Problem Behavior in Children With

Intellectual Disabilities: Parenting Stress,

Empowerment and School Services
Jennifer S. Nachshen, Ph.D., 1 Nathalie Garcin, Ph.D., C.Pscyh, 2
& Patricia Minnes, Ph.D., C.Psych 3
1
Q ueen’s University and C oncordia University
2
Q ueen’s University & PR EM -TG C
3
Q ueen ’s Un iversity and O ngw anada

The Child Behavior Checklist3 was used to examine the relationship between child behavior problems
and various positive and negative stress and support outcomes in 100 Canadian parents of children
with intellectual disability (ID). The highest scores were observed on the Thought, Attention, and
Social Problems subscales, suggesting the Internalizing and Externalizing broad-band scales may
underestimate behavior problems in children with ID. The parents of the 43% of children with
clinically significant scores on the Total Problems scale reported more stress and lower levels of well-
being, social support, and family-centered school services than the parents of the children without
clinically significant scores on the Total Problems scale; however, their levels of empowerment were
similar. Parents who reported both Internalizing and Externalizing problems in their children
reported the most negative experiences.
Keywords: behavior problems, Child Behavior Checklist (CBCL), children, developmental disability,
developmental disorder, empowerment, family-centered services, intellectual disability, mental
retardation, parent stress, psychiatric disorder

n intellectual disability (ID) is defined as behavior problems in a Canadian sam ple of

A a significant lim itation in both

intellectual functioning and conceptual,
social and practical adaptive skills, originating
children with ID will be reported.
Parents of children with ID have been shown
to experience more stress than parents of children
before the age of 18. 5,37 This disability m anifests without disabilities, 9,21 as well as higher incidence
as a lowered ability to cope with com m on life of socio-econom ic disadvantage, physical illness,
dem ands and the failure to m eet the standards of and mental health effects including worry,
personal independence expected for the individual tiredness, and depression. 23 Previous studies have
in at least two of the following dom ains: focused on the characteristics of the child, such
comm unication, self-care, domestic skills, social as age, 25,45 type of disability, 45 and level of
skills, self-direction, com munity, academ ic skills, disability 28 to determine the relationship of these
work, leisure, and health and safety. characteristics to parental adaptation. An
Individuals with ID are at higher risk than im portant focus of research is the m itigation of
individuals without disabilities for developing a m aladaptation through the use of positive,
psychiatric disorder. 11 Research has reported the proactive coping mechanisms. 28 As well, many
prevalence of m ental health problems to occur in researchers have examined the use of formal 33
approximately 10 to 40% of individuals with and informal 16,56 support as a buffer for fam ily
ID. 48,49 Studies have also shown a high incidence m aladaptation. Child behavior problem s have
of clinically significant behavior problem s in been shown to impact fam ily outcom es 6,7,47,50,52 in
children with ID. 24,38,53,55 Behavior problems may fam ilies of children with ID. Research has shown
begin to develop in children with ID as young as that the severity of a child’s behavior problem s is
two-years-old 6 and rem ain stable across tim e, 55 an im portant contributor to a variety of outcomes,
possibly developing into a dual diagnosis in including parental stress and coping. 14,39 A strong
adulthood. 6 Behavior problems in children are negative relationship between child behavior
m ost often referred to as being either internalizing problem s and parent stress has been shown to
or externalizing in nature, and can include account for differences in parent stress regardless
behaviors that are a danger to oneself or to of ID diagnostic status 6,7,27 or specific etiological
others, such as self-injury, self-isolating or biting diagnosis. 1 Furtherm ore, m others who are m ore
and hitting. In this study, the prevalence of stressed are more likely to be users of form al

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support services, including m ental health, decisions and the enhancem ent of family
physical health, and com m unity services, 27 strengths and capabilities. These goals are
straining our social service system s. The purpose achieved through an interaction style that is
of the current study is to exam ine the relationship fam ily-oriented, positive, sensitive, responsive,
between child behavior problems and various and friendly. The fam ily-centered approach
positive and negative stress- and support-related respects the knowledge and com petencies of
outcomes in Canadian parents of children with parents and is designed to involve parents in
ID. decision-making. The authors posit that fam ily-
Despite findings that parents of individuals centeredness is critical in the school system,
with behavior problem s actively seek help from where parents are expected to participate in
m edical, psychological, and behavioral services, 38 educational decisions for their children. Parents
the research regarding the relationship between viewed the more fam ily-centered practice
child behavior and formal resources has been descriptions as being m ore ideal than descriptions
variable. Using the Double ABCX model Orr, et of practices that were less fam ily-centered. 43 The
al. 46 found that behavior problems did not current study explored whether the presence of
significantly predict family resources although clinically significant behavior problems is related
they did predict an outcom e of parental stress as to parents’ perceptions of fam ily-centered school
well as the parents’ ability to refram e their services.
perception of the stressor. Herm an and The value of social support is described
Marcenko 32 also found that the am ount of care frequently in studies of parental stress and
required by children with a disability did not coping. 8,15,25,26 Research has shown that being
predict the use or quality of inform al or formal connected to informal sources of support can
support services. However, Floyd and Gallagher 27 “buffer” the effects of a stressor. 16 Intagliata and
found that increased utilization of formal services Doyle 35 submit that parent groups m ay be popular
was related to the presence of child behavior because of the social support provided by “a very
problems, regardless of ID status. Floyd and special group of others all of whom share the
Gallagher argue that correlations between care same types of stress and burden as they do.” (p.6)
demands and service use m ay be attenuated by A recent review of the literature on social support
the helping nature of the services themselves; and outcomes in mothers of children with
thus, parents who have more demands receive autism 13 highlighted the benefit of social support,
m ore services, thereby reducing their dem ands. It as com pared to more formal sources of support,
m ay also be argued that the more im portant as a buffer for parental stress. Shin and
service use variable concerns the degree to which Crittenden 51 found that maladaptive behavior
the parent finds the service useful or helpful. predicted decreased social support in Am erican
Particularly relevant to the experiences of parents of children with ID, but did not predict
parents of young children with ID is the nature of social support at all in a Korean sample. The
service delivery in the school system . Current current study will explored the differences in
Canadian law has confirmed that school boards social support in parents of children with ID with
m ust accom m odate the needs of children with and without behavior problem s.
developmental disabilities in order to provide an Recently, researchers have argued for an
appropriate educational environm ent. As such, increase in studies exam ining positive outcomes
both segregated and integrated classroom s in fam ilies of children with disabilities. 31 Glidden 29
continue to exist in Canada and, in each setting, argued that “positive outcom es can coexist and
the school must develop an individualized even be orthogonal to negative outcom es but may
program. Parents are expected to participate in never get m easured if investigators are not
this process. They are encouraged to speak out for hypothesizing that they are present.” (p.482) An
their child’s needs, which can be an em powering exam ple of a positive outcom e is fam ily
experience. The degree to which the schools are em powerm ent. Fam ily em powerm ent has been
fam ily-centered in their interactions with fam ilies defined as: “… an intentional, ongoing process…
is especially important. 43 The relevant goals of through which people lacking an equal share of
fam ily-centered practices include the provision of valued resources gain greater access to and
emotional and educational supports to fam ilies, control over those r e s o u r c e s . ” 17 (p . 2 )
opportunities to participate in services and m ake Em powerm ent outcomes include intrapersonal

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(beliefs about control, self-efficacy, and perceived class or school and of those, 70% w ere in a
competence), interactional (the individual’s segregated developmental program, whereas 22%
relationship to their social environment), and were in a developmental program with integration.
behavioral (the person’s actions taken to exert Each participant family chose either the
some control over the environment) components. 57 m other or the father to complete the
A correlational analysis 51 indicated that higher questionnaires and mothers formed the m ajority
levels of empowerm ent were found to be of the respondents (97% ), w ith a m ean age of
significantly related to lower parental stress, more 40.32 years (SD = 5.45). The m ajority of parents
flexible and adaptable fam ily functioning, lower were married, rem arried or in a comm on-law
stress due to the child, parental employment, and relationship (85% ). The parents were highly
higher parental education. Self-efficacy, which educated, w ith 69% having at least a college or
can be viewed as a component of empowerment 51 university education. Only 16% had a high school
has been found to be strongly related to child education or less. Socioeconomic status (SES) was
behavior problem s in mothers of children with calculated using Hollingshead’s Four-Factor Index
autism. 30 In addition to exam ining differences in of Social Status, 34 revealing a mean SES of 48.19
negative family outcomes such as stress, this (SD = 12.33; m aximum SES = 66), indicating a
paper will contribute to the literature by high-SES sam ple.
exam ining the positive outcome of empowerment
P R O C ED U RE
for parents of children with ID with and without
behavior problems. Participants were recruited through several
organizations serving individuals with disabilities,
M ETHOD
local school boards, list-serves and websites, and
P ARTICIPANTS
through posters and advertisem ents about the
The presence of an ID was assessed using four study. Parents who were interested in
questions. The first asked the parents to list any participating contacted the researcher by phone
diagnoses that the child had received. The parents or by em ail. The questionnaire package took
were then asked if the child was in a special approximately one to two hours to complete.
school or class, whether or not the child had been Questionnaire packages were mailed or delivered
identified as an exceptional student, and whether personally to fam ilies who then returned their
or not the child had an Individualized Education packages once completed.
Plan (IEP). Children with a diagnosis of an ID
M E AS UR E S
and/or who had been identified by their school as
having an ID were included in the study. Children Dem ographics
whose diagnostic or IEP status was unclear or
A dem ographic questionnaire included
clearly indicated that the child did not have an ID
questions relating to the child, the parent
were excluded from the study. Children were not
completing the questionnaire, and the rest of the
directly assessed by the research team; therefore,
fam ily.
the intellectual level and specific adaptive
behavior skills of the sam ple are unknown. • The Child Behavior Checklist
Participants included 100 parents of children with
The Child Behavior Checklist 3 (CBCL) is a
ID from across Canada. The m ajority of parents
113-item checklist that measures children’s
were from Ontario (82% ), 15% were from the W est
competencies and problems as reported by their
Coast of Canada (British Columbia, Alberta, and
primary caregiver. Nine subscales reflect
Manitoba), and 3% were from New Brunswick.
syndrom es, or groupings of symptom s which have
The two most com mon diagnoses were autism
been shown to empirically co-occur. Internalizing
(38% ) and Down syndrom e (32% ). An additional
s u b s c a le s in c lu d e W ith draw n , S o m a tic
5% had a diagnosis of cerebral palsy or spina
Com plaints, and Anxious/Depressed.
bifida, while 13% had another diagnosis, such as
Externalizing subscales include Delinquent
fragile X syndrom e or fetal alcohol syndrom e. The
Behavior and Aggressive Behavior. The CBCL
rem aining 12% had a disability due to an
employs T-scores, in reference to age and gender
unknown cause. The children had a m ean age of
norms, so that scores can be compared across age
8.61 (SD = 2.63) 70% of which were boys. Twenty-
groups. Norms for this version of the CBCL were
seven percent of the children were in a special
only available for children without disabilities.

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Social Problem s, Thought Problems, Attention centered practice. Parents are asked to select the
Problems and Other Problems are also m easured. statement that best reflects the typical practice,
As well, a Total problem score is m easured. and a statement that reflects the practices that
A review by Em bregts 22 states that the CBCL they would consider to be ideal.
has frequently been used with children with The internal consistency of the scale was
intellectual disabilities; however, the instrument found to be adequate (a = .90). The construct
was not norm ed on a population of children with validity of the measure was assessed by
ID. A factor analysis conducted on the CBCL by comparing it to the Helpgiving Practices Scale. 19
Borthwick-Duffy, et al. 12 found that the broad- Moderately large correlations were found. The
band factor structure was confirmed for children authors conclude that the FCESPS is a reasonable
with developm ental disabilities. A recent re- m easure of perceptions of fam ily-centered
exam ination of the reliability of the subscales of practices in elem entary schools for both parents
the CBCL for children with ID, using parents as of children with and without developmental
respondents, found adequate internal consistency disabilities.
for all narrow-band and broad-band scales. 10
• The Social Support Index
Although Achenbach 4 recom mends using raw
scores for statistical research with the syndrom e The Social Support Index 40 (SSI) is a 17-item
scales, the Internalizing, Externalizing, and Total instrument that uses a 5-point Likert scale
Problems scales can be compared using T-scores, ranging from Strongly Disagree to Strongly Agree.
to prevent the age and sex variables from being The SSI was not specifically designed for fam ilies
confounded with other variables. of children with intellectual disabilities; however,
it measures the degree to which fam ilies view
• The Parenting Stress Index
their com munity as a source of support. The
The Parenting Stress Index 2 (PSI) is a 120-item internal reliability of the SSI has been found to be
self-report instrum ent developed to measure adequate (a = .82), with test-retest reliability of r
stress in parent and child dom ains, and has been = .83. 42
used with families of children with developmental
• The Family Member Well-Being Index
disabilities. 9,46 The Child Domain consists of six
subscales: A d a p ta b ility, Acceptability, The Fam ily Member W ell-Being Index 41
D e m a n d in g n e s s , M ood, D is t r a c t i b ility / (FMW B) is an 8-item m easure of the fam ily
Hyperactivity, and Reinforces Parents. The Parent m em bers’ well-being in the areas of health,
Dom ain consists of seven subscales: Depression, tension, energy, cheerfulness, fear, anger,
Attachm ent, Restriction of Role, Sense of sadness, and general concern. This 8-item scale,
Com petence, Social Isolation, Relationship with which was not developed specifically for use with
Spouse, and Parental Health. The internal families of children with intellectual disabilities,
consistency of the PSI subscales ranged from .70 has been found to have adequate reliability (a =
to .83 for the subscales of the Child Domain and .86) and validity.
from .70 to .84 in the Parent Dom ain. Factor
• The Family Empowerment Scale
analytic studies have supported the structure of
the PSI and it has been validated in studies with The Fam ily Em powerm ent Scale 36 (FES) is a
parents of children both with and without 34-item instrum ent developed to assess
intellectual disabilities. 2 empowerment in fam ilies whose children have
“em otional disabilities.” The fram ework of the
• The Family-Centered Elementary School
questionnaire consists of two dimensions. The
Practices Scale
first dim ension reflects three levels of
The Fam ily-Centered Elementary School empowerment: (a) Fam ily, (b) Service System , and
Practices Scale 44 (FCESPS) is a 20-item scale (c) Comm unity/Political. Only the family level was
designed to measure fam ily-centered practices in used in this analysis, reflecting the ability to
elementary schools. Fourteen items address m anage day-to-day situations. The second
general family-centered school practices, and six dim ension reflects th e expression of
items address fam ily-centered special education empowerment: (a) Attitudes, (b) Knowledge, and
practices. Each item on the scale consists of five (c) Behaviors. Responses fall on a 5-point Likert
statem ents reflecting different levels of family- scale ranging from Not True at All to Very True.

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 109

The psychometric properties of the (BP) group; n = 43) or not (No Behavior Problem (No
questionnaire were examined in a study of 440 BP) group; n = 57). The children in the two groups
parents of children with emotional and behavioral did not differ in age (t(98) = -.75, ns). The no BP
disorders. 36 The scale was found to have adequate group (M = 50.52, SD = 11.39) had a higher SES (t
internal consistency for each of the three = 2.09, p < .05) than the BP group (M = 45.31, SD
subscales (Fam ily: a = .88; Service System: a = = 12.97); however, both groups were found to be in
.87; and Com munity/Political: a = .88). The test- the middle class range. A Chi-square analysis
retest reliability (N = 107) was also found to be revealed that there was no significant difference in
adequate for each of the three subscales (Fam ily: the distribution of boys and girls between the two
r = .83; Service System : r = .77; and groups (P2 (1) = 0.36, ns).
Com m unity/Political: r = .85) over a 3- to 4-week T-tests were run to determine differences in the
interval. Validity of the scale was assessed outcome variables based on Total Problems status.
through a factor analysis, which supported the Not surprisingly, parents of children with BP (M =
correspondence of the Level dimension of the 151.11, SD = 21.02) reported more stress on the
conceptual fram ework. As well, the questionnaire Child Domain of the PSI, t(98) = -7.62, p < .001,
was found to significantly discriminate parents than parents of children without BP (M = 119.07,
who were involved in a variety of advocacy–related SD = 20.66). Furthermore, parents of children with
activities from those who were not. The FES has BP (M = 141.86, SD = 24.89) reported more stress
been also been successfully used in studies on the Parent Domain of the PSI, t (98) = -3.63, p
involving families of children with ID. 54 < .001, than parents of children without BP (M =
125.23, SD = 20.83). Parents of children with BP
R ESULTS (M = 40.53, SD = 15.56) also reported significantly
less overall well-being on the Family Member Well-
The percentage of children reported by their
Being scale, t(98) = 2.21, p < .05, than parents of
parent to have problems within the clinically
children without BP (M = 46.86, SD = 13.07).
significant range on each of the narrow-band
In regard to informal sources of support, the
scales on the CBCL is presented in Figure 1. On
difference between the groups on the SSI was not
the broad-band scales of the CBCL, 14% of
significant, t(98) = 0.72. Parents of children with
parents reported that their child had only
BP (M = 51.05, SD = 12.28) reported that their
Internalizing Problems in the clinical range, 11%
typical school services were significantly less
reported only Externalizing Problem s in the
family-centered, t(98) = 3.00, p < .01, than parents
clinical range, and 7% reported the presence of
of children without BP (M = 43.60, SD = 12.27).
both clinically significant Internalizing and
However, the difference between the groups with
Externalizing Problem s. Forty-three percent of the
regard to their ideal school services was not
children were reported by their parents to have a
significant, t(98) = 0.30. These findings suggest
Total Problem s scale score in the clinically
that parents of children with BP perceived more
significant range. disparity than parents of children without BP
Due to the large number of identified children between the services that they were currently
with Down syndrom e (n = 32) and autism (n = 38), receiving and their ideal level of services.
it was possible to com pare the two groups on the Despite reporting more stress, less well-being,
narrow-band scales of the CBCL to determ ine the and less social support than parents of children
differences in behavior problems by diagnosis. without BP, parents of children with BP reported
The mean age of the children in the autism group similar levels of empowerment on each of the
was 8.13 (SD = 2.81), which did not differ (t(67) = Family (t(98) = 0.81, ns), Service System (t(98) =
0.74, ns) from the m ean age of the children in the 1.22, ns), and Community/Political (t(98) = 0.22)
Down syndrom e group (M = 8.63, SD = 2.65). The subscales of the Family Empowerment Scale.
results of T-scores presented in Figure 2 To further examine the role of behavior
dem onstrate that parents of children with autism problems, the children were separated into four
report significantly more behavior problem s on all groups depending on whether they had clinically
scales except for the Delinquent Behavior significant Internalizing problems only (n = 14),
subscale. Externalizing problems only (n = 11), both
Participants were separated into two groups, Internalizing and Externalizing problem s (n = 7),
depending on whether their Total Problems Scale or no behavior problem s (n = 57; children with
score was in the clinical range (Behavior Problem Total problem scores in the clinical range were

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110

F IGURE 1. P ERCENTAGE OF C HILDREN W ITH C LINICALLY S IGNIFICANT S CORES

ON THE S UBSCALES OF THE CBCL

F IGURE 2. T-S CORES ON THE S UBSCALES OF THE CBCL FOR C HILDREN W ITH
D OWN S YNDROME (n=32) AND A UTISM (n=38)

Down Syndrome

Autism

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 111

excluded from this group, even though they did not van der Ende and Verhulst 18 who suggested that
have Internalizing or Externalizing scores in the “these areas of problem behavior should be a
clinically significant range). Table 1 contains the m ajor point of focus in the care of these children.”
findings for the analyses. Post-hoc analyses of (p.1093) Furtherm ore, the Social, Thought and
significant results revealed that parents who Attention Problem s subscales do not contribute to
reported both externalizing and internalizing either the Internalizing or Externalizing factors on
problems experienced more stress on the Parent the CBCL; thus, research em ploying only the
and Child Domains of the PSI, lower levels of social broad-band scales may underestimate behavior
support, and lower family empowerment than the problem s in children with ID. Given these
other three groups. Parents of children with differences, when comparing children with and
neither internalizing nor externalizing behaviors without ID, it is of im portance for researchers to
reported the least stress. Parents of children with include the analyses of all the narrow-band
internalizing and externalizing behavior problems subscales of the CBCL.
reported equivalent levels of stress, social support, Parents of children with autism reported
and empowerment. One interesting finding was significantly m ore problem behaviors on all scales
that parents of children with internalizing behavior of the CBCL than parents of children with Down
problems reported lower levels of family-centered syndrom e, except for the Delinquent Behavior
school services than parents of children with subscale on which the difference was non-
externalizing behavior problems or neither type of significant. Dykens and Hodapp 20 describe a
behavior problems. Similarly, parents of children “Down Syndrom e advantage,” (p.57) which they
with both types of behavior problems also reported attribute to the relative visibility of the diagnosis
lower levels of family-centered school services. as well as two characteristics of children with
D ISCUSSION Down syndrom e, nam ely sociability and a lack of
psychopathology. According to their review,
Consistent with estimates from previous children with Down syndrome are less likely than
studies both in the US and Canada investigating children with other disorders to evidence
behavior problems in children with ID, 6 ,7 ,2 4 43% of psychopathology and when they do, the symptoms
the parents in this Canadian sample reported tend to be less severe. It m ay also be that the
clinically significant behavior problems in their specific tool used was more sensitive to the
children with ID. Interestingly, the prevalence problem s associated with disorders of the autism
estimates of behavior problems in this sample of spectrum , including items such as “stares
children also appear to correspond with prevalence blankly,” “withdrawn,” “repeats strange acts,” and
estimates of dual diagnoses in the adult “strange behaviors.” 18
population.4 8 ,4 9 This parallel lends support to the Considering the results of previous research
hypothesis that these problems are stable over the highlighting the saliency of behavior problems as
life span.5 5 Further longitudinal research should be predictors of fam ily outcomes, 6,7 it is not
conducted to investigate whether childhood surprising that parents of children with behavior
behavior problems develop into psychopathology in problems reported more stress, less well-being,
adulthood. These findings highlight the need to and perceptions of less fam ily-centered school
study the d evelop m en ta l trajec tories of services than parents of children without behavior
psychopathology in individuals with ID in order to problem s. Interestingly, both groups reported
promote early identification and intervention in equivalent levels of social support and the positive
this population. outcome of em powerm ent. These findings support
More parents reported internalizing versus the notion that positive outcomes m ust be
externalizing problems in their children with ID; exam ined in addition to negative fam ily outcomes,
however, an examination of Figure 1 suggests that as the two may exist sim ultaneously. 29,31
the traditional structure of the broad-band Not surprisingly, parents of children with both
clusters of the CBCL m ay not capture the range of Internalizing and Externalizing problems reported
behaviors displayed by children with ID. M ore the m ost negative and the least positive outcomes
specifically, children in this sam ple were most whereas parents of children without any behavior
likely to display clinically significant behavior problem s reported the least negative and the m ost
problems on the Social Problem s, Thought positive outcomes. Generally, parents of children
Problems, and Attention Problems subscales, with only Externalizing and only Internalizing
corroborating results of a study by Dekker, Koot,

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 T ABLE 1. ANOVA S AND P OST -H OC A NALYSES FOR I NTERNALIZING O NLY , E XTERNALIZING O NLY , B OTH
AND N EITHER G ROUPS ON O UTCOME V ARIABLES
Scale df F p Internalizing Externalizing Both Neither Post Hoc
(M, SD) (M, SD) (M, SD) (M, SD) Analyses

PSI Child Domain 3,85 22.50 < .001 145.41, 20.50 145.90, 18.86 175.00, 9.43 119.18, 20.83 B > I = E > N

PSI Parent 3,85 8.71 < .001 140.93, 22.54 131.42, 24.49 164.60, 14.14 124.81, 20.47 B > I = E
Dom ain B > N , I > N
E = N

Social Support 3,85 4.24 < .01 46.64, 7.14 49.82, 5.17 37.00, 7.55 47.33, 8.45 B < I = E = N
Index

FCESPS: Typical 3,85 5.88 < .01 39.79, 10.59 49.91, 10.05 37.14, 9.81 51.21, 12.32 I = B < E = N
Services

FCESPS: Ideal 3,85 0.22 ns 71.57, 3.91 71.64, 3.29 70.71, 4.11 71.05, 2.98
Services

FES: Fam ily 3,85 3.01 < .05 51.07, 5.51 52.00, 6.99 44.14, 9.25 49.75, 5.04 B < I = E = N
Em powerment

FES: Service 3,84 1.31 ns 51.07, 5.51 52.00, 6.99 44.14, 9.25 49.75, 5.04
System
Em powerment

FES: Comm unity/ 3,85 1.96 ns 39.93, 7.29 35.27, 9.13 32.29, 5.68 36.16, 7.02
Political
Em powerment

Fam ily M ember 3,85 2.09 ns 39.36, 15.74 48.09, 14.55 35.43, 10.55 46.09, 13.80
W ell-Being

NOTE: PSI Parenting Stress Index, FCECPS Fam ily-Centered Elementary School Practices Scale,
FES Fam ily Em powerm ent Scale
 113

behaviors were equivalent. However, one of the ACKNOWLEDGMENT: This research was
most surprising findings was that parents of supported by a doctoral fellowship from the Social
children with Internalizing problems reported Science Human Research Council of Canada.
equivalent levels of perceived family-centered
R E FE RE N CE S
services as parents of children with both
Externalizing and Internalizing problems. Parents 1. Abbeduto L, Seltzer M M , Shattuck P, et al. Psychological w ell-being
and coping in m others of youths with autism , Down syn drom e, or
of children with Externalizing problems, however, fragile X syndrom e. Am J Ment Retard 2004;109:237-254.
were similar to parents of children without any 2. Abidin RR. P arenting Stress Index— Manual. Charlottesville, VA:
clinically significant behavior problems. This Pediatric Psychology, 1995.
finding suggests that families of children who are 3. Achenbach TM . Child Behavior Checklist for Ages 4-18 (CBCL).
withdrawn or depressed may be falling through the Burlington, VT: U niversity of Verm ont Press, 1991a.

cracks when it comes to family centered-services in 4. Achenbach TM . Manual for the Child Behavior C hecklist/4-18
and 1991 Profile. Burlin gton, VT: University of Verm ont,
the school, lending support to the adage “the Departm ent of Psychiatry, 1991b.
squeaky wheel gets the oil.” Another plausible 5. Am erican Psychiatric Association. D iagnostic and Statistical
hypothesis is that parents whose children display Manual of M ental D isorders, Text Revision. W ashington, DC:
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