Complementary Therapies in Clinical Practice (2006) 12,5 563 [608112]

Complementary Therapies in Clinical Practice (2006) 12,5 5–63
The influence of the training and support
programme on the self-efficacy and psychological
well-being of parents of children with disabilities:A controlled trial
Julie Barlow/C3, Lesley Powell, Mollie Gilchrist
Interdisciplinary Research Centre in Health, Coventry University, Whitefriars Building, Whitefriars Street,Coventry CV1 5FB, UK
Summary The purpose of the study was to examine the effectiveness of an
intervention for parents of children with disabilities in a controlled study focusing on
parents’ self-efficacy, psychological well-being and perceptions of change in
children’s sleeping, eating and mobility. The Training and Support Programme(TSP) was designed to equip parents with a simple massage skill that they could use
with their children in the home environment. Parents were trained in massage by
therapeutic massage therapists in 8-weekly sessions, each lasting 1 h. The samplecomprised 95 parents (49 in the Intervention Group, 46 in the Waiting-list Control
Group) who attended the TSP with their children. Data were collected by self-
administered questionnaires at baseline (before commencing the TSP), and at 8-week follow-up. The TSP demonstrated statistically significant positive effects onparents’ anxious mood, self-efficacy for managing children’s psychosocial well-
being, self-efficacy in giving massage therapy, and perceptions of children’s sleeping
and eating. Relatively high levels of psychological distress were found amongparents, particularly mothers. Overall, findings suggest that wider implementation
of the Programme is warranted, and greater attention needs to paid to the
psychological well-being of parents caring for children with disabilities.&2005 Elsevier Ltd. All rights reserved.
Background
Parents of children with disabilities often assume
the primary burden of care, balancing timeconsuming and complex treatment regimes with
other aspects of family life, work commitments andleisure activities. Typically, mothers of childrenwith disabilities bear the greatest burden of care,
1
and have been found to experience higher levels ofdepression and anxiety compared with mothersof children of typical development.
2Mothers’ARTICLE IN PRESS
www.elsevierhealth.com/journals/ctnm
KEYWORDS
Parents of children
with disabilities;
Training and support;
Self-efficacy
1744-3881/$ – see front matter &2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctcp.2005.02.005/C3Tel.: +44 24 7688 7452.
E-mail address: [anonimizat] (J. Barlow).

psychological distress was independent of type of
disability but was related to the level of daily care
required by children. Breslau et al.2concluded that
easing the daily burden of care and enablingmothers to participate more fully in their child’streatment regime as well as employment andactivities outside the home, might protect mothersfrom the risk of psychological distress. Similarly,Merlo and Barnett
3found that among mothers of
children with a congenital anomaly, the presence
and severity of psychological and psychosomaticproblems were related to factors such as theamount of daily care children required and numberof hospitalisations.
Parents report multiple sources of stress related
to a child’s disability that can lead to anger ,frustration and a sense of isolation. Heiman
4
investigated the resilience, coping strategies andfuture expectations of parents of children withdisabilities and found that parents tended toexhibit adverse emotional and psychological reac-tions to the diagnosis of their child’s disability.Some parents experienced considerable stress aswell as feelings of depression, anger , shock, denial,self-blame and guilt.
Many parents had been forced to modify social
activities, a situation that left them feelingfrustrated and dissatisfied. Scorgie et al.
5found
that although dealing with health professionals wasbeneficial, it could also be a source of stress forparents of children with disabilities.
Parents reported feeling frustrated when faced
with long waits for referrals, conflicting, inade-
quate or confusing medical diagnoses, the tendency
to focus on negatives rather than offering a holisticapproach, and the perceived lack of time withhealth professionals. Similarly, Barlow et al.
6
reported that delay in obtaining treatment, lackof information and lack of opportunity to discusstheir child’s condition with health professionalswere stressors experienced by parents of children
with juvenile idiopathic arthritis (JIA). Moreover,
parents felt a constant need to vigilantly monitortheir child’s health status for changes in symptomsor side effects of treatments.
Support for these qualitative findings was pro-
vided by a study of families attending outpatientclinics at a regional hospital,
7which found that
mothers of children with JIA exhibited poorer
physical function, poorer general health percep-
tions, and greater anxious and depressed moodswhen compared to UK normative data.
Bailey et al.
8conducted a survey of the needs of
400 parents of young children with disabilities. T womain needs emerged. The first need was for moreinformation about children’s condition or disability,how to teach children about the condition and its
management, and information about present as
well as future services. The second main need wasto feel more included in their child’s care. Indeed,parents believed that both they and their childrenwould benefit from greater parental involvement inchildren’s care at home.
These findings are noteworthy given the range of
health and social care professionals that can be
involved in children’s care. In the face of such an
array of professional expertise, parents can beginto doubt their own ability to develop caring skills.
Following a study of 365 mothers, Silvers et al.
9
concluded that the distress experienced by mothersof children with disabilities could be reduced byinterventions promoting skill-building and emo-tional validation. This finding accords with theore-
tical models of stress, suggesting that cognitive
appraisal and coping mechanisms may play amediating role in the stress process.
Support for the importance of improving parental
coping ability is provided by Florian and Findler ,
10
who found that self-mastery, self-esteem, andfamily network size were the main predictors ofmothers’ psychological well-being and marital
adaptation. Furthermore, parenting self-efficacy
has been found to be a significant predictor ofmaternal perceptions of child adjustment
11and
self-efficacy for managing the child’s condition hasbeen shown to mediate the impact of children’s illhealth on maternal well-being.
7
In sum, parents of children with disabilities may
be at risk of psychosocial distress and can lack
confidence (self-efficacy) in their own abilities to
contribute to their children’s care. Increasingparental self-efficacy and perceptions of involve-ment in their children’s care may be one way toenhance parental psychosocial well-being. This wasthe rationale underlying the development of theTraining & Support Programme (TSP). The masteryexperience used to enhance self-efficacy was that
of gentle massage.
The Training and Support Programme
There is some evidence to support the positive
effects of massage for the person giving massage. Ina comparison of infant massage (intervention) and
reading (control group) among mothers and their
hospitalised premature infants, Cody
12found that
the mothers in the massage group reported agreater sense of well-being, increased self-esteemand showed an increased in positive perceptions oftheir babies. Moreover, the massaged infantsshowed evidence of greater weight gain. FieldARTICLE IN PRESS
J. Barlow et al. 56

et al.13compared the effects of giving versus
receiving massage, and found that giving massage
had greater positive effects than receiving mas-sage. Finally, a number of studies conducted at theTouch Research Institute (USA) have reportedbenefits for parents who massaged their childrenwith various health conditions, such as diabetes,asthma and arthritis.
14
The TSP was designed for parents of children
with disabilities regardless of the type of disability.
The purpose of the TSP is to provide parents withbasic massage skills that they can use in the care oftheir children in the home environment. Parentsare trained in massage by therapists alreadyqualified in therapeutic massage. The TSP com-prises 8-weekly sessions, each lasting 1 h. The firstsession includes a consultation between carer and
therapist to ascertain the child’s case history,
parents’ concerns and expectations of the TSP ,and an introduction to massage. During sessions2–8, one therapist works with one parent: child
dyad, training the carer in massage. The precisetechniques used are tailored to meet the specificneeds of each child and parent and the sametherapist works with the same parent: child dyad
throughout the 8-week Programme providing con-
tinuity of care. Thus, the TSP offers an individua-lised package of instruction during which timeparents receive 8 h of contact time with atherapist. In addition, each parent receives aTraining Pack and a 50 ml bottle of Sweet AlmondOil. The Training Pack includes an introduction tothe TSP , a list of contra-indications, instructions on
massage techniques to accompany the sessions,
diagrams, and, photographs of parents using mas-sage on their children to illustrate specific move-ments. All therapists use the same lubricant (SweetAlmond Oil) during the TSP .
Several pilot studies and a process evaluation of
the TSP have been conducted.
15–18Taken together ,
results show that parents find the Programme
enjoyable, they value learning a new skill that
can be used in the care of their children at home,and they welcome the opportunity to spend qualitytime with their children. The results of the processevaluation revealed statistically significant im-provements in parents’ self-efficacy in their abilityto carry out massage, parents’ self-efficacy formanaging children’s psychosocial well-being, and in
levels of anxious mood at the end of the Pro-
gramme.
15In addition, parental reports of chil-
dren’s sleeping and eating showed significantimprovements. Analysis of qualitative data showedthat some parents perceived improvements inchildren’s bowel movements, awareness of theirbodies, movement, and communication (both ver-bal and non-verbal). A controlled study is necessary
to examine in a more systematic way whether these
positive outcomes are due to attending the TSP .Hence, the purpose of the study reported here wasto determine whether attending the TSP influencedparents’ self-efficacy, psychological well-being,and perceptions of children’s sleeping, eating andmobility in a controlled study. The term ‘parent’ isused to refer to the main carer (e.g. mother , father,
grandparent, foster parent).
Method and sample
Sample
One hundred and fifteen parents were identified
from a range of sources including the local media,Sense (West), Lincoln District Health Authority,
South-Warwickshire Combined Care, The Lady
Hoare Trust, The Dyspraxia Foundation, The Mus-cular Dystrophy Campaign, Blackpool BoroughCouncil Social Services Department, Essex SocialServices Department and a local Child DevelopmentCentre. Study entry criteria were:
/C15Child with a disability or health impairment agedup to 16 years of age.
/C15Parent or main carer able to attend eight sessions
with the child.
The study ethos was one of inclusion rather than
exclusion and our focus was on parents’ well-being.Thus, children with a range of disabilities from mildcolic to life-threatening conditions and rare syn-dromes were included. Support for a non-catego-rical approach is provided by studies that showpronounced differences within rather than be-tween disease categories,
19a point echoed by
organisations representing children with rare dis-
orders.20Fifteen parents expressed an interest in
the study but felt they could not commit to an 8-week programme. Reasons given included child’sadmission to hospital, personal circumstances andparents’ ill-health. Of the remaining 100 whocompleted the baseline questionnaire and attendedthe TSP , five parents failed to complete the follow-
up assessment. Comparisons between these non-
responders and those who completed all measure-ments were conducted and are reported in theResults section.
Fifteen therapists were recruited and trained in
the delivery of the TSP and study requirements. Allwere qualified in therapeutic massage.ARTICLE IN PRESS
The influence of the training and support programme on the self-efficacy and psychological well-being 57

Procedures
Pilot work had shown that failure to offer the TSP
to the Control Group resulted in high rates ofattrition. Thus, a controlled study design with an
intervention and a waiting-list control group was
used (i.e. all parents received the intervention). Inaddition, TSP therapists have their own client listand are not always able to take on a parent: childdyad at short notice. A pragmatic approach wasadopted whereby after returning the baselinequestionnaire to the research team, participantseither commenced the TSP as soon as possible
(Intervention Group, n¼49) or were allocated to a
waiting list (Control Group, n¼46) and received
the intervention after 8 weeks. Thus, all 95participants received the TSP .
Data were collected by self-administered ques-
tionnaires mailed to parents (with a reply paidenvelope for return) at two points in time: baselineand 8-week follow-up. Outcome measures included
parental self-efficacy for managing children’s psy-
chosocial well-being, self-efficacy for massage,parents’ psychological well-being (e.g. anxietyand depression), self-rated health, and parents’perceptions of children’s eating, mobility and sleeppatterns.
Measuring instruments
Parent and child demographics (e.g. age, sex andeach child’s diagnosis) were collected at baseline
only.
A visual analogue scale (VAS) was used to
measure parents’ perceived Health Status using a
10 cm horizontal line, anchored 0 ( ’’
Poor’’) to 10
(
’’
Perfect’’) health.
The Parent’s Self-Efficacy Scale (PSES) was used
to assess parents’ confidence in their ability tomanage their children’s psychosocial well-being
and was adapted from the Parent’s Arthritis Self-
Efficacy Scale
21designed for parents of children
with JIA. The PSES consists of 7 statements eachrated on a scale anchored ‘very uncertain’ (1) to‘very certain’ (7). Statements included: ‘Howcertain are you that you can do something to helpyour child feel better when his/her conditionmakes him/her feel sad?’ Item scores are summed
to give a total score (range 7 –49).
One item was used to assess parents’ self-efficacy
in their ability to carry out massage therapy. Usingthe same format as the PSES, scores range from 1to 7.
Parents’ psychological well-being was measured
using the Hospital Anxiety and Depression Scale(HADS) developed by Zigmond and Snaith.
22The
HADS has 14 items (7 for anxiety and 7 for
depression), is quick and easy to complete andhas established reliability and validity.
23The HADS
was designed to detect the presence and severityof relatively mild degrees of mood disorder in non-psychiatric, hospital outpatients. Scores range from0–21, with higher scores indicating greater anxiety
and greater depression.
Based on earlier pilot work,
18parents’ percep-
tions of their child’s Sleeping, Eating, and Mobility
were each assessed using a VAS anchored 0 (
’’
No
difficulty’’) to 10 (
’’
Great deal of difficulty’’).
Analysis
Data were analysed using the Statistics Package for
Social Scientists.24Baseline characteristics were
examined to determine differences betweenresponders and non-responders using Fisher’sExact, Pearson’s chi-square and Mann –Whitney
tests as appropriate. Baseline mean scores werecompared using t-tests on all study variables
(self-efficacy, anxiety, depression, carer health
status, confidence in massage therapy, and
parents’ perceptions of children’s eating, mobilityand sleep patterns) for both the Intervention andControl Groups. Change scores (post-TSP scores —
baseline scores) were calculated. Univariateanalyses of variance were performed between thetwo groups, with respective baseline scores ascovariates. A significance level of 5% was used
throughout.
Results
Parents characteristics
The majority of parents were mothers (88%) whowere married or living with a partner (84%), white
European (94%) and had formal educational quali-fications (92%). Parents’ health problems includedcongenital heart condition, myxadaema, high bloodpressure, back problems, renal problems, epilepsy,diabetes, myotonic dystrophy, eczema, asthma,psoriatic arthritis, sensory impairments and multi-ple sclerosis. Carer characteristics are shown in
Table 1 .
The non-responders ( n¼5) were all mothers,
four of whom had other children. Therewas a significantly higher proportion of parentswith formal educational qualifications amongresponders (Fisher’s Exact, P¼0:038). However,
the numbers involved are too small to drawARTICLE IN PRESS
J. Barlow et al. 58

any conclusions. There were no other statistically
significant differences between responders andnon-responders.
At baseline, 69.4% and 40.8% of the Intervention
Group scored X8 on anxious and depressed moods,
respectively. At follow-up, the proportions at risk
of clinically anxious and depressed moods had
decreased to 61.7% and 27.7%, respectively. Atbaseline, 67.4% and 45.7% of the Control GroupscoredX8 on anxious and depressed moods. At
follow-up these proportions had reduced to 62.8%and 34.9%, respectively. Women’s scores for theHADS (anxiety and depression) were compared withpopulation norms. Normative data for the HADS are
different for males and females. As the sample was
predominantly female, the comparison was con-ducted with females’ data only. At baseline, 72.6%of females were at risk of clinically anxious moodcompared with a population norm of 39%. Similarly,48.8% were at risk of clinically depressed mood atbaseline compared with a population norm of14%.
25The proportions at risk of clinically anxious
and depressed moods were statistically significantlygreater than published norms, with Po0:001 and
P¼0:001 respectively.
Children’s characteristics
Children presented with a diverse range of dis-
abilities. The primary medical diagnoses are pre-
sented in Table 2 . Child characteristics are shown in
Table 3 .
Complementary therapies received by children
included Brainwave therapy, Conductive education,Music therapy, Cranial osteopathy, Bowen, Homeo-pathy, Reiki, basic meditation and Aromatherapy.
Comparisons
There were no statistically significant differences inmean baseline measures between the Control andARTICLE IN PRESS
Table 1 Parent characteristics.
Intervention Group Control Group
n¼49 n¼46
Mean ( SD) Mean ( SD)
Mean age (years) 38.7 (9.5) 37.5 (6.5)
n(%) n(%)
Relationship to child
Mother/C342 (85.7) 40 (87.0)
Father/C35 (10.2) 6 (13.0)
Grandmother 2 (4.1) —
Marital status
Married or living with partner 41 (83.7) 39 (84.8)Single 5 (10.2) 3 (6.5)
Other (divorced, separated) 3 (6.1) 4 (8.7)
Education qualifications
Yes 45 (91.8) 43 (93.5)
Current work
Employed (full or part-time) 24 (49.0) 22 (47.8)Unable to work due to own ill-health 2 (4.1) —
Unable to work due to child’s ill-health
Homemaker 6 (12.2) 8 (17.4)
Other (e.g. voluntary work, student, unemployed, retired) 9 (18.4) 11 (23.9)
8 (16.3) 5 (10.9)
Ethnic origin
White European 46 (93.9) 43 (93.5)
Other (Asian, Black/Afro Caribbean) 3 (6.1) 3 (6.5)
Parent health problems
Yes 16 (32.7) 12 (26.1)
/C3Includes foster and step parents.The influence of the training and support programme on the self-efficacy and psychological well-being 59

Intervention Groups. Compared to the Control
Group, the Intervention Group was found to havesignificant improvements on anxious mood(P¼0:03), self-efficacy for managing children’s
psychosocial well-being ( P¼0:004), and self-effi-
cacy for giving massage ( P¼0:005). Although not
statistically significant, change scores for theIntervention Group on depressed mood and par-ental health status were in the expected direction(see Table 4 ). Compared to the Control Group, the
Intervention Group reported significant improve-ments in children’s sleeping ( P¼0:004) and eating
(Po :0001).Discussion
The results of this controlled study suggest that the
TSP may be an effective way of improving parents’psychological well-being in terms of anxious mood
and self-efficacy for giving massage and for mana-
ging children’s psychosocial well-being. In addition,parents’ perceptions of children’s sleeping andeating improved. Further studies are neededto determine whether these improvements aremaintained over time and to examine whetherparents continue to carry out massage without theregular support of therapists. In addition, parents’ARTICLE IN PRESS
Table 2 Children’s primary disability/C3.
Disabilities Number of children
Intervention Control
Cerebral palsy 12 13
Autistic spectrum disorders (includes Rett syndrome) 5 11Global developmental delay and learning difficulties 2 7
Epilepsy (includes West syndrome) 5 3
Muscular dystrophy 2 1Dyslexia, dyspraxia 3 —
Arthritis 3 —
Down’s syndrome 3 2Respiratory conditions (e.g. asthma, severe chronic lung disease) 2 5
Other (e.g. Russell –Silver syndrome, hydrocephalus, lissencephaly, colic,
achondroplasia, hyper-mobility, Perthes disease, leukemia, chromosomeabnormalities)10 3
No diagnosis 2 1
Total 49 46
/C3Multiple disabilities are not reflected in the table.
Table 3 Children’s characteristics. Standard deviations and percentages are shown in brackets.
Intervention Group Control Group
(n¼49) ( n¼46)
Mean ( SD) Mean ( SD)
Age (years) 6.7 (4.6) 6.3 (4.1)
Age range (years) 0.25 –16 0.67 –16
Age at diagnosis (years) 1.8 (2.6) 1.8 (2.6)
Age range (years) 0 –10 0 –12
n(%) n(%)
Sex
Male 30 (61.2) 31 (67.4)
Female 19 (38.8) 15 (32.6)
Siblings: Yes 38 (77.6) 31 (67.4)Receiving any other complementary therapy
No 43 (87.8) 40 (87.0)J. Barlow et al. 60

perceptions of improvement on children’s sleeping
and eating suggest that future studies wouldbenefit from the inclusion of more objectivemeasures of children’s functioning.
Although it is generally accepted that caring for a
child with illness or disability is stressful, there are
few published studies documenting the exact
proportions of mothers or fathers who fall withinthe at risk categories for clinical anxiety anddepression. One exception is a study by Manuel etal.
26who found that 30% of a sample of 270 mothers
of children with cerebral palsy had depressivesymptoms. High levels of psychological distresswere evident in our sample, with the proportions atrisk of clinically anxious and depressed moods being
significantly greater than published norms.
25The
proportions of females at risk of clinically de-pressed mood in this study were 48.8% in bothgroups at baseline and had decreased to 27.7% and43.9% in the Intervention and Control Groups at 8-
week follow-up.
The relatively high levels of distress accords with
the general literature reporting the potentialburden on parents of caring for a child withdisabilities,
27and supports the original rationale
underlying development of the TSP intervention.The results of this study support the suggestion thatinterventions aiming to provide parents with skillsARTICLE IN PRESS
Table 4 Means (standard deviation) on study variables at baseline and 8-week follow-up.
Baseline Change scores Pvalues for change scores
Intervention Control Intervention Control
n¼49 n¼46 n¼49 n¼46
Parental self-efficacy (PSE)
Mean ( SD) 33.9 (9.1) 32.9 (8.9) 4.1 (9.0) /C00.1 (6.2) 0.004
(Range 7 –49)
m¼better
Parental self-efficacy for massage
Mean ( SD) 5.5 (1.7) 5.4 (1.8) 0.7 (1.9) 0.0 (1.5) 0.005
(Range 1 –7)
m¼better
Anxious mood
Mean ( SD) 9.5 (4.2) 9.9 (4.6) /C01.7 (3.0) 0.4 (2.7) 0.030
(Range 0 –21)
m¼worse
Depressed mood
Mean ( SD) 6.7 (4.3) 7.2 (4.4) /C00.8 (2.6) /C00.3(1.4) 0.301
(Range 0 –21)
m¼worse
Parent’s current health status
Mean ( SD) 6.2 (2.6) 6.7 (2.0) 0.4 (2.4) /C00.3 (1.4) 0.323
(Range 0 –10)
m¼better
Parents’ perception of child’s eating difficulty
Mean ( SD) 3.8 (3.4) 4.2 (3.6) /C01.0 (1.7) 0.5 (1.7) o0.001
(Range 0 –10)
m¼worse
Parents’ perception of child’s mobility difficulty
Mean ( SD) 5.6 (4.1) 5.5 (3.5) /C00.5 (1.5) /C00.1(2.5) 0.323
(Range 0 –10)
m¼worse
Parents’ perception of child’s sleeping difficulty
Mean ( SD) 4.5 (3.1) 4.3 (3.3) /C01.6 (2.9) /C00.0 (2.4) 0.004
(Range 0 –10)
m¼worseThe influence of the training and support programme on the self-efficacy and psychological well-being 61

training and self-efficacy may mediate maternal
well-being.9,11In addition, the TSP helps parents to
feel more involved in their children’s care, thusmeeting one of the main needs expressed byparents of young children with disabilities whoparticipated in the survey conducted by.
8
The immense diversity of children’s disabilities
requires some comment. Parents were caring forchildren with a diverse range of disabilities; some
being relatively minor and short lived (e.g. colic),
whilst the majority appeared to be long term and insome cases multiple, life-threatening or with thepotential to adversely influence the child’s quality oflife (e.g. cerebral palsy, muscular dystrophy, autism).Not all children had problems with mobility, sleepingor eating. Thus, there was a floor effect in operationin the assessment of these features making it more
difficult for the study to detect change.
This difficulty may be overcome by adopting a
parent-generated approach to assessment of chil-dren whereby each parent identifies key areas ofchildren’s functioning that they would like to seeimprove. Hence, children with primarily physicalconditions may aim to improve mobility whereasthose with psychological disorders or learning
difficulties may choose to focus on communication,
an area that appeared to improve for a number offamilies.
The significant improvement in perceptions of
children’s sleep is important. Improved sleepamong children could lead to more restful nightsfor parents, who in turn may feel better able tomanage their child’s care. Furthermore, both
quantity of sleep and sleep patterns have been
found to affect behavioural adjustment, daytimefunctioning and mental and language developmentin children.
28,29In addition, successful interven-
tions aimed at improving sleep for children withintellectual disabilities have been shown to reducestress and increase perceived control and satisfac-tion with child’s sleep among mothers.
30The
calming effect of parental massage on recipients
(i.e. children with disabilities) appears to be a keyoutcome of the training programme.
A number of caveats need mentioning. The
sample size was relatively small and a pragmaticapproach was adopted whereby parents eitherattended the TSP immediately or were allocatedto a waiting list. A randomised, controlled study
will be necessary to confirm the findings reported
here. Attaining an adequate sample size is adifficulty faced by many researchers in the fieldof interventions for children with long-term healthconditions or disability and their families.
31
A non-categorical approach can be useful in this
regard. However, as noted in our study, not allchildren had problems with mobility thus floor
effects are in operation for some respondents and it
is more difficult to detect a significant change overtime.
Longer-term assessments are needed to deter-
mine whether parents continue to use massage over1, 2, or 3 years, for example, and to determinewhether benefits reported here are maintained,whether benefits become attenuated over time or
whether additional benefits emerge. For example,
changes in depressed mood may take longer than 8-weeks to manifest. Larger scale studies are neededto clarify the effects on parents’ psychologicalwell-being, particularly in terms of the trendtowards improvement on anxious mood in theIntervention Group. Also, a wider range of mea-sures could be used, such as indicators of commu-
nication between parent and child and parental
perceptions of stress.
In conclusion, training parents in the art of
massage in a supportive environment appears tobe worthy of future investigation. The currentstudy has provided a firm foundation for furtherdeveloping this approach in order to meet theneeds of a greater number of families living with
childhood disabilities.
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ARTICLE IN PRESS
The influence of the training and support programme on the self-efficacy and psychological well-being 63