 31.99, p < 0.001; Down syndrome: χ2(4) = 58.77, p < 0.001; typically
developing: χ2(4) = 98.16, p < 0.001). Specifically, parents of children with high functioning
autism, Down syndrome, and typical development used turning to religion more than
social support (high functioning: Z = 2.87, p < 0.01; Down syndrome: Z = 4.14,
p < 0.001; typically developing: Z = 4.99, p < 0.001), problem-solving (high functioning:
Z = 1.92, p < 0.05; Down syndrome: Z = 3.69, p < 0.001; typically developing: Z = 4.73,
p < 0.001), avoidance strategy (high functioning: Z = 3.88, p < 0.001; Down syndrome:
Z = 4.26, p < 0.001; typically developing: Z = 5.49, p < 0.001), and positive attitude
(high functioning: Z = 2.65, p < 0.01; Down syndrome: Z = 2.63, p < 0.01; typically devel-
oping: Z = 4.73, p < 0.001). In parents of children with high functioning autism, Down
syndrome, and typical development, no statistical differences were found between positive
attitude and problem-solving (high functioning: Z = 0.48, p > 0.05; Down syndrome:
Z = 1.83, p > 0.05; typically developing: Z = 1.88, p > 0.05). Parents of children with
Down syndrome used social support less than positive attitude (Z = 3.46; p < 0.001)
and problem-solving (Z = 3.67; p < 0.001). Parents of children with high functioning
autism instead preferred to use problem-solving rather than the social support strategy
(Z = 2.02; p < 0.05), while no statistical difference among positive attitude and social
support (Z = 1.73; p > 0.05) was found. Furthermore, no statistical differences in the
 CHILD CARE IN PRACTICE 9

use of social support rather than problem-solving (Z = 1.88; p > 0.05) and positive attitude
(Z = 1.53; p > 0.05) were found in parents of typically developing children. Finally, parents
of children with high functioning autism, Down syndrome, and typical development used
less avoidance strategy than social support (high functioning: Z = 2.8; p < 0.01; Down syn-
drome: Z = 3.83; p < 0.001; typically developing: Z = 5.43; p < 0.001), problem-solving
(high functioning: Z = 3.47; p < 0.001; Down syndrome: Z = 4.23; p < 0.001; typically devel-
oping: Z = 5.49; p < 0.001), and positive attitude (high functioning: Z = 3.77; p < 0.001;
Down syndrome: Z = 4.2; p < 0.001; typically developing: Z = 5.48; p < 0.001).
Avoidance strategy was the least coping strategy also in parents of children with low
functioning autism. In fact parents of children with low functioning autism used less avoid-
ance strategy than positive attitude (Z = 3.52; p < 0.001), turning to religion (Z = 3.41;
p < 0.001), social support strategy (Z = 3.15; p < 0.01), and problem-solving (Z = 3.52;
p < 0.001). However, parents of children with low functioning autism used more positive
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attitude strategy than social support (Z = 2.36; p < 0.05), and problem-solving coping
(Z = 2.26; p < 0.05). There were no statistical differences in the use of turning to religion
strategies with social support (Z = 0.163; p > 0.05), problem-solving (Z = 0.93; p > 0.05), and
positive attitude (Z = 0.15; p > 0.05). Finally, no statistical differences between problem-
solving and social support strategies were found (Z = 1.65; p > 0.05).

Differences between groups in social support

In Table 1 the mean score and SD of SSQ sub-scales in the four groups are illustrated.
Using the Kruskal–Wallis test no significant differences were found among families
groups in any variables considered (see Table 1).
Parents of children with high functioning autism reported a lower level of familial
support than parents of typically developing children, while those of a child with low func-
tioning autism reported a lower level of support from friends compared with families with
non-disabled children. Parents of children with autism reported receiving more help from
their family than from friends, and this is also the case for parents of typically developing
children. Parents of children with Down syndrome reported the same support from family
and friends (see Table 2).

Differences within groups in coping strategies

Interesting results were found comparing support from others with that of familial
support and help guaranteed from friends. All groups reported that the level of the
former is significantly lower than other types of support. This was confirmed in families
with a child with low functioning autism that were not sufficiently supported by the social
context compared with family (Z = 3.3; p < 0.001) and friends (Z = 3.12; p < 0.001). This
was also confirmed by parents of low functioning children who reported greater support
from family (Z = 3.92; p < 0.001) and friends (Z = 3.82; p < 0.001) than from others. The
same analysis was given by parents of children with Down syndrome who did not receive
enough support in the social context, but only from their family (Z = 4.17; p < 0.001) and
friends (Z = 4.18; p < 0.001).
Insufficient support from others was evident also in families with non-disabled
children, where the main support came from family (Z = 5.51; p < 0.001) and friends
(Z = 5.44; p < 0.001).
 10 F. CUZZOCREA ET AL.

Relationships among coping strategies, social support and parental stress

To analyse which factors might influence parental stress, multiple regression analysis in
the four groups were calculated separately (Table 3).
More specifically, these analyses determined the extent of the relationship between
potential predictor variables (coping strategies and social support) and relevant dependent
variables (total PSI, parent stress, children difficulties and parent–child dysfunctional
interactions). In order to control the possibility of type I error, the relatively small
number of subjects and the difficulty to have a strong theoretical prediction recommend
us to use the simultaneous method. Two sets of four separate multiple linear regressions
were conducted for each group. In the first set, the five specific coping strategies (Social
Support, Avoidance Strategies, Positive Attitude, Problem-solving, and Turning to Reli-
gion) were entered simultaneously as predictor variables, and the three sources of parental
stress (Parental Distress, Parent–Child Dysfunctional Interactions, parental stress related
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to the children’s difficulties) and the total score of parental stress as criterion variables. In
the second set of multiple regression, instead, the three different sources of social support
(support from family, support from friends, support from others) were entered simul-
taneously as predictor variables, and the three sources of parental stress (Parental Distress,
Parent–Child Dysfunctional Interactions, parental stress related to the children’s difficul-
ties) and the total score of parental stress as separate criterion variables. In families of chil-
dren with high functioning autism, the parents’ coping strategy seems to reduce stress
caused by parent–child dysfunctional interaction (F(5,14) = 4.39; p < 0.01; R 2 = 0.61)
and, more specifically, the “turning to religion” strategy negatively correlates to parent–
child dysfunctional interaction.
Coping strategies are relevant to parent distress for families of children with Down syn-
drome (F(5,18) = 3.53; p < 0.05; R 2 = 0.49), but represent a risk factor. In fact, these parents
tend to use “avoidance strategies” that are related to increasing parental distress. In
addition, the analysis underlined that the use of positive attitude cannot help parents to
manage their stress.
The most relevant relationships among these variables, observed in family groups, are
represented in Figure 1, and the statistical analysis showed different relations among these
variables in the four groups of parents (Table 3).
Different correlations were found in families of children with low functioning autism
and for parents of typically developing children. In these situations, coping strategies
did not represent an effective protective factor in reducing parental distress. Regression
analysis determined the relationship between social support and parental distress and
revealed significant differences among families groups. Social support did not influence
the parental distress perceived by parents of children with high functioning autism. In
parents of children with low functioning autism, the analysis instead highlighted a signifi-
cant decrease in parent distress (F(3,12) = 3.92; p < 0.05; R 2 = 0.50). In particular, support
from others seems to be a protective factor for parent distress.
For a child with Down syndrome, social support is a main factor that can help parents
to manage all types of stress. In fact, in parents of a child with Down syndrome the analysis
highlighted a significant decrease in total stress perceived (F(3,20) = 7.38; p < 0.01; R 2 = 0.53)
and, more specifically, significant influences on parent distress (F(3,20) = 4.24; p < 0.05; R 2 =
0.39), on parent–child dysfunctional distress (F(3,20) = 8.16; p < 0.001; R 2 = 0.55) and on
Downloaded by [Francesca Cuzzocrea] at 20:47 23 November 2015

Table 3. Regression of coping strategies and social support on parental stress in the four groups.
Coping strategies (COPE) Social support satisfaction (SSQ)
SS AS PA PS TR Family Friends Others
ASD (LF) PD 0.07 (0.14) 0.35 (0.21) –0.92 (0.20) 0.11 (0.17) 0.02 (0.19) 0.32 (0.37) 0.60* (0.41) –0.10 (4.27)
P-CDI –0.07 (0.11) 0.22 (0.16) –0.33 (0.15) 0.28 (0.13) 0.31 (0.15) 0.21 (0.39) 0.47 (0.44) –0.10 (4.52)
DC 0.27 (0.16) 0.11 (0.23) –0.30 (0.22) –0.24 (0.19) 0.23 (0.22) 0.51* (0.34) 0.41 (0.38) –0.17 (3.91)
PSI-TOT –0.13 (0.16) 0.14 (0.23) –1.10 (0.22) 0.37 (0.19) –0.16 (0.22) 0.32 (0.43) 0.41 (0.48) –0.05 (4.97)
ASD (HF) PD 0.03 (0.37) 0.56 (0.47) –0.42 (0.57) 0.01 (0.81) 0.37 (0.45) –0.33 (0.37) 0.13 (0.27) 0.04 (1.11)
P-CDI –0.13 (0.42) 0.11 (0.52) –0.35 (0.63) –0.09 (0.90) –0.45* (0.50) –0.22 (0.37) 0.05 (0.27) –0.35 (1.11)
DC –0.22 (0.39) 0.15 (0.49) –0.12 (0.59) –0.25 (0.84) –0.06 (0.47) –0.10 (0.42) 0.08 (0.30) 0.13 (1.26)
PSI-TOT 0.01 (0.31) 0.58* (0.39) –0.32 (0.48) –0.05 (0.68) 0.47 (0.38) –0.13 (0.44) 0.11 (0.32) 0.20 (1.32)
Down Syndrome PD 0.00 (0.29) 0.56** (0.23) 0.55* (0.21) –0.60 (0.29) 0.31 (0.18) –0.62** (0.25) –0.02 (0.25) –0.04 (0.46)
P-CDI 0.11 (0.30) 0.53* (0.24) 0.06 (0.22) –0.39 (0.30) 0.19 (0.19) –0.54** (0.19) –0.37* (0.19) 0.01 (0.35)
DC 0.46 (0.32) 0.24 (0.26) –0.22 (0.24) –0.83* (0.32) 0.35 (0.20) –0.71*** (0.20) 0.11 (0.20) 0.38** (0.37)
PSI-TOT 0.12 (0.36) 0.56* (0.29) 0.33 (0.26) –0.55 (0.36) 0.27 (0.23) –0.66*** (0.25) –0.15 (0.25) 0.03 (0.47)
Typically developing PD –0.34* (0.10) 0.39* (0.10) –0.13 (0.12) 0.04 (0.11) 0.14 (0.08) –0.29 (0.24) –0.21 (0.12) –0.09 (0.72)
P-CDI –0.17 (0.10) 0.26 (0.11) –0.14 (0.13) 0.24 (0.12) 0.43* (0.09) –0.32 (0.24) –0.01 (0.12) 0.07 (0.75)

CHILD CARE IN PRACTICE

DC –0.01 (0.10) 0.33 (0.11) –0.23 (0.13) 0.05 (0.11) 0.00 (0.09) –0.32 (0.23) –0.01 (0.12) –0.12 (0.71)
PSI-TOT –0.32 (0.13) 0.31 (0.14) –0.14 (0.17) 0.08 (0.15) 0.10 (0.11) –0.27 (0.31) –0.16 (0.16) –0.03 (0.96)
Note: Data presented as β (standard error). ASD, autistic spectrum disorder; LF, low functioning; HF, high functioning. Parenting Stress: PD, Parental Distress; P-CDI, Parent-Child Dysfunctional
Interaction; DC, Difficult Child coping: SS, Social Support; AS, Avoidance Strategies; PA, Positive Attitude; PS, Problem-solving; TR, Turning to Religion. ***p < 0.001; **p < 0.01; *p < 0.05.

11
 12 F. CUZZOCREA ET AL.
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Figure 1. Graphic representation of regression analysis.

Note: Dotted lines represent negative effects, whereas unbroken lines represent positive effects.

stress caused by children’s difficulties (F(3,20) = 11.50; p < 0.001; R 2 = 0.63). In particular,
support from the family seems to be a protective factor for stress perceived by these parents:
negative correlations between this kind of support and parental distress, parent–child
dysfunctional interactions, children difficulties, and total stress were found. Support from
friends seems to reduce the stress related to parent–child dysfunctional interaction, while
support from others seems to increase the stress related to child difficulties.
For parents of typically developing children, the social support received seems to be not
correlated with the different type of stress and the total score.

Discussion and conclusion

Important differences were found between families of children with a disability and
families of children with typical development. As expected in the first hypothesis, it
seems that parents with autistic children face a tougher situation: they perceive more
stress than parents of non-disabled children and than parents of children with Down syn-
drome. This finding is consistent with results from previous studies: comparing parents of
children with low functioning autism and parents of children with high functioning
autism, the PSI subscales show that the perception of dysfunctional parent/child inter-
actions and, particularly, the perception of child difficulties represent the main factors
of the higher stress in the first group of parents. In fact, children with low functioning
autism are certainly less manageable than those with high functioning autism. Interesting
results were found also comparing parents of children with Down syndrome with those of
non-disabled children: differences between these two groups are very slight and mainly
related to parent–child interactions.
Parents of typically developing children differ from each other also in relation to the fre-
quency with which they use specific coping strategies when dealing with stress. Parents of
 CHILD CARE IN PRACTICE 13

children with Down syndrome and those of typically developing children address problems
almost in the same way: in fact, in problematic situations both tend to adopt “positive atti-
tude” and, above all, “turning to religion”, as do parents of autistic children. However, given
the small sample size, the “turning to religion” strategy could be used more due to a greater
degree of religiosity among this group of parents. This aspect should be explored in detail in
a future study. In all of the groups, “problem solving”—the most functional strategy—is
used almost with the same frequency, though parents of children with low functioning
autism use it more frequently, while parents of non-disabled children seem to use it less.
“Avoidance strategy”, instead, is the least functional coping strategy and seems to be used
less in all families: however, parents of children with low functioning autism use it more
than the other three groups. No differences in the request for “social support” among the
four groups were found. Among the sources of social support, “familial support” is the
most important for all families. In accordance with previous research, the perception of
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functional support from others (e.g. specialist and social institutions) is very low (Jones
& Passey, 2004; White & Hastings, 2004). Moreover, while satisfaction about support is
not high in any group, parents of children with low functioning autism are the least satisfied.
It is important to bear this finding in mind, especially in relation to the limited effects of
social support on stress levels in this study. Analyses showed that the coping strategies
usually used by parents are not very functional for the management of their stress, except
for parents of children with high functioning autism: in this group, in fact, coping strategies
seem to reduce stress related to dysfunctional parent–child interactions. However, rather
than reduce the stress related to their parental role, coping strategies used by parents of chil-
dren with Down syndrome seem to increase it. For such parents, coping strategies are more
a risk factor than a resource. It is important to point out that parents tend to use more fre-
quently dysfunctional coping strategies and our results confirmed previous findings that
show how the use of dysfunctional coping strategies is correlated with higher stress levels
(Dunn et al., 2001).
The perception of social support has different effects on parental stress in the four groups
considered. For parents of children with Down syndrome in particular, family support is
highly functional: it seems that by increasing support, all aspects of stress are reduced
(related to parental role, children difficulties, parent–child interactions and total stress).
For parents of children with autism, the support received is not as functional. It seems to
have negative effects, especially for parents of children with low functioning autism. In
this group, in fact, perception of social support received from all sources is very low, and
therefore satisfaction with this support is probably lower than the other groups.
These findings support the evidence that it is the quality of such support, rather than
the quantity available, which is important (Smith, Greenberg, & Seltzer, 2012; Weiss et al.,
2013). The type and quality of support offered, the person providing the assistance and
contextual issues may all play a role in determining whether parents perceive support
as beneficial (Ekas, Lickenbrock, & Whitman, 2010; Hogan, Linden, & Najarian, 2002).
Parents may perceive certain types of social support as negative ”social strain” and exacer-
bate stress (Lakey, Tardiff, & Drew, 1994). For example, research has shown that an acute
stressor may initiate immediate support mobilisation, whereas chronic stressors, as often
experienced by parents of children with autistic spectrum disorder, may erode support
over time (Thoits, 1995). Sources of social support may in fact avoid parents in distress
because these sources are unsure how to help (Chesler & Barbarin, 1984) or they feel
 14 F. CUZZOCREA ET AL.

their effort will not make a difference (Brickman et al., 1982). Future research could
examine how to work with informal social networks of parents of children with autism
to help them to be available and offer meaningful support (Weiss et al., 2013).
This research has the advantage of having analysed stress levels of parents of children
with autism, not only comparing them with parents of children with other disabilities, but
also investigating the differences between high and low functioning. There is a lack of
results in the literature, and research so far has usually analysed the family system of chil-
dren with high functioning autism. This study highlights the need for a deeper analysis of
stress conditions with which parents of children with autism have to cope, taking into
account the specific characteristics of the management that the types of autism require.
In particular, it was found that for such parents the use of functional coping strategies
may be irrelevant or even negative for parental stress reduction. Similarly, social
support is effective only when stress levels are not high; but when the support received
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is insufficient, or unsatisfactory, it turns out to be counter-productive and can itself be

a source of stress (Murdaca, 2008a).
Several limitations of the present study must be taken into account. A limitation of this
study is that all of the measures in the model are collected from self-report questionnaires.
Further research with cross-reported analysis is necessary (Gugliandolo, Costa, Cuzzocrea,
Larcan, & Petrides, 2015). The cross-sectional nature of the data is also a limitation for
answering questions about the direction of effect between variables. The direction of
effects may not be possible to test, and it is important to recognise that many of the
relationships could be bidirectional rather than unidirectional. Further research with
longitudinal studies is necessary to deepen the knowledge of the direction of effects.
Another limitation is the small sample size that does not allow broader generalisations;
despite its limitations, the study provides results that confirmed the importance of reflect-
ing about which support society, and, in particular, specialists, can give these families
(Cuzzocrea et al., 2013). Furthermore, all children belonged to a two-parent family,
which may affect the generalisability of findings. Future research needs to address this
limitation, including other family structures. Most of the time, parent training was pro-
posed generically for families with a disabled child, where the main object is to give
parents a strategy to better manage the needs of their children (Cuzzocrea, Larcan, &
Oliva, 2008). The results of this research, however, highlight the importance of focusing
attention on the specific needs of parents related to different disabilities of their children
(Murdaca, 2008b). In line with previous studies (Ogbu, Brady, & Kinlen, 2014; Perriconem
Polizzi, Morales, Marino, & Faavra Scacco, 2012; Perricone et al., 2013, 2014), it seems
more important to focus on parent coping strategies and to propose specific training
for implementing functional strategies to manage their stress. Further research could
investigate possible gender differences between fathers and mothers or possibly how
two parents (of the same child) may react differently in stress management strategies
and in the perception of social support, in relation to other types of disabilities, as well
as in relation to different forms of autism. Indeed, there are still many aspects regarding
the family life of parents of children with a disability and, especially, of those with children
with an autistic spectrum disorder that require further studies into resilience, also in
relation to the different cycle stages of family life. Childhood disabilities impact parents
in significant ways, and information about parental functioning could help us to intervene
with these parents more effectively. Further research could investigate the clinical
 CHILD CARE IN PRACTICE 15

implications, toward understanding factors that affect parental adjustment to a stressor

such as the chronic illness or disability of a child.

Authors’ contributions
F. Cuzzocrea assisted with the concept, study design, data analysis and generation of the initial draft
of this manuscript. A. M. Murdaca and P. Filippello assisted with manuscript preparation and
interpretation and manuscript editing. S. Costa assisted with scoring data and data analysis and
with the final version of the manuscript. R. Larcan assisted with the concept, manuscript prep-
aration and editing and study supervision. All authors take responsibility for the integrity of the
data and the accuracy of the data analysis. All authors contributed to and have approved the
final manuscript.
Downloaded by [Francesca Cuzzocrea] at 20:47 23 November 2015

ORCID
Francesca Cuzzocrea http://orcid.org/0000-0002-3527-2386
Anna Maria Murdaca http://orcid.org/0000-0002-7484-8309
Sebastiano Costa http://orcid.org/0000-0002-2392-6039
Pina Filippello http://orcid.org/0000-0002-9327-0119
Rosalba Larcan http://orcid.org/0000-0002-9908-1650

References
Abidin, R. R. (1995). PSI–Parent Stress Index. Odessa: Psychological Assessment Resources Inc.
Bailey, D., Wolfe, D. M., & Wolfe, C. R. (1994). With a little help from our friends: Social support as
a source of well-being and of coping with stress. Journal of Sociology and Social Welfare, 21(2),
127–152.
Boss, P. (2002). Family stress management. Thousand Oaks, CA: Sage Publications, Inc.
Boss, P. (2006). Loss, trauma, and resilience: Therapeutic work with ambiguous loss. New York:
W. W. Norton & Co.
Brickman, P., Rabinowitz, V. C., Karuza, J. Jr, Coates, D., Cohn, E., & Kidder, L. (1982). Models of
helping and coping. American Psychologist, 37, 368–384.
Burr, W. R. (1973). Theory construction and the sociology of the family. New York: John Wiley & Sons.
Burr, W. R., Klein, S. R., Burr, R. G., Doxey, C., Harker, B., Holman, T. B., … White, M. S. (1994).
Reexamining family stress: New theory and research. Thousand Oaks, CA: Sage Publications.
Chan, J. B., & Sigafoos, J. (2001). Does respite care reduce parental stress in families with develop-
mentally disabled children? Child and Youth Care Forum, 30, 253–263.
Chesler, M. A., & Barbarin, O. A. (1984). Difficulties of providing help in a crisis: Relationships
between parents of children with cancer and their friends. Journal of Social Issues, 40, 113–134.
Cuzzocrea, F., Larcan, R., Baiocco, R., & Costa, S. (2011). Family functioning, parenting, and couple
satisfaction in families of children with a disability. Disability and the Family, 16(2), 7–24.
Cuzzocrea, F., Larcan, R., Costa, S., & Gazzano, C. (2014). Parents’ competence and social skills in
siblings of disabled children. Social Behavior and Personality, 42(1), 45–58. doi:10.2224/sbp.2014.
42.1.45
Cuzzocrea, F., Larcan, R., & Oliva, P. (2008). Parent training for families with mental retarded chil-
dren. International Journal of Psychology, 43, 309–309.
Cuzzocrea, F., Larcan, R., & Westh, F. (2013). Family and parental functioning in parents of dis-
abled children. Nordic Psychology, 65(3), 271–287. doi:10.1080/1912276.2013.824–201
Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism
spectrum disorders: Associations with child characteristics. Journal of Autism and Developmental
Disorders, 38(7), 1278–1291.
 16 F. CUZZOCREA ET AL.

Dunn, M. E., Burbine, T., Bowers, C. A., & Tantleff-Dunn, S. (2001). Moderators of stress in parents
of children with autism. Community Mental Health Journal, 37, 39–52.
Ekas, N. V., Lickenbrock, D. M., & Whitman, T. L. (2010). Optimism, social support, and well-being
in mothers of children with autism spectrum disorder. Journal of Autism and Developmental
Disorders, 40, 1274–1284.
Filippello, P., Harrington, N., Buzzai, C., Sorrenti, L., & Costa, S. (2014). The relationship between
frustration intolerance, unhealthy emotions, and assertive behaviour in Italian students. Journal
of Rational-Emotive & Cognitive-Behavior Therapy, 32, 257–278.
Freeman, M. F., & Tukey, J.W. (1950). Transformations related to the angular and the square root.
Annals of Mathematical Statistics, 21, 607–611.
Glidden, L. M. & Schoolcraft, S. A. (2007). Family assessment and social support. In J. W. Jacobson,
J. A. Mulick, & J. Rojahn (Eds.), Handbook of intellectual and developmental disabilities (pp. 391–
424). New York: Springer.
Gray, D. E. (2006). Coping over time: The parents of children with autism. Journal of Intellectual
Disability Research, 50, 970–976.
Downloaded by [Francesca Cuzzocrea] at 20:47 23 November 2015

Guarino, A., Di Blasio, P., D’Alessio, M., Camisasca, E., & Serantoni, G. (2007). PSI-Parenting Stress
Index—Forma breve—Per l’identificazione precoce di sistemi relazionali genitore-bambino stres-
santi [PSI-Parenting Stress Index—Short Form—To the early identification of the stressfull rela-
tional system parent-child]. Firenze: Giunti, OS.
Gugliandolo, M. C., Costa, S., Cuzzocrea, F., Larcan, R., & Petrides, K. V. (2015). Trait emotional
intelligence and behavioral problems among adolescents: A cross-informant design. Personality
and Individual Differences, 74, 16–21.
Hastings, R. P. (2003). Child behaviour problems and partner mental health as correlates of stress in
mothers and fathers of children with autism. Journal of Intellectual Disability Research, 47, 231–237.
Hastings, R. P., Kovshoff, H., Brown, T., Ward, N. J., Espinoza, F. D., & Remington, B. (2005).
Coping strategies in mothers and fathers of pre-school and school-age children with autism.
Autism: The International Journal of Research and Practice, 9, 377–391.
Hastings, R. P., Kovshoff, H., Ward, N. J., Degli Espinosa, F., Brown, T., & Remington, B. (2005).
Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children
with autism. Journal of Autism and Developmental Disorders, 35, 635–644.
Hastings, R. P., Thomas, H., & Delwiche, N. (2002). Grandparent support for families of children
with Down syndrome. Journal of Applied Research in Intellectual Disabilities, 15, 97–104.
Higgins, D., Bailey, S., & Pearce, J. (2005). Factors associated with functioning style and coping
strategies of families with a child with an autism spectrum disorder. Autism, 9(2), 125–137.
Hill, R. (1949). Family under stress. New York: Harper & Row.
Hogan, B. E., Linden, W., & Najarian, B. (2002). Social support interventions: Do they work?.
Clinical Psychology Review, 22(3), 381–440.
Jonckheere, A. R. (1954). A test of significance for the relation between m rankings and k ranked
categories. British Journal of Statistical Psychology, 7, 93–100.
Jones, J., & Passey, J. (2004). Family adaptation, coping and resources: Parents of children with
developmental disabilities and behaviour problems. Journal on Developmental Disabilities,
11(1), 31–46.
Kruskal, W. W., & Wallis, W. A. (1952). Use of ranks in one-criterion variance analysis. Journal of
the American Statistical Association, 47, 583–621.
Lakey, B., Tardiff, T. A., & Drew, J. B. (1994). Negative social interactions: Assessment and relations
to social support, cognition, and psychological distress. Journal of Social and Clinical Psychology,
13, 42–62.
Larcan, R., & Cuzzocrea, F. (2011). Funzionamento della famiglia e sviluppo psico-sociale dei fra-
telli di individui con disabilità intellettive [Family functioning and psychosocial development of
siblings of individuals with intellectual disabilities]. Psicologia Clinica dello Sviluppo, 15(1), 123–
153.
Larcan, R., Cuzzocrea F., & Oliva, P. (2008). Family stress, parenting skills and socio-cognitive com-
petences of retarded children siblings. International Journal of Psychology, 43, 462–462
 CHILD CARE IN PRACTICE 17

Lazarus, R. S. (1996). The role of coping in the emotions and how coping changes over the life
course. In C. Magai & S. H. McFadden (Eds.), Handbook of emotion, adult development, and
ageing (pp. 289–306). San Diego, CA: Academic Press.
Mann, H. B., & Whitney, D. R. (1947). On a test of whether one of two random variables is stochas-
tically larger than the other. Annual of Mathematical Statistics, 18, 50–60.
McCubbin, H. I., & Patterson, J. M. (1981). Systematic assessment of family stress, resources and
coping: tools for research, education and clinical intervention. St. Paul: University of
Minnesota, Family Social Science.
Murdaca, A. M. (2008a). Buone prassi per l’integrazione sociale delle persone disabili. Esempi di part-
nership tra famiglie, associazioni, scuola e territorio [Good practices for social integration of dis-
abled people. Examples of partnerships between families, associations, schools and territory].
Pisa: Del Cerro.
Murdaca, A. M. (2008b). Complessità della persona e disabilità. Le nuove frontiere culturali dell’in-
tegrazione [The complexity of the person and disability. The new frontiers of cultural inte-
gration]. Pisa: Del Cerro.
Downloaded by [Francesca Cuzzocrea] at 20:47 23 November 2015

Ogbu, H. U., Brady, B., & Kinlen, L. (2014). Parenting in direct provision: Parents’ perspectives
regarding stresses and supports. Child Care in Practice, 20(3), 256–269.
Patterson, J. M. (1988). Families experiencing stress: I. The Family Adjustment and Adaptation
Response Model: II. Applying the FAAR Model to health-related issues for intervention and
research. Family Systems Medicine, 6, 202–237.
Perricone, G., Polizzi, C., Morales, M. R., Marino, S., & Favara Scacco, C. (2012). Functioning of
family system in pediatric oncology during treatment phase. Pediatric Hematology and
Oncology, 29, 652–662.
Perricone, G., Polizzi, C., Carollo, A., Morales, M. R., De Luca, F., Maniscalco, F., & Caldas Luzeiro,
J. (2014), Coping and parental role competence of mothers of preterm infant. Minerva
Pediatrica, 66, 177–186.
Perricone, G., Prista Guerra, M., Cruz, O., Polizzi, C., Lima, L., Morales, M. R., et al. (2013).
Maternal coping strategies in response to a child’s chronic and oncological disease. A cross-cul-
tural study—Italy & Portugal. Pediatric Reports, 5, 43–47.
Santamaria, F., Cuzzocrea, F., Gugliandolo, M. C., & Larcan, R. (2012). Marital satisfaction and
attributions style in parents of children with autism spectrum disorder, Down syndrome and
nondisabled children. Life Span and Disability, 25, 19–37.
Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support: The
Social Support Questionnaire. Journal of Personality and Social Psychology, 44, 127–139.
Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiri, L. R., & Franceschini, S. (2008). Coping
Orientation to Problems Experienced—Nuova Versione Italiana (COPE-NVI). Psicoterapia
Cognitiva e Comportamentale, 14, 27–53.
Sirin, S. R. (2005). Socioeconomic status and academic achievement: A meta-analytic review of
research. Review of Educational Research, 75, 417–453.
Smith, L. E., Greenberg, J. S., & Seltzer, M. M. (2012). Social support and well-being at mid-life
among mothers of adolescents and adults with autism spectrum disorders. Journal of Autism
and Developmental Disorders, 42, 1818–1826.
Spada, M. M., Nikčević, A. V., Moneta, G. B., & Wells, A. (2008). Metacognition, perceived stress,
and negative emotion. Personality and Individual Differences, 44, 1172–1181.
Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? Journal
of Health and Social Behavior, 35, 53–79.
Weiss, J. A., Robinson, S., Fung, S., Tint, A., Chalmers, P., & Lunsky, Y. (2013). Family hardiness,
social support, and self-efficacy in mothers of individuals with autism spectrum disorders.
Research in Autism Spectrum Disorders, 7, 1310–1317.
White, N., & Hastings, P. (2004). Social and professional support for parents of adolescents with
severe intellectual disabilities. Journal of Applied Research in Intellectual Disability, 17, 181–190.
Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics, 1, 80–83.

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