Mediating Role of Family Burden and Family Stress: Children Disability Type and Parenting Styles

Abstract

Having a child with disability in the family affects mother's family burden (FB), family stress (FS) and parenting styles (PS). The mediating role of FB and FS in the relationship between children`s disability type (CDT) and mothers` PS is examined. 461 mothers having autism spectrum disorder (ASD), physical disability (PDC) and mental retardation (MR) participated in the study. Serial mediator effect, which is one of the mediator model analyzes was used. Mothers of children with ASD and MR, exhibited significantly lower democratic parenting style (DS) than mothers of children with PDC. While FB and FS cumulatively reduce DS in mothers of ASD children, they were found to have a direct effect in mothers of children with MR. In mothers of ASD children, increasing FB indirectly increased authoritarian style (AS) by increasing FS, while in mothers of MR children, the FS effect was more pronounced, while the FB effect was limited. Mothers of ASD and MR children had significantly higher permissive parenting style (PPS) levels than mothers of children with PDC. This was observed through direct and sequential effects in mothers of children with ASD, while in mothers of children with MR, this was more direct and indirectly mediated by FS. Studies and trainings can be planned to reduce the FB and FS levels in the DS of mothers with disabled children.

Keywords

• Parenting styles
• disabled children
• family burden
• family stress
• parent attitutes

Supporting Institution

There is no financal supporting organization.

Ethical Statement

Ethical procedures have been followed and the standards governing research involving human participants (currently in force in the Turkey) have been met. Ethical approval for the research procedures has been given by the Faculty of Health Sciences, Uskudar University Non-Interventional Research Ethics Committee, Istanbul, Turkey.

References

1. Adıyaman, A., Can, V. & Sarman, A. (2025). The impact of earthquake preparedness training on mothers with physically disabled children: A randomized controlled study. Scientific Reports, 15, 9554. https://doi.org/10.1038/s41598-025-94426-y
2. Alemdar, D., Yılmaz, G. & Günaydın, N. (2023). The spiritual and religious coping of mothers with disabled children in Turkey: Correlation between stress coping styles and self‑efficacy. Journal of Religion and Health. 62, 888–905. http://dx.doi.org/10.1007/s10943-022-01630-5
3. Aral, N. & Kadan, G. (2018). Child rearing attitudes In a K. Tepeli & E. Durualp (Eds.). Family life cycle. (pp. 181-207). Ankara: Hedef Publications.
4. Ardahan Akgül, E., Doğan, P., Karakul, A., Özdemir, V., Özgüven Öztornacı, B. & Yıldırım Sarı, H. (2023). Comparison of the parenting attitudes of the parents of the children with and without intellectual disability in preschool period. Izmir Democracy Unıversity Health Sciences Journal Iduhes, 6(3), 483-496. https://doi.org/10.52538/iduhes.1228196
5. Argumedes, M., Lanovaz M.J., & Larivee, S. (2018). Brief report: Impact of challenging behavior on parenting stress in mothers and fathers of children with autism spectrum disorders. Journal of Autism and Developmental Disorders. 48, 2585–2589. https://doi.org/10.1007/s10803-018-3513-1
6. Arif, A., Ashraf, F., & Nusrat, A. (2021). Stress and coping strategies in parents of children with special needs. Journal of the Pakistan Medical Association, 7(5), 1369-1372.
7. Avsaroglu, S. & Okutan, H. (2018). Investigation of life satisfaction optimism and psychological symptom levels of parents with disabled children. MANAS Journal of Social Studies, 7(1), 59-76. https://dergipark.org.tr/en/pub/mjss/issue/40516/485818
8. Aydın, A. & Sönmez, O. (2014). The effect of rearing attitudes of mothers having intellectually disabled children to the social skills of their children. YYU Journal of Education Faculty, 2014, 11 (1), 149-168.

9. Ayran, G. & Baran, M. (2016). Discipline methods and child raising attitudes of mothers having disabled and healthy child. Balıkesir Health Sciences Journal. 5(1), 1-6. https://doi.org/10.5505/bsbd.2016.86547
10. Bag, S. (2022). The effects of depression severity on the stress coping methods of mothers with mentally disabled children. Istanbul Medical Journal. 23(1), 34-38. https://doi.org/10.4274/imj.galenos.2022.99075
11. Baumgardner, M., Stolz, H.E., Renegar, R.G., McCaig, J.L., & Reimnitz, S.J. (2022). Perceived parenting history and current parenting attitudes: Examining maternal stress and depression as mediators. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-022-02240-1
12. Bedel, F. (2017). The effect of mother training programme on child rearing attitudes and mother-child relationship among mothers of children with special needs. [Master dissertation, University of Selcuk]. Konya. http://acikerisimarsiv.selcuk.edu.tr:8080/xmlui/bitstream/handle/123456789/12361/493062.pdf?sequence=1&isAllowed=y
13. Berger, R. (2013). Introducing disability studies. Lynne Rienner Publishers.
14. Boer, A.A., & Munde, V.S. (2014). Parental attitudes toward the inclusion of children with profound intellectual and multiple disabilities in general primary education in the Netherlands. The Journal of Special Education. December 4, 1-9. https://doi.org/10.1177/0022466914554297
15. Brown, T.A. (2015). Confirmatory factor analysis for applied research. Guilford Press.
16. Büyüköztürk, Ş., Kılıç Çakmak, E., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2020). Scientific research methods in education (29th ed.). Pegem Academy Publishing.
17. Copley, M.F., & Bodensteiner, J.B. (1987). Chronic sorrow in families of disabled children. Journal of Child Neurology, 2, 67-70.
18. Cuzzocrea, F., Larcan, R., Costa, S., & Gazzano, C. (2014). Parents’ competence and social skills in siblings of disabled children. Social Behavior and Personality, 42(1), 45-58. http://dx.doi.org/10.2224/sbp.2014.42.1.45
19. Çiftçi, N., Batmaz, M. & Kendirkıran, G. (2024). The relationship between family burden and purpose, meaning and life orientation of parents of intellectual disabled children. Manisa Celal Bayar University Journal of Institute of Health Science. 11(4), 576-585. https://doi.org/10.34087/cbusbed.1454691
20. Degirmenci, G.Y. & Demircioglu, H. (2020). Investigation of the family stressors of mothers who has child with special needs in adolescence age. Journal of Occupational Therapy and Rehabilitation, 8(1), 9-22.
21. Doğan Bal, T. & Akyüz, İ. (2023). Examination of the care process of women caring for a gravely disabled family member in the context of care burden and life satisfaction. Pesa International Journal of Social Studies. 9(2), 77-87. https://doi.org/10.25272/j.2149-8385.2023.9.2.02
22. Eldeniz-Çetin, M. & Sönmez, M. (2018). Identification of the problems experienced by mothers with children with multiple disabilities. Elementary Education Online, 17(3), 1252-1267.
23. Estes A., Munson, J., Dawson, G., Koehler, E., Zhou, X-H., & Abbott, R. (2009). Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay. Autistic Society, 13(4), 375-387. https://doi.org/10.1177/1362361309105658
24. Estes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G., & Munson, J. (2013). Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders. Brain and Development, 35, 133–138.
25. Farhadi, A., Bahreini, M., Moradi, A., Mirzaei, K. & Nemati, R. (2022). The predictive role of coping styles and sense of coherence in the post‑traumatic growth of mothers with disabled children: a cross‑sectional study. BMC Psychiatry, 22, 708. https://doi.org/10.1186/s12888-022-04357-5
26. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175-191.
27. Fu, W., Pan, Q, Zhao, M., Ji, C. & Peng, P. (2024). Understanding positive parenting style and parenting efficacy in parents having children with disabilities in China: The mediating role resilience. Current Psychology, 43, 2731–2744. https://doi.org/10.1007/s12144-023-04438-y
28. Gau, S.S.F., Chou, M.C., Lee, J.C., Wong, C.C., Chou, W.J., Chen, M.F. & Wu, Y.Y. (2010). Behavioral problems and parenting style among Taiwanese children with autism and their siblings. Psychiatry and Clinical Neurosciences, 64(1), 70-78. http://dx.doi.org/10.1111/j.1440-1819.2009.02034.x
29. Gıcı Vatansever, A. & Ahmetoğlu, E. (2023). Coaching parents in teaching their children with autism spectrum disorder. Tırakya University Journal of Social Science. 25(2), 599-624. https://doi.org/10.26468/trakyasobed.1214061
30. Gökmenoğlu, S. & Başer, D. (2023). Parents of children diagnosed with mild intellectual disability in terms of perceived stress levels and family needs. Journal of Society & Social Work. 34(3), 631-657. https://doi.org/10.33417/tsh.1205128
31. Gugliandolo, M.C., Liga, F., Larcan, R. & Cuzzocrea, F. (2023). Parents of children with developmental disorders: Family hardiness and resilience, Journal of Intellectual & Developmental Disability, 48(3), 334-339, https://doi.org/10.3109/13668250.2022.2079056
32. Han, F. & Gao, X. (2025). The challenge coping and resilience of the families of school-aged children with autism spectrum disorder in China: A qualitative study. Behavioral Sciences, 15(4), 409. https://doi.org/10.3390/bs15040409
33. Hassan, A.A., Hamid, A.M. & Eltayeb, N.H. (2021). Burden on parenting of children with special needs: Review article. EAS Journal of Nursing and Midwifery, 3(2), 63-75. https://doi.org/10.36349/easjnm.2021.v03i02.002
34. Holroyd, J. (1987) Questionnaire on resources and stress for families with chronically ill or handicapped members. Brandon: Clinical Psychology Publishing.
35. Kaner, S. (2004). Perceived stres, social support and life satisfaction in parents with disabled children. Ankara University Scientific Research Projects.
36. Kapçı E.G., & Erdinç-Demirci, S. (2009, October 1-3). Evaluation of the parent attitude scale in mothers with children between the ages of 3-13. 18th. National Educational Sciences Congress, Izmir.
37. Karpuzluk, A. & Akalın, A. (2024). Parenting stress and childbearing motivations in mothers of children with autism spectrum disorder: An analytical cross-sectional study. Anatolian Journal of Health Research, 5(2), 140-148. http://dx.doi.org/10.61534/anatoljhr.1439898
38. Keser, N., Kapcı, E.G., & Odabaş, E. (2012). Comparison of children with and without chronic health problems on self-perception, emotional-behavioral problems and parental attitudes. Turkish Journal of Child And Adolescent Mental Health, 19(2), 57-68.
39. Klem, L. (1995). Reading and understanding multi-variate statistic. In L.G. Grimm & P.R. Warnold (Eds.). Path analysis (pp. 65–97). American Psychological Association.
40. Küçüker, S. (1998) An evaluation of psychometric properties of Qustionnaire on Resources and Stress-F for parents of young children with and without disability. Unpublished research report, Ankara University, Ankara.
41. Lebni, J.Y., Ziapour, A., Khosravi, B., Rahimi, Z. & Kandi, K. (2021) Lived experience of mothers of children with disabilities: A qualitative study of Iran. Journal of Public Health: From Theory to Practice. 29, 1173–1179. https://doi.org/10.1007/s10389-020-01215-0
42. Mandeep Kaur, M. & Khanna, A. (2023). Reducing the stress of caregivers of disabled children with stress inoculation training. Indian Association of Health, Research and Welfare, 14(4), 449-453. https://iahrw.org/our-services/journals/indian-journal-of-health-wellbeing/
43. Miller, J.E., Nugent, C.N. & Russell, L.B. (2015). Risk factors for family time burdens providing and arranging health care for children with special health care needs: Lessons from nonproportional odds models. Social Science Research. 52, 602–614. http://dx.doi.org/10.1016/j.ssresearch.2015.04.003
44. Miranda, A., Mira, A., Berenguer, C., Rosello, B. & Baixauli, I. (2019). Parenting stress in mothers of children with autism without intellectual disability: Mediation of behavioral problems and coping strategies. Frontiers in Psychology, 10(464). https://doi.org/10.3389/fpsyg.2019.00464
45. Montes, G. & Halterman, J.S. (2007). Psychological functioning and coping among mothers of children with autism: A population-based study. Pediatrics, 119(5), e1040-1046. https://doi.org/10.1542/peds.2006-2819
46. Nandini, V. & Anuradha, K. (2021). Impact of training on perceived stress of parents with intellectually disabled children. Issues Ideas Education, 9(1), 49–61. https://doi.org/10.15415/iie.2021.91006
47. Noroozi, F., Farrar, Z., Gharibi, T. & Roqayeh Gashmard, R. (2024). Family self-support in managing down syndrome children: A qualitative study. The Scientific World Journal, Article ID 9992595, 15 pages, https://doi.org/10.1155/2024/9992595
48. Onwuakagba, I.U., Okoye, E.C., Simon, L.A., Okonkwo, U.P. & Nwankwo, M.J. (2024). Burden, needs, and attitudes of parents of children with cerebral palsy in a middle‑income country. Journal of Public Health. 32, 1083–1092. https://doi.org/10.1007/s10389-023-01896-3
49. Özmen, D. & Çetinkaya, A. (2012). The problems experienced by families with disabled children. Journal of Ege University Nursing Faculty, 28(3), 35-49.
50. Özyürek, A. (2022). Determination of child rearing attitudes and influencing factors of parents with disabled children. Journal of Society & Social Work. 33(4), 1121-1140. https://doi.org/10.33417/tsh.1061679
51. Özyürek, A. & Ergun, S. (2021). Examining child-rearing attitudes of mothers who have 9-12 age group children of diagnosed with autism spectrum disorder and normal development. Manisa Celal Bayar University Journal of Social Sciences, 19(2), 1-14. https://doi.org/10.18026/cbayarsos.545390
52. Park, G.A. & Lee, O.N. (2022). The moderating effect of social support on parental stress and depression in mothers of children with disabilities. Hindawi Occupational Terapy International, Article ID 5162954, 1-8. https://doi.org/10.1155/2022/5162954
53. Picardi, A., Gigantesco, A., Tarolla, E., Stoppioni, V., Cerbo, R., Cremonte, M., Alessandri, G., Lega, I., & Nardocci, F. (2018). Parental burden and its correlates in families of children with autism spectrum disorder: A multicentre study with two comparison groups. Clinical Practice & Epidemiology in Mental Health, 31(14), 143–176. https://doi.org/10.2174/1745017901814010143
54. Phillips, B.A., Conners, F. & Curtner-Smith, M.E. (2017). Parenting children with down syndrome: An analysis of parenting styles, parenting dimensions, and parental stress. Research in Developmental Disabilities, 68, 9–19. http://dx.doi.org/10.1016/j.ridd. 2017.06.010
55. Platt, C., Roper, S.O., Mandleco, B. & Freeborn, D. (2014). Sibling cooperative and externalizing behaviors in families raising children with disabilities. Nursing Research, 63(4), 235-242. https://doi.org/10.1097/NNR.0000000000000046
56. Rfat, M., Koçak, O., & Uzun, B. (2023). Parenting challenges in families of children with a diagnosis of autism spectrum disorder: A qualitative research study in Istanbul. Global Social Welfare: Research, Policy & Practice. Advance online publication. https://doi.org/10.1007/s40609-023-00270-1 PMID:36852134
57. Robinson, C., Mandleco, B., Olsen, F., & Hart, C. (2001). The parenting styles and dimensions questionnaire (PSDQ). In B.F. Perlmutter, J. Touliatos & M.A. Straus (Eds.), Handbook of family measures techniques (pp. 319-321). Thousand Oaks: Sage Publications.
58. Sabancıoğulları, S. & Yıldırım, F. (2025). Group Counseling Education Program for parents of children with autism spectrum disorder. Journal of Psychosocıal Nursing, 63(7), 42-51. https://doi.org/10.3928/02793695-20250304-01
59. Sarı, H.Y. & Başbakkal, Z. (2008). Developing a Family Burden Assessment Scale for the families of children with intellectual disability. Journal of Anatolia Nursing and Health Sciences, 11(3), 86-95.
60. Sarı, T., Işık, M., Kaya, A., Gamsızkan, Z. & Sarı, E. (2024). The effect of family counseling on anxiety, depression, and stress levels in mothers of disabled children: A randomized controlled trial. The Anatolian Journal of Family Medicine. 7(2), 48–54. https://doi.org/10.5505/ajfamed.2024.13471
61. Sarıkaya, S. (2011). Child with mental disability managing parents' stress levels and life satisfied examination. [Unpublished doctoral dissertation]. University of 9. Eylul, Izmir.
62. Savari, K., Naseri, M. & Savari, Y. (2023). Evaluating the role of perceived stress, social support, and resilience in predicting the quality of life among the parents of disabled children, International Journal of Disability, Development and Education, 70(5), 644-658, https://doi.org/10.1080/1034912X.2021.1901862
63. Schiltz, H.K., McVey, A.J., Gonning, K., Haendel, A.D., Murphy, C., Van Hecke, A.V. & Gerdes, A. (2022). Examining differences in parenting stress, parenting efficacy, and household context among mothers of youth with autism and/or ADHD. Journal of Child and Family Studies, 31, 774–789. https://doi.org/10.1007/s10826-021-02083-2
64. Sethi, S., Bhargava, S.C., & Dhiman, V. (2007). Study of level of stress and burden in the caregivers of children with mental disablility. Eastern Journal of Medicine, 12(1/2), 21.
65. Sharabi, A. & Marom-Golan, D. (2018). Social support, education levels, and parents’ involvement: A comparison between mothers and fathers of young children with autism spectrum disorder. Topics in Early Childhood Special Education. 13, 54-64. https://doi.org/10.1177/0271121418762511
66. Shastri, U., Prakasan, N., Satheesan, L., Kumar, K. & Kalaiah, M.K. (2025). Parental stress, learned helplessness and perceived social support in mothers of children with hearing loss and mothers of typically developing children. Audiology Research, 15, 1-12, https://doi.org/10.3390/audiolres15010001
67. Shokoohi–Yekta, M., Zamani, N. & Ahmadi, A. (2011). Anger management training for mothers of mildly mentally retarded and slow learner children: Effects on mother-child relationship. Procedia Social and Behavioral Sciences, 15, 722–726. https://doi.org/10.1016/j.sbspro.2011.03.172
68. Sobel, M.E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 290-321.
69. Şahin, H., Çakmak, A. & Erdem, Y. (2025). Evaluation of the family burden and social isolation status of mothers of children with special needs. Ankara University Faculty of Educational Sciences Journal of Special Education, 26(1), 67-81. https://doi.org/10.21565/ozelegitimdergisi.1339610
70. Şahin Varol, H. & Altun Yılmaz, E. (2023). Evaluation of mothers with disabled children in terms of depressive symptoms and perceived social support. Journal of Nursing Science. 6(2), 97–105. https://doi.org/10.54189/hbd.1305082
71. Thomas, P.A., Liu, H. & Umberson, D. (2017). Family relationships and well-being. Innovation in Aging, 1(3), 1–11. https://doi.org/10.1093/geroni/igx025
72. Uguz, S., Toros, F., İnanç, B.Y. & Çolakkadıoğlu, O. (2004). Assessment of anxiety, depression and stres levels of mothers of disabled children. Turkish Journal of Clinical Psychiatry, 7(1), 42-47. https://jag.journalagent.com/kpd/pdfs/KPD_7_1_42_47.pdf
73. Vega, V. (2024). Understanding psychological flexibility, parenting stress, and parenting style as predictors of parent-child relationships. [Unpublished doctoral dissertation]. Kean University, New Jersey.
74. Ventola, P., Lei, J., Paisley, C., Lebowitz, E. & Silverman, W. (2017). Parenting a child with ASD: Comparison of parenting style between ASD, anxiety, and typical development. Journal of Autism and Developmental Disorders, 47(9), 2873-2884.
75. Visilopoulou, E. & Nisbet, J. (2016). The quality of life of parents of children with autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 23, 36–49.
76. Yavuzer, H. (2019). Mother-father and child. İstanbul: Remzi Publishing.
77. Yılmaz, G. (2019). Mothers with disabled children: Needs, stress levels and family functionality in rehabilitation. Scandinavian Journal of Caring Sciences. 524-532. https://doi.org/10.1111/scs.12783
78. Zabun Sever, M. & Tas Arslan, F. (2021). Family burden and anger level among mothers of children with intellectual disability. Balıkesir Health Sciences Journal/BAUN Health Science Journal, 10 (3), 391-397. https://doi.org/10.53424/balikesirsbd.987835