Predicting adequacy of parenting by people with mental retardation

ChildAbusr& Neglecr, Vol. 16.pp. 165-178, 1992 Printed in the U.S.A. Ail rights reserved.

Copyright

0145-2134192 $5.00 +.OO E! 1992 Pergamon Press Ltd.

PREDICTING ADEQUACY OF PARENTING BY PEOPLE WITH MENTAL RETARDATION ALEXANDER J. TYMCHUK SHARE/UCLA Parenting Project, Department of Psychiatry, School of Medicine, UCLA, Los Angeles

Abstract-While there has been increased attention placed upon the inadequacy of parenting by persons with mental retardation, such attention does little to increase our understanding of the complexities of parenting. A refocusing of research and intervention efforts is needed to examine the concomitants of adequacy of parenting. What we know about both the inadequacy as well as the adequacy of parenting by persons with mental retardation and the limitations of the information upon which we base these statements is reviewed. New foci are suggested in understanding both adequacy and the inadequacy of parenting by persons with mental retardation. Ke.y Words-Prediction,

Adequacy, Parents, Mental retardation.

INTRODUCTION THE ISSUE OF PARENTING by people with mental retardation is extremely complex and controversial and one in which pejorative historical perspectives, current subjective opinion and limited empirical information make it difficult to give clear and authoritative answers to the many questions that comprise this issue (Tymchuk, 1990a). However, it is clear that people with mental retardation are becoming parents and will continue to do so. Unlike any other group of parents, the adequacy of parenting by persons with mental retardation will continue to be scrutinized despite the limited empirical information on which to base such scrutiny (Tymchuk, Andron & Unger, 1987). When examining adequacy of parenting by persons who are mentally retarded, tmditionally, child developmental theorists and early intervenors have focused upon the cognitive development of the child as a criterion (e.g. Garber, 1988; Ramey & Campbell, 1984). Child cognitive development, while important, is only a single child outcome of parenting adequacy. In reality, when questions are first raised about the adequacy of parenting by a person with mental retardation in either a legal (Hayman, 1990; Wald, 1976) or a clinical framework (Tymchuk, 1990a), child physical and emotional health and safety are the primary concerns. At the same time, there has not been a examination of the relationship between individual autonomy, full citizenship and personal growth of the parent him- or herself and adequacy of parenting. These are questions similar to those asked about other types of parents (e.g., Booth, Barnard, Mitchell, & Spieker, 1987; Cohler & Musick, 1984; Delgado, 1986). The purpose of this article is to discuss these traditional outcomes, what we know about them including the validity of the information on which this knowledge is based and to present additional outcome variables and the evidence for their consideration in a comprehensive discussion of parenting by people with mental retardation. Received for publication December 17, 1990; final revision received July 23, 199 1;accepted July 24, 199 1. Reprint requests to Alexander J. Tymchuk, Ph.D., UCLA, Neuropsychiatric Health Sciences, 760 Westwood Plaza, Los Angeles, CA 90024- 1759. 165

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Issues Related to the Adequacy of Current Information There are, however, a number of issues regarding the validity of the information we currently have on parents with mental retardation that must be considered before any thoughtful discussion of adequacy of their parenting can occur. First, much of what we know today was derived from earlier work during a particularly restrictive period of time which by its very nature was biased against people with mental retardation becoming parents (Buck v. Bell, 1927; Koller, Richardson, & Katz, 1988; Scheerenberger, 1983). These early descriptions continue to be uncritically accepted in current discussions of this topic, when in reality, they should largely be discarded or at least critically reexamined (Tymchuk et al., 1987). A second issue with our current information base is that there has been little empirical research on parents with mental retardation (Tymchuk, 1990a). Much of what we know has been derived from subjective descriptions, based upon single or small numbers of mothers who may or may not have been mentally retarded, who were referred for suspicion, and sometimes for evidence, of abuse and/or neglect (Bowden, Spitz, & Winters, 197 1; Crain & Miller, 1978) or for other service needs, with infants or very young children, to systems that were generally ill-prepared for the multiple needs of this population (e.g., Espe-Sherwindt & Kerlin, 1990; Lynch & Bakley, 1989; Tymchuk et al., 1987). Or alternately, analyses were made of parents referred for suspicion of abuse and generalizations then made from the disproportionate number of parents with IQs in the mental retardation range to all parents with mental retardation (e.g., Seagull & Scheurer, 1986). Attempts too have been made to generalize from work with parents with borderline IQs who may or may not currently be or were ever diagnosed as mentally retarded (e.g., Fantuzzo, Wray, Hall, Goins, & Azar, 1986; Martin, Ramey, & Ramey, 1990; Slater, 1986). Such generalization has been made in part based upon the assumption that parents with actual diagnoses of mental retardation are similar to those with borderline IQs. While there may be many similarities between the two groups, there are substantial differences suggesting that these are two very different populations which may require very different strategies. Some persons with diagnoses of mental retardation and particularly some who may be parents today, who, invariably have mild mental retardation, may have been institutionalized for varying lengths of time, probably were in special educational programs, perhaps participating in special vocational programs and were outside society’s mainstream. All of these situations have been shown to not provide either optimal socialization or any parenting skills (e.g., Baller, 1936; Block, 1984; Brandon, 1960; Brantlinger, 1988; Dowdney, Skuse, Rutter, Quinton, & Mrazek, 1985). A third issue is that although we have been attempting to predict adequacy of parenting by persons with mental retardation (i.e., a positive outcome), such adequacy often has been defined peculiarly as inadequacy of parenting (usually seen as abuse and/or neglect which are negative outcomes). This preoccupation with the prediction of “inadequacy of parenting” rather than with the “adequacy of parenting” by persons with mental retardation has led to a prolonged focus upon the description of negative aspects of parenting by persons with mental retardation. Thus, descriptive as well as research reports have invariably reported on how poorly people with mental retardation parent while essentially ignoring any evidence to the contrary and may be part of a self-fulfilling prophecy (Accardo & Whitman, 1990; Schilling, Schinke, Blythe, & Barth, 1982; Seagull & Scheurer, 1986; Whitman & Accardo, 1989). Such a preoccupation has led to a determination of how many and who are inadequate as parents rather than an equal effort examining how many and who are adequate as parents by whatever standard is to be used. Such determination itself is related to an interest upon child removal rather than upon the identification of reasons for such inadequacy, of ways to remediate parenting deficiencies or upon the identification of reasons for such adequacy and then of ways to bolster and foster those strengths (Tymchuk, 1990a; Tymchuk & Dess, 1977). Early

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on, for example, Mickelson ( 1947, 1949), while reporting on the inadequacy of parenting by approximately one third of the persons with mental retardation in her studies, also reported that a third of the parents provided satisfactory care while another third provided somewhat adequate care. Ainsworth, Wagner, and Strauss ( 1945) in an even earlier followup of women who had been discharged from an institution before the second world war were more positive remarking not only on how well the majority of the women did both as parents but also as workers filling jobs vacated by other workers in the war effort. More recently, Ramey and his colleagues (Martin et al., 1990) reported that while the homes of 54% (or 22 families) in their experimental group of mothers with low IQs were seen as inadequate on followup, the homes of 42% (or 19 families) in their contrast group were seen as adequate. At the same time, 93% of the children in their experimental group compared to 69% of the children in their contrast group had IQs in the normal range after a followup of 54 months. Feldman, Case, Towns, and Betel ( 1985) also found remarkable similarities between HOME scores for their sample and reported norms. While important, the emphasis has continued to be upon those families and children who do poorly. Of equal or even of greater importance, however, given the inadequate response by society to remedying reasons for such perceived parenting deficiencies, is the identification and reinforcement of reasons why a substantial proportion of the homes are seen as adequate and why a substantial proportion of the children have IQs at least in the normal range. This information is indicative of a substantial proportion of poor people with low IQs assuming individual responsibility, doing reasonably well and whose children also may do well (Garmezy & Rutter, 1983).

METHOD What Are We Attempting to Predict? Parental ~nade~~~~c~as de~ned as the oc~rrence of abuse a~d/or neglect. The two most often used descriptors of parents with mental retardation have been that they are abusive and/or neglectful (Schilling et al., 1982). Each of these variables has been viewed both as an outcome of parenting inadequacy as well as a predictor of future inadequacy (i.e., the recurrence of abuse and/or neglect). While early attitudes suggested that most or all parents with mental retardation abused and/or neglected their children, more recent research has shown that neither of these assertions is correct (Tymchuk & Andron, 1990). Although there is a need for the prospective study of more representative samples of parents with mental retardation, abuse perpetrated by these parents may be infrequent. In a number of studies of parents with mental retardation who actually were referred for parent education (e.g., Feldman et al., 1986; Peterson, Robinson, & Littman, 1983) or of randomly selected mothers with low IQs some of whom had IQs in the mental retardation range (e.g., Garber, 1988; Martin et al., 1990; Slater, 1986), neither observed or suspected child abuse nor concomitants of abuse such as physical punishment nor child abuse reporting requirements were mentioned. In fact then, purposeful abuse by the mother may be rare. Where purposeful abuse does occur, often it is as a result of another person associated with the mother rather than the mother herselfincluding a husband or partner (either male or female) who is emotionally disturbed or who engages in criminal behavior (e.g., takes or sells drugs) or who may be a relative (mother or sister) (Koiler et al., 1988; Lynch & Bakley, 1989; Tymchuk & Andron, 1990). Where a mother with mental retardation commits purposeful child abuse, this is a very strong predictor of the occurrence of future abuse in the absence of the provision of any parenting education or supports (e.g., Tymchuk & Andron, 1990). At the same time, it appears that if a mother with mental

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retardation has committed purposeful abuse, she is less likely to benefit from that intervention either being reluctant to acquire or to maintain the skills taught (e.g., Tymchuk & Andron, 1990). There are no studies with parents with mental retardation of other factors that have been shown to be predictive of purposeful abuse in other populations such as being abused as a child herself, the frequency of stressful events or of a general inability to cope or such child related characteristics as temperament, health impairment or disability. Parental adequacy as defined as the nonoccurence of abuse. While less attention has been paid to what factors differentiate abusive from nonabusive parents with mental retardation, there are predictors of the nonoccurrence of abuse (i.e., the adequacy of parenting at least as defined as the nonoccurrence of abuse). Parents with mental retardation who do not purposefully abuse their children have adequate suitable societal (e.g., financial assistance, parenting classes, planned oppo~unities for success) as well as familial supports (Tymchuk & Andron, 1990; Zetlin, 1986; Zetlin, Weisner, & Gallimore, 1985). It is not clear whether other factors such as not having been abused as a child, having had appropriate child-rearing models or parenting education or having a single child without health or behavioral problems are predictive of the nonoccurrence of abuse in this population. Of interest, is the appearance that IQ by itself, is not a predictor either of the occurrence or of the nonoccurrence of purposeful child abuse in parents with mental retardation. Parental inadequacy as defined as the occurrence of neglect. Unlike abuse, child neglect appears to occur often when a parent is mentally retarded; however, it is unclear whether the frequency of neglect is any greater than that seen among other poor people and to what extent, the idea of neglect (as well as abuse) becomes a self-fulfilling prophecy. Neglect in this population appears to occur out of omission (e.g., Tymchuk & Andron, 1990). While an IQ below a certain level, usually taken to be 60, by itself is a predictor of neglect, the best predictor appears to be the absence of suitable societal or fan&at supports who can help prevent neg~ect~~~ conditions (e.g., Tymchuk & Andron, 1990). Another major predictor of the presence of neglect is the degree to which there is a discrepancy between the mother’s own resources including her knowledge, skills and experiences and the needs, not only of her child, but also of her family and of herself and the length of time that this discrepancy has existed. Other characteristics that are related to an inability to cope include having more than one child, living with a partner who has a medical or emotional problem or having a problem in addition to her mental retardation including depression (Koller et al., 1988; Lynch & Bakley, 1989; Tymchuk, submitted, Tymchuk & Andron, 1990). Having a spouse/partner with mental retardation may not necessarily be related to neglect. Pa~e~ltal adeqL~a&~~ as de~ned as the nonoccurrence ef neglect. While there has been significantly less study of those mothers in which there is an absence of neglect or who at least have not come to the attention of agency staffs, there appear to be some excellent predictors of such absence. The most critical predictor is the presence of suitable socia1 and other supports that are matched as closely as possible to the needs of the mother including her learning style and learning capacity. Given the limited information on which we must necessarily base our conclusions, it appears that some mothers with the greatest needs may be living in situations with their own or their husband’s parents which may or may not be beneficial (Tymchuk & Andron, 1990). Such arrangements might lower the reported incidence of neglect. Critical characteristics of other supports include their availability (i.e., proximity, transportation provided), comprehensiveness (i.e., covers all needs including financial, medical, educational for the mother as well as her child), frequency and dumtion (i.e., provided often enough and long

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enough), longevity (i.e., is available as long as needed potentially for years), place (i.e., provided within the home for maximum generalization) and being provided by staff with training specifically to work with parents with mental retardation (e.g., Budd & Greenspan, 1985; Es~-She~indt & Kerlin, 1990; Lynch & Bakley, 1989; Tymchuk & Andron, 1990). Unfortunately, there have been no published data on any program in which all of these factors have been addressed. What Else Are We Trying to Predict? Other Parent Outcomes Current knowledge and skill. Other, more recently considered parental outcomes, but ones that are implied in the questions of abuse and/or neglect, have been the areas and levels of parenting knowledge and occasionally, the parenting skills of a person with mental retardation. Parental knowledge and skill have been seen as both predictors of parental adequacy as well as outcomes of interventions designed to improve adequacy of parenting. However, less attention has been paid to the development of knowledge and skill in part because the methodology for such dete~ination in parenting by a mother with mental retardation is stili very rudimentary and is limited by the lack of an agreed-upon definition of the complexities of parenting, by the consequent inadequate operationalization of the concepts and by the noticeable lacks of suitable empirically established methodologies for such determination. This determination also has been undermined by the conceptualization of parenting as static rather than as dynamic such that current knowledge and skills are emphasized to the exclusion of the future acquisition of knowledge and development of skills, by the lack of attention to the identification of processes by which those skills are developed, by the use of in vitro rather than in vivo situations for the development of parenting knowledge and skill and by the use of a middleclass standard for comparison and for programmatic development purposes. As in other areas of knowledge and skill for persons with mental retardation where recognition of these issues has occurred and with consequent task analysis and o~rationalization resulting in learning these (e.g., Jones, VanHasselt, & Sisson, 1989), are needed in parenting. In response to perceived needs and in the absence of other tools, individual service providers have chosen tools from other areas for use with parents with mental retardation sometimes mismatching assessment tool to the intervention. The HOME (Bradley & Caldwell, 1984) for example, has been used widely for prediction as well as for outcome purposes in interventions with mothers with low IQs. When a low rating is obtained, however, the HOME’s general ratings provide little on which to base the type of precise interventions that are needed with parents with mental retardation in such areas as home safety (Tymchuk, Hamada, Andron, & Anderson, 1990a) or responding to emergencies (Tymchuk, Hamada, Andron, & Anderson, 1989, 1990b). Other service providers have developed a brief instrument for their own needs invariably without attention to the empiricism required to ensure that any results, positive or negative, are as a result of the inte~ention and not of the assessment device (e.g., Accardo & Whitman, 1990). Healthcare and safety. While there have been few empirical studies of the assessment of any area of parenting knowledge or skill by people with mental retardtion, those that have been published, demonstrate that some proportion of the parents with mental retardation studied have limited knowledge and few of the in vitro or in vivo skills necessary for the adequate provision of healthcare or safety of a child by themselves (Tymchuk et al., 1989, 1990a, 1990b). The greatest lack of knowledge for healthcare, safety and emergency responsiveness occurs with illnesses or emergencies that require good identification and understanding of the significance of symptoms (e.g., raised brown spots) and often complex responses (e.g., choking or ~isoning) and for which there is the greatest potential danger to the child (Tymchuk,

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1990a, 1990b; Tymchuk et al., 1989, 1990a, 1990b). The actual suggested responses by the mothers too often include behaviors that if implemented would be even more harmful to the child or to themselves. Such limited knowledge and skill in child healthcare and safety in parents with mental retardation, which are normatively seen as components of adequate parenting within Western society, however, appear to be very similar to the levels of knowledge and skill of other poor parents who are not mentally retarded. As a result of the diagnosis of mental retardation, their own parents or relatives, may have initiated informal and ongoing supports including child healthcare and safety responsibility for the parent with mental retardation and her child. Thus, a significant predictor of the adequacy of the provision of healthcare and safety for a child of a person with mental retardation is the adequacy of supports that person has regardless of their own level of knowledge and skill. In the absence of those supports, the limitation in parenting knowledge and skill, places their children in apparently as great or greater degree of endange~ent as those of other poor parents.

Decision making. The ability of parents with mental retardation to recognize decisions that need to be made in each area of parenting in preparation for their child’s attainment of each developmental level, has been questioned. While adequate decision making is a predictor of adequacy of parenting, little is known either about the decision making processes used, or the actual decisions made by any parent, including those with mental retardation, in any given situation. In the only studies to date, parents with mental retardation made in vitro high and low risk decisions that were remarkably similar to those of other poor parents (Tymchuk, Yokota, & Rahbar, 1990), their decision making processes were characterized by rapidity rather than deliberation and lacked all of the traits of thoughtful decision making (Tymchuk, Andron, & Rahbar, 1988). Generally, mothers with higher IQs made better decisions and understood more of the situations; however, mothers with problems in addition to their retardation regardless of IQ, often did the poorest, as did the only mother who had abused her children.

O~parent-child interaction. Parent-child style of interaction as an area of parenting knowledge and skill determination in general has received the greatest amount of empirical attention and has been seen as a predictor of parental inadequacy or adequacy. Numerous studies have demonstrated differences in parent-child interactional style of poor mothers with low IQs and that of middleclass mothers as the normative standard of comparison and between poor mothers with low IQs of children with low or normal IQs. The mother-child interactions of poor mothers with low IQs have been seen to be less varied, less reinforcing and more directive than those of middleclass mothers (e.g., Mira, 1982, 1984). And while the first type of interaction has been associated with lower IQs in their children (e.g., Ramey & Campbell, 1984), a more positive, supportive and varied style, has been shown to be associated with higher IQs in the children of poor mothers with low IQs (e.g., Slater, 1986). There has been very limited empirical study of the manner in which the mother with mental retardtion interacts with her child as a baby or later in life or in other than laboratory circumstances. Despite this limitation, the parent-child style of interaction of mothers with mental retardation has been characterized as being less varied, less supportive and less reinforcing and more punitive and directive than middlecla~ mothers (e.g., Feldman et al., 1986; Mira, 1984; Peterson et al., 1984). It is not clear whether this style of interaction is significantly different than that of other poor mothers with low IQs or whether all mothers with mental retardation act in this manner. It also has been assumed that this style of interaction, as it does with children of poor mothers with low IQs, places the child of a mother with mental retardation at significant risk for cognitive delay.

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Several recent studies have suggested that mothers with mental retardation are not necessarily punitive towards their children (Feldman et al., 1986; Tymchuk & Andron, in press-a). Correlational studies of small samples of mothers with low IQs or with mental retardation and their children show that a restricted style of interaction is related not only to lower child IQ, but also to decreases in child IQ over time (e.g., Martin et al., 1990). While a lower child IQ can be predicted from such a restricted style of interaction, less is known about the predictors of this style of interaction itself in mothers with mental retardation. One type of parent-child style, largely based upon middleclass standards, however, has not necessarily been seen as a required component of adequate parenting within Western society. Unlike child healthcare and safety, there is less consensual agreement about the necessity of a single normative style of interaction for adequacy of parenting. For parents with mental retardation then who invariably are poor, there is a need to consider the appropriate use of a single standard because it places them in the position of being doubly jeopardized as they not only have to overcome the deficits inherent in poverty, but also those related to their mental retardation (Tymchuk, 199 1). Parent-child interaction: Dealing with child problematic behavior. Another aspect of parentchild interaction, is how a parent deals with or responds to child problematic behavior and/or disciplines their child. An outcome for adequacy of parenting for any parent then is whether how they deal with child problematic behavior or how they discipline their child not only at any given time in the child’s development, but also whether these parent behaviors change in a timely manner, is seen as normative. There are some generally accepted methods not only for dealing with child problematic behavior, but also in disciplining. Unfortunately, this area is remarkable for the virtual total absence of mention by traditional early intervenors. It is almost as if none of the parents who have been studied in the multitude of descriptive studies have had to deal with child problematic behavior with their children during any of the periods they were studied. At the same time, parent training as an intervention, developed in response to a clear clinical need for such an effort and has focused upon child problematic behavior that has reached a point such that either the parent seeks help or their treatment of the child is seen as sufficiently different from acceptable standards that they are brought to the attention of authorities. Parent training too, has focused upon middle class samples of mothers and younger children exhibiting behavior problems chiefly hyperactivity or tantrums who have access to services (e.g., Breiner & Beck, 1984). The methods used have mirrored this focus which include complex written parent training manuals (e.g., Helm & Kozloff, 1986) although there have been efforts to individualize parent training (e.g., Tymchuk, 1973, 1979, 1985). While there has been limited study of how parents with mental retardation actually deal with child problematic behavior or discipline their child or whether they change in a timely manner over a child’s development, it has been assumed that they have great difficulty in doing so and that their style is verbally or physically punitive harshly administered. It also has been assumed that these styles would be immutable over the development of their children from infancy to adolescence. These characterizations, however, have been made in the total absence of empirical data and have been generalized from subjective descriptions of individual or unrepresentative small samples of mothers. In several studies of parents with mental retardation (e.g., Feldman et al., 1986; Garber, 1988) or of mothers with low IQs (e.g., Ramey et al., 1984; Slater, 1986) there is no mention either of child problematic behavior or of inappropriate disciplining by the mother or in the absence of child problem behavior, of nonnormative responses by the mother. In other studies, low rates of child problematic and of maternal punitive behavior, but not necessarily in response to the child behavior, were reported (Tymchuk & Andron, 1988). Tymchuk, An-

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dron, and Tymchuk ( 1990) reported significant differences between the responses of mothers with mental retardation and those of a comparison group of other poor mothers on a questionnaire in which such questions were asked as “What is the best way to teach your child something?” and “What is wrong with hitting your child?” Significant differences were not found on two other questionnaires in which illustrations depicted both child adaptive and maladaptive behavior. While this study depicted in vitro situations, nonetheless, the findings are important because of the similarity in scores for the two groups because the increases in accuracy across different methods of information presentation for both groups suggest that illustrations are needed for work with parents in poverty and who may or may not be mentally retarded. The greatest number of errors in both groups related to what to do when the child was depicted as misbehaving where reprimanding instead of ignoring was chosen. The mothers with mental retardation rarely stated that they would reinforce their child for an appropriate behavior, but did state that they would punish them for an inappropriate behavior. It appears then that mothers with mental retardation may not know how to reinforce. At the same time, however, it may be that they also do not know whal to reinforce. In a case study, a woman with mental retardation with three delayed children, verbal punishment and harsh commands were prevalent and were virtually the sole means of verbal communication between mother and the three children. When training began, this woman could not identify a single “good” behavior in any of her children, but she could state what she found as bad. And a major part of this woman’s training then involved examining videotapes of each of her children in reliably identifying good behavior (Tymchuk & Andron, 1988). Since there have been only a few studies of the knowledge and/or skill of parents in poverty who may or may not be mentally retarded in dealing with child problematic behavior, it is not precisely clear what the predictors are either of these levels of knowledge or skill. It also is not apparent what the predictors are of an inability to identify good behavior in their child, of the ability to readily identify “bad’ behavior, of the lack of reinforcement or of the preference for punishment. And it is not clear what the consequences are for the child. Some conjecture, however, can be made including an absence of role models and/or appropriate education for this type of behavior themselves. It is apparent that this is a seriously understudied area of concern. Capacity to Acquire, Maintain, and Generalize Parenting Knowledge and Skill Although any discussion of adequacy of parenting by persons with mental retardation must include a discussion of their capacity to acquire, maintain and to generalize both parenting knowledge and skills, there has been little empirical work in this area. Given the pejorative atmosphere in which there was a virtual total disregard for the parenting abilities of people with mental retardation and a consequent lack of educational opportunities, our current assessment of these abilities is an inaccurate one. And until a system is in place whereby a person with mental retardation who is or who wishes to be a parent is provided with empirically established assessment and educational interventions, our assessment of learning capacity will remain inaccurate. Our attempts to predict the adequacy of current parenting as well as ofpotential parenting of persons with mental retardation then also will remain inaccurate and inherently unfair. What we know about the capacity to acquire, maintain and generalize parenting knowledge and skills by parents with mental retardation. A generalization can be made that in virtually all areas of parenting, many parents, chiefly mothers, with mild mental retardation can acquire both the knowledge and the skills both in vitro and in vivo such that they attain a level of

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knowledge and skill similar to that of other parents living in poverty or they can learn to recognize that their skills are not adequate to the healthcare of their child so that they can use approp~ate support resources. However, such learning is quickly lost for about half of the small groups of mothers involved in: identifying and remediating dangers in the home (Tymchuk et al., 1990a); responding to common home emergencies (Tymchuk et al., 1989, in press); for the use of child stimulatory language, behaviors and materials (Feldman et al., 1986; Peterson et al., 1983; Slater, 1986; Tymchuk & Andron, in press-a); for the use of normative methods for dealing with child problematic behavior (Tymchuk, Andron, & Tymchuk, 1990); and for decision making (Tymchuk et al., 1988). Predictors ofadequate learning. There are a number of environmental and parental factors that have been identified as predictive of adequate learning of these skills the most important of which is the extent to which the intervention matches the characteristics of the mother. Other environmental predictors include adequate training of professional staff, open attitudes towards the abilities of parents with mental retardation, approp~ateness and availability of materials, continuity and singularity of agency involvement and adequacy of supports. Parental predictors include adequate reading recognition and comprehension, an IQ at above 60, adequate emotional and physical health, not having been institutionalized, adequate role models, and previous parenting education. Predictors of ~~adeqz~atelearning. There also are both environmental predictors of parental inadequate (defined as very slow rate) learning of these skills. The environmental predictors include staff that are inadequately trained with pejorative attitudes towards parents with mental retardation (e.g., Bakley, 1986), educational methods and materials that are not matched to the learning characteristics of the parents, unavilability of interventions, interventions at centers rather than within the parent’s home, many people providing the intervention, living with a person who is emotionally disturbed, no familial supports, having more than one child and having a child who is older or who has a developmental delay or medical disorder. The parental predictors of inadequate learning of parenting skills include reading recognition and comprehension below Grade 4, an IQ below 60, the presence of a medical or an emotional disorder in addition to retardation and having been institutionalized. Predictors of maintenance ofskills. Predictors of the maintenance of these skills include many of the environmental as well as the parental factors mentioned above as well as the longevity, duration, and frequency of the educational effort. the periodicity, and the comprehensiveness of that effort.

RESULTS Child Outcomes of Inadequacy/Adequacy

of Parenting by Persons With Mental Retardation

Child cognitive delay. Child cognitive delay has been seen as the most important outcome of being raised by parents with mental retardation. Children born of and raised by parents where one or both parent is mentally retarded, have been seen to be at significant risk for cognitive delay within the first three years of life (e.g., Martin et al., 1990). This statement of risk has been supported by the results of two areas of study. The first support was derived from a study of Reed and Reed (1965) which suggested that 40% of the children born of parents with mental retardation had IQs in the mental retardation range. The second area of support has derived from the study of children of parents, usually mothers, with low IQs. Approximately

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40% of some of the children of these mothers have IQs in the mental retardation range (e.g., Feldman et al., 1985; Martin et al., 1990). Usually, IQ of only the youngest child is reported even in families where there may be multiple children. Child IQ also appears to be related to the IQ of the mother such that the lower the maternal IQ, the lower the child IQ. While other predictors of adequacy of child cognitive delay include a limited parenting style often demons~ated by mothers with mental retardation, less is known about the rate of cognitive development of their children.

Adequate child cognitive development. Less is known about adequate cognitive development of children of parents with mental retardation in part because of the focus placed upon the identification of factors that contribute to cognitive delay. While it has been assumed that all parents with mental retardation exhibit a nonstimulating punitive interactional style and that this is associated with child cognitive delay all of the time, neither of these assumptions has been adequately studied. It is apparent that not all parents with mental retardation exhibit a negative parenting style. It also is apparent that some of their children demonstrate adequate cognitive development in spite of a negative parenting style. Such resiliency needs much greater study.

Child emotional delay/aberration/adequacy. There has been little attention paid to emotional delay or aberrations in the emotional development of children of parents with mental retardation. It has been largely assumed that these children would have much the same flat affect seen in children described living in institutions (Seagull & Scheurer, 1986) although in the Feldman et al. ( 1986) study there were few differences in compliance between the young children of the intellectually limited mothers and those of the middle class mothers. At the same time, Tymchuk and Andron (in press-a) reported similar results between children of all ages of mothers with mental retardation and those of poor mothers. Little is known about adequate emotional health in the children of parents with mental retardation or its predictors. Child physical development as an outcome. While child cognitive development has been seen as a primary outcome when consideration of the adequacy of parenting by a mother with mental retardation, child physical development and the rate of that development are of even greater importance but have received much less attention.

DISCUSSION

what shooed We Be Attempting to Predi&t?New Foci for Predicting Both Inadequacy and Adequacy q-fParenting by People With Mental Retardation While the traditional focus of concerns regarding persons with mental retardation being a parent was upon how inadequate that parenting was, it is apparent that there is not only a need for an expanded view of what constitutes inadequacy of parenting by persons with mental retardation and an identification of the factors that are related to such inadequacy, but also for a definition of adequacy o~pffrent~ng and an identification of the factors that are related to such adequacy. Given the little programmatic support for learning parenting skills, current levels of knowledge and skill cannot be taken as indicative of the capabilities to acquire new skills. At the same time, when such meager efforts are expended, there is little chance for success which then reinforces the idea that parent with mental retardation cannot learn. Outcome measures must mirror content of knowledge and skill, the processes by which these are acquired and the rate of such acquisition.

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It is also apparent that in order to fully understand the factors that effect either inadequacy or the adequacy of parenting by a person with mental retardation, we must expand our view backwards to examine those historical factors that influenced the development of the parent making her or him what s/he is today. The literature also suggests that given the historical and current pejorative perceptions of the parenting abilities of people with mental retardation and the consequent lack of educational opportunities, there is a need to examine not only current levels of adequacy or inadequacy, but also how rapidly and adequately they adapt to new opportunities and how readily they unlearn old methods of child interaction as their child develops. Predicting inadequacy of parenting. Based upon the previous review, the primary maternal outcomes when inadequacy of parenting is of interest, are the mother’s perpetration of abuse and neglect while the child outcomes include child cognitive and emotional delay, child behavior problems and health problems. Those factors that have been associated with these outcomes of inadequacy include the identified historical (a) environmental (ever institutionalized, in special education), (b) familial (abused as a child, one or both parents with mental retardation and/or with an emotional or medical problem or engaged in a criminal activity such as illicit drug usage), and (c) maternal (the presence of a lifelong medical or emotional disorder, negative attitudes towards parenting) factors and the identified current (a) environmental support (income below poverty level, inadequacy of support agencies including untrained staff using interventions designed for other populations, involvement with multiple agencies), (b) familial (no parenting models, no parent support, a husband/partner with an emotional disorder, who is abusive or with a medical disorder), (c) child (having more than one child, having a child over the age of six and having a child with a medical and/or behavioral problem and/or a difficult temperament) and (d) maternal emotional (having an emotional disturbance in addition to her retardation, high stress level, poor self-esteem), cognitive (IQ below 60, reading recognition and comprehension below grade 4, no or limited parenting knowledge and skills), health (having a medical problem in addition to her retardation), learning style (poor decision making, coping and problem solving) and child interactional style (punitive, authoritarian, nonempathic) factors related to such inadequacy. These identified factors suggest that whether a mother with mental retardation currently perpetrates abuse on her child or will in the future is determined in part by historical (e.g., how she was treated as a child) as well by current factors including the inadequacy of supports and maternal characteristics. These factors also suggest, however, that how she was treated (i.e., ever institutionalized, abused) is predictive of a mother’s own punitive/authoritarian style of child interaction, her health status, her learning styles and her lack of parenting knowledge and skills which are in turn predictive of child delays and the development of health and/or behavior problems. Future research can examine such sequential cause and effect relationships. Predicting adequacy ofparenting. When prediction of adequacy of parenting is of interest, the initial as well as the ongoing maternal outcomes include maternal knowledge and skill in healthcare (healthcare, safety, responding to emergencies), in child stimulatory behaviors (for adequate child cognitive, emotional and social status as well as development), in dealing with child problem behaviors and in disciplining children. There also are process variables associated with the adequate acquisition, maintenance, generalization and development of these outcomes including the rapidity with which the mother learns new material and unlearns old behaviors (e.g., such as using punishment all the time), how well she makes decisions, problem solves and copes/adapts to new situations. The initial child outcomes include current cognitive (e.g., language, reading), emotional (affect), and physical (e.g., head circumference,

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body weight, body length, extremity lengths) development and current health status (e.g., immunizations up to date, appropriate number, type and severity of illnesses and of accidents for that age). The ongoing child outcomes include the rate at which such cognitive, emotional and physical development occurs, the adequacy of health at each developmental stage and the ultimate 1eveIs attained. Those factors that have been associated with outcomes of adequacy also include ~j~tu~ical (a) environmental (e.g., living with own parents), (b) familial (e.g., having appropriate parent role models), (c) maternal (e.g., adequate physical and emotional health) and current (a) environmental (e.g., adequate resources and supports), (b) familial (e.g., supportive and healthy partner), (c) maternal (e.g., adequate education and skills), and (d) child factors (e.g., having only one healthy child). While two sets of predictions are suggested, a shift away from prediction of inadequacy to the prediction of adequacy of parenting should be emphasized. Shifting this focus allows for the identification of reasons for such adequacy and ways in which to maximize those reasons including moving the focus away from factors inherent in the person such as IQ to other present as well as historical environmental factors which are amenable to intervention. At the same time, expanding both the predictors as well as the outcomes allows us to begin the development of a definition. Clinicians also can apply the factors presented to individual clients depending whether their focus is upon identifying inadequacy or adequacy of parenting.

CONCLUSIONS While maternal and child predictors and outcomes suggested here have some empirical validity, much more research is needed. In order to perform such research a national effort is required. Such an effort would require an assessment of current and planned federal and state expenditures and coordination of these resources to match the research needs. Currently, the President’s Committee on Mental Retardation is following such a plan (Tymchuk, 1990a).

REFERENCES Accardo, P., & Whitman, B. (1990).Children of mentally retarded parents. American Journal ofDiseases qfchildren, 144,69-70. Ainsworth, M., Wagner, E., & Strauss. A. (1945). Children of our children. American Journal &Mental De$ciency, 49,227. Bakley, S. ( 1986). But I wasn’t traitledfor this: A rnan~a~jbr working with muthers who are retarded. San Diego, CA: Department of Special Education, San Diego State. Bailer, W. (I 936). A study of the present social status of a group of adults who, when they were in elementary schools, were classified as mentally deficient. Genetic Psychology Monographs, 18(3), 165-244. Block, A. (1984).Twenty-year follow-up of pupils in a special class for the mentally retarded: A study of a complete school community. American Journul of Orthopsychiatr_v?54, 436-443. Booth, C. L., Barnard, K. E., Mitchell, S. K., & Spieker, S. J. (1987). Successful intervention with multi-problem mothers: Effects on the mother-infant relationship. Infant Mental Health Journal, 8, 288-306. Bowden, J., Spitz, H., & Winters, J. (197 I). Follow-up of one retarded couple’s matriage. Mental Retardation, 9, 42-43. Bradtev, R., & Caldwell, B. f 1984). Home ~~~e~ai~on for meas~ir~ment ofthe env~r~nmen&~Administration manual (rev..ed.). Little Rock: University of Arkansas. Brandon. M. (1960). A survev of 200 women discharaed from a mental deficiency. hospital. Journal ofMental Science, 108, 442: Brantlinger, E. (1988). Teachers’ perceptions of the parenting abilities of their secondary students with mild mental retardation. RASE, 9, 3 1-43. Breiner, J., & Beck, S. (1984). Parents as change agents in the management of their developmentally delayed children’s noncompliant behaviors: A critical review. Applied Research in Mental Retardation, 5, 259-278.

Parents

with mental

retardation

177

Buck v. Bell, 274 U.S. 200, 47 S. Ct. 584 (1927). Budd, K., & Greenspan, S. (1985). Parameters of successful and unsuccessful interventions with parents who are mentally retarded. Mental Retardation, 23, 269-273. Cohler, B., & Musick, J. (1984). Intervention amongpsychiatrically impairedparents and their young children. San Francisco, CA: Jossey-Bass. Crain, L., & Miller, G. (1978). Forgotten children: Maltreated children of mentally retarded parents. Pediatrics, 61,

130-132. Delgado, L. (1986). Training young parents to identify and report illness in their children. Unpublished master’s thesis, Southern Illinois University at Carbondale. Dowdney, L., Skuse, D., Rutter, M., Quinton, D., & Mrazek, D. (1985). The nature and quality ofparenting provided by women raised in institutions. Journal ofchild Psychology and Psychiatry, 26, 599-625. Espe-Sherwindt, M., & Kerlin, S. (1990). Early intervention with parents with mental retardation: Do we empower or impair? Infants & Young Children, 2, 2 l-28. Fantuzzo, J., Wray, L., Hall, R., Goins, C., & Azar, S. (1986). Parent and social-skills training for mentally retarded mothers identified as child maltreaters. American Journal of Mental Deficiency, 91, 135- 140. Feldman, M., Case, L., Towns, F., & Betel, J. (1985). Parent education project I: The development and nurturance of children of mentally retarded parents. American Journal of Mental Deficiency, 90, 253-258. Feldman, A., Towns, F., Betel, J., Case, L., Rincover, A., & Rubino, C. (1986). Parent education project II: Increasing stimulating interactions of developmentally handicapped mothers. Journal of Applied Behavior Analysis, 19,

23-37. Garbcr, H. (1988). The Milwaukee Project: Preventing mental retardation in children at risk. Washington, DC: American Association on Mental Retardation. Garmezy, N., & Rutter, M. (1983). Stress, coping & development in children. New York: McGraw-Hill. Hayman, R. (I 990). Presumptions of justice: Law, politics, and the mentally retarded parent. Harvard Law Review, 103, 1201-1271. Helm, D., & Kozloff. M. (I 986). Research on parent training: Shortcomings and remedies. Journal ofAutism and

Developmental Disorders, 16, l-22. Jones,

R., Van Hasselt,

V., & Sisson. L. (1989).Acquisition and maintenance of emergencyjiresafety skills in blind manuscript, Western Psychiatric Institute, Pittsburgh, PA. S., & Katz, M. (1988). Marriage in a young mentally retarded population. Journal of Mental

adolescents. Unpublished Koller,

H., Richardson,

Deficiency Research. 32, 93-102. Lynch,

E., & Bakley.

S. (1989).

Serving

young

children

whose

parents

are mentally

retarded.

Infants & Young

Children, 1. 26-38. Martin, S., Ramey, C., & Ramey, S. (1990). The prevention of intellectual impairment in children of impoverished families: Findings of a randomized trial of educational day care. American Journal of Public Health, 80, 844-847. Mickelson, P. ( 1947). The feebleminded parent: A study of 90 family cases. American Journal ofMental Deficiency, 51,644-645. Mickelson, P. ( 1949). Can mentally deficient parents be helped to give their children better care? American Journal of Mental Deficiency, 53, 5 16-534. Mira, M. (1982). Evaluating the effects of treatment of mentally retarded parents for custody decisions. Paper presented at the annual meeting of the American Association on Mental Deficiency, Boston, MA. Mira, M. ( 1984). Parent/child interactions in play: A comparison among mentally retardedparents and nonretarded parents oftwo socio-economic levels. Paper presented at the annual meeting at the American Association on Mental Deficiency, Minneapolis, MN. Peterson, S., Robinson, E., & Littman, I. (1983). Parent-child interaction training for parents with a history of mental retardation. Applied Research in Mental Retardation, 4, 329-342. Ramey, C., & Campbell, F. (1984). Preventive education for high-risk children: Cognitive consequences of the Carolina Abecedarian Project. American Journal ofMental Deficiency, 88, 5 15-523. Reed, R., & Reed, S. (1965). Mental retardation: A family study. New York: Saunders. Scheerenberger, R. (1983). A history ofmental retardation. Baltimore: Brooks. Schilling. R., Schinke, P., Blythe, B., & Barth, R. (1982). Child maltreatment and mentally retarded parents: Is there a relationship? Mental Retardation, 20, 20 l-209. Seagull, E., & Scheurer, S. (1986). Neglected and abused children of mentally retarded parents. Child Abuse and Neglect, 10, 493-500. Slater, M. A. (1986).Modification of mother-child interaction processes in families with children at-risk for mental retardation. American Journal of Mental Dehciency, 91, 257-267. Tymchuk, A. (1973). A mobile communication device for use in training behavior modifiers. Behavior Therapy, 4,

48 l-482. Tymchuk, A. (1979). Parent and.fumily therapy. New York: Spectrum. Tymchuk, A. (1985).Social learning principles in &ures. Portland, OR: Ednick. Tymchuk, A. ( 1990a). Parents with mental retardation: A national strategy. Washington, DC: President’s Committee on Mental Retardation. Tymchuk, A. (1990b). Assessing home emergency skills of parents and others who are mentally handicapped. Mental Handicap, 18, 136- 142. Tymchuk, A. (199 1). Self-concepts of mothers with mental retardation. Psychological Reports, 68, 503-5 10. Tymchuk, A. (submitted). Depression symptomatology in mothers with mental retardation.

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Tymchuk, A., & Andron, L. (1988). Clinic and home parent training of a mother with mental handicap caring for three children with developmental delay. Mental Handicap Research, 1, 24-38. Tymchuk, A., & Andron, L. (1990). Mothers with mental retardation who do or do not abuse or neglect their children. Child Abuse & Neglect, 14, 3 13-323. Tymchuk, A., & Andron, L. (in press-a). Project Parenting: Child interactional training for mothers with mental handicap. Mental Handicap Research. Tymchuk, A., & Andron, L. (in press-b). Rationale, approaches, results and implications of programs to enhance parenting skills of people with mental handicap. In A. Craft (Ed.), Practice issues relating to sexuality and mental handicap. London: Routledge. Tymchuk, A., Andron, L., & Rahbar, B. (1988). Effective decision-making/problem-solving training with mothers who have mental retardation. American Journal of Mental Retardation, 92, 5 1O-5 16. Tymchuk, A., Andron, L., 81 Tymchuk, M. (1990). Training mothers with mental handicaps to understand behavioural and developmental principles. Mental Handicap Research, 3. 5 1-59. Tymchuk, A., Andron, I,., & Unger, 0. (1987). Parents with mental handicaps and adequate child care-A review. Mental Ha~djeup. 15,49-53. Tymchuk, A., & Dess, J. (1977). Marriage and family counseling with mentally retarded parents. Paper presented at the annual meeting of the American Association on Mental Deficiency, New Orleans. Tymchuk, A., Hamada, D., Anderson, S., & Andron, L. ( 1989). Emergency training for mothers who are mentally retarded: A reolication. The Mental Retardation & Learning Disabihtv Bulletin, 17, 34-45. Tymchuk, A., Hamada, D., Andron, L., & Anderson, S. (199Ga, June). Home safety training with mothers who are mentally retarded. Education and Training in Mental Retardation, 142-149. Tvmchuk, A., Hamada, D., Andron, L., & Anderson, S. (1990b). Training mothers with mental retardation to -respond to common home emergencies. Child and Family Behavior Therapy, 12, 3 l-47. Tvmchuk. A.. Yokota. A.. & Rahbar. 8. (1990). Decision making abilities of mothers with mental retardation. -Research in Developmental Disabilities, il, 97- 109. Wald, P. (1976). Basic and personal rights. In M. Kindred (Ed), The mentally retardedcitizen and the taaw.New York: The Free Press. Whitman, B., & Accardo, P. (Eds). (1989). When a parent is mental& retarded. Baltimore, MD Brookes. Zetlin. A. i 1986). Mentallv retarded adults and their siblines. American Journal of~~ental Dehciencv, 91, 2 17-225. Zetlin; A., ‘Weisner, T., & Gallimore, R. (1985). Diversity. shared functioning, and the role of benefadtors: A study of parenting by retarded persons. In S. Thurman (Ed.). Children of handicapped pare~zts (pp. 69-95). New York: Academic Press.

R&sum&-Alors qu’il existe un inter% croissant pour les difficult&, likes au fait de devenir parent pour les personnes retard&es mentales, cet inter&t n’a malheureusement pas ameliore significativement notre comprehension de la complexite de la relation parents-enfant. La recherche et les efforts d’intervention necessitent un recentrage afin d’examiner les tenants et aboutissants dune relation parents-enfant consider6e comme adequate. Notre connaissance des criteres d’adequation ou d’inaddquation de l’attitude parentale des individus retard&s mentaux ainsi que les limites de I’information sur laquelle nos affirmations sont basees sont reconsider&es et mises au point. Resumen-A pesar de que ha aumentado la atencibn que se le concede a la incapacidad para la crianta que tienen 10s padres con retard0 mental, esta atencion ha aportado poco en la comprensibn de las complejidades de la crianza para 10s padres. Es necesario reenfocar 10s trabajos de investigation e intervencmn para examinar las variables concomitantes en la educaci6n adecuada que 10s padres le ofrecen a sus hijos. Se hate una revisibn de lo que sabemos sobre la adecuada 6 inadecuada educacibn que ofrecen 10s padres con retard0 mental a sus hijos, as1 coma las hmitaciones de la informacibn sobre la que basamos nuestros conocimientos. TambiCn se ofrecen sugerencias sobre nuevos focos de atenciitn para profundizar en el conocimiento de la educacmn adecuada e inadecuada que ofrecen 10s padres con retard0 mental a sus hijos.