Intellectual disability parents: how video feedback can support their parental role
Parents with intellectual disabilities (DI) may face greater and specific difficulties in raising their children and interacting with them.
Advertising message Intellectual disability, previously defined as mental retardation, is included by DSM-5 (APA, 2013) among neurodevelopmental disorders. Intellectual disability is characterized by a more or less serious deficit in cognitive functions, such as reasoning, abstraction and learning, and by the difficulty of adapting autonomously to daily life and to the social context.
Emerson and colleagues (2015) note that parents with DI often live in conditions of socio-economic disadvantage: in their study, carried out in the United Kingdom, they found that families in which at least one of the parents had an intellectual disability, compared to families in which the parents did not have this diagnosis, they were poorer, reported a lower financial status and tended to live in a rented house. Parents with DI were also more often unemployed than those without DI, received less intergenerational support and were more socially isolated.
To these socio-economic difficulties are added those related to the interaction with their children. According to a study by Hamby, Lunkenheimer and Fisher (2019), parents with DI find it more difficult to build a cognitively stimulating environment. In addition, they may have internalized familiar patterns of neglect or they may have difficulty accessing positive examples of parenting, precisely because, as mentioned above, they have less contact in turn with their parents. Parents with DI can internalize other people’s negative beliefs about their parenting skills. Other difficulties they may encounter are related to planning, self-regulation and attention deficits. For example, a parent with DI might struggle to remember calling a babysitter; he may not be able to contain his anger or not be able to watch TV and at the same time be careful that his child is not hurt. Finally, parents with DI may have a hostile attribution bias, that is, have a tendency to trace the cause of others’ behaviors to hostility towards them, judging, for example, that their child is crying on purpose to irritate them.
Wickström, Höglund, Larsson and Lundgren (2017) note that children of parents with DI are four times more likely to receive a diagnosis of DI in turn than their peers. In addition, they are more exposed to the risk of traffic accidents, drowning, burns, suffocation or poisoning. The children of parents with DI represent a significant part of the children with whom social services are concerned, since they are often subject to neglect and, more rarely, to physical abuse or sexual abuse (Schuengel, Kef, Hodes and Meppelder, 2017).
Although the difficulties are present, a Dutch study (Willems, de Vries, Irini and Reinders, 2007) concluded that 33% of the parents with DI they interviewed were a “sufficiently good parent”, and that this was partly predicted by the quality of social support received.
Faced with this situation, Hamby and colleagues (2019) underlined the importance of conceiving parenting support interventions specifically addressed to parents with DI. In this regard, the authors proposed the use of video feedback, an intervention that consists in videotaping some interactions in ecological contexts between parents and children, and then commenting them later with a psychologist. The aim is to reinforce the resources already present in the report. The goal of Hamby and colleagues is to identify, through a systematic analysis, the characteristics of the video feedback that can be advantageous specifically for parents with DI.
Advertising message The authors argue that the intervention with video feedback has some strengths: first of all highlighting the skills of parents with DI contrasts negative beliefs about their parenting that they may have internalized and helps them feel more capable parents. This increases the motivation to engage in further effective parenting behaviors.
A further advantage is that video feedback is an intervention suitable for those with cognitive difficulties, because each session is relatively short (lasts about an hour), has a well-defined goal and a structure that is repeated in the various sessions. The program includes a total of about 10 sessions, so it is concentrated in a relatively limited time; thus decreases the risk that families stop joining the program because it is too prolonged over time.
The use of video feedback teaches parents concrete skills and not just abstract concepts. For example, teach parents to verbally label objects or situations in order to support children in the language learning process. Through reflection on the relationship with their children, parents with DI are also encouraged to exercise their executive functions, for example to pay more attention to the positive behaviors of the child or to increase their self-control.
The intervention through video feedback also supports the reflective function of the parents, that is, their ability to understand their children’s thoughts, emotions, motivations and behaviors. By verbalising the child’s possible internal states, the psychologist helps the parent to replace hostile attributions with more realistic, functional and positive ones. In this way the parent can train himself to give himself more adaptive explanations of his child’s behavior.
A further advantage of the video feedback is that reflections on how to improve one’s parenting take place starting from video recordings made in the context of normal family life, at home, during meals, during play. During the sessions, various daily experiences can be videotaped, in order to generalize the skills learned to the different contexts in which they must be put into practice. Since the intervention starts from the recording of what actually happens at home, it can be adapted to the needs of each family.
Finally, the video feedback facilitates a positive vision of parental support interventions, since generally a positive relationship is established between the person performing the intervention and the person using it. This increases the chances that parents with DI will turn to parental support programs in the future too.
The authors point out that this method of intervention can have limits, especially as regards economic sustainability, as the video feedback provides a one-to-one relationship between user and operator. In this regard, they suggest the possibility of verifying in the future the effectiveness of the video feedback carried out in group sessions. Another critical issue concerns the absence of data on the long-term effects of the intervention.
Although with some limitations, interventions that use the video feedback technique are promising to allow better relationship experiences for parents with DI and their children.