Emeritus Professor Bruce Tonge is a child psychiatrist at Monash University and chief investigator for the Stepping Stones Triple P parenting program. He speaks about the mental health of children with intellectual disability, the challenges faced by their parents and carers, and how Stepping Stones Triple P can help.
Why are mental health difficulties so common among children with an intellectual disability?
"Children with intellectual disability (ID) have a least three times the level of serious emotional and behavioural problems than typically developing children. This is due to the complex interaction of biopsychosocial factors such as impaired brain function, cognitive deficits, and social stress through ostracism and rejection. Genetic causes of ID, such as Prader-Willi syndrome, have a specific profile of disturbed behaviours – for example, obsessions and psychosis. Autism similarly has a defining profile of behavioural, cognitive and social impairments. Cognitive impairment makes it difficult for the child to comprehend events and learning problems create stressful school experience."
What are the unique challenges faced by parents and carers of children with an intellectual disability?
"Parents have a higher level of mental health problems and stress, which is due to, but also compounds, the child’s problems. The family is more likely to experience socio-economic hardship. A significant stressor is the challenge of finding services and help for their child’s behavioural difficulties. Less than 10 per cent of children with ID and mental health problems receive specific assistance for these problems."
What are your top strategies for parenting children with an intellectual disability?
"Our research has demonstrated that the most common problems relate to:
- disruptive behaviours – for example, tantrums, ADHD problems, aggression
- anxiety, including fearfulness, school refusal, obsessions and trauma-related anxieties
- depression with high levels of irritability, communication difficulties and self-absorbed behaviours – for example, pica, repetitive self-injury.
The top strategies for managing this range of problems relate to:
- promoting a positive relationship with the child
- encouraging desirable behaviour
- teaching new skills and behaviours
- promoting self-control
- improving communication
- using logical consequences
- using quiet time and other methods to calm down."
How can Stepping Stones Triple P help parents and carers?
"Stepping Stones Triple P is an evidence-based parent education and skills training program that offers a range of assistance to suit the specific needs of parents, from seminar and web-based advice through to a detailed therapist-led group or individual program. Parents choose the problems that are most problematic and the management strategies focus on those problems. Stepping Stones is a mental health intervention available in Queensland, New South Wales and Victoria."
How effective is the program?
"Stepping Stones Triple P has a strong evidence base with more than 250 international trials, studies and published papers. A recent meta-analysis conducted by Tellegen and Sanders (2013) offers a review of the effectiveness of Stepping Stones with parents of children with a disability (the paper is titled Stepping Stones Triple P-Positive Parenting Program for children with disability: A systematic review and meta-analysis)."
Can you recommend any resources for families and professionals?
"Stepping Stones Triple P is supported by a comprehensive range of online resources for parents, including tip sheets, the fostering of local parent support groups, and an extensive range of information. Also, parents of children with a disability in Victoria, and professionals who work with them, might like to complete the My Say Survey to receive free Stepping Stones parenting support or training and accreditation."
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