PARENTING STRESS ASSOCIATED WITH DIFFERENTLY ABLED CHILDREN...THAT MAY INFLUENCE SEEKING DENTAL CARE?

Faraz Ahmed 1 , * Arathi Rao 2 and Suprabha BS 3 .  1. Post Graduate Student, Paedodontics& Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore. 2. Professor & Head, Paedodontics& Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore. 3. Professor, Paedodontics& Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (2), 1765-1768 1766 burden on their emotional and financial assets have excessive stress and reduced level of comfort as compared to the parents of normal children5, 6. Parenting behavior is influenced by many factors and one such aspect is parenting stress. Parenting stress can be described as excess anxiety and tension specifically related to the role of a parent and to parent-child interactions7. Plethora of evidence is there that additional amount of emotional stress is experienced by parents of children with retardation. It is reported that parents of mentally and physically challenged children are more upset, socially secluded and confined in their parental roles in comparison with parents of children with normal behaviour8. Increased levels of stress across all sections in parents of children with developmental disorders have been reported by Beckman9. It is reported that behavioral and developmental disability was linked with excessive parenting stress than medical disorder 10.
It is documented that parental stress and adaptation rely upon the kind of disability, the family's coping facilities, conventional and unconventional supports in the society. Parent's previous psychological make up, accessibility and standard of professional assistances, marital interaction, religious perspectives, attitudes, number of members in the family also affects family adaptation. The quantity of assistance the parents obtain from companions, family members and professionals, regulates the self-resolution and intellectual performance of the parents6,11.

Type of stress:-
The nature of stress and areas of stress in parents of the mentally challenged have been studied extensively12-15. a. Care stress b. Social stress -poor social relationships and lack of holidays or free time c. Emotional stress d. Financial stress -Families with low income is reported to be correlated with increased stress because of insufficient facilities.
Factors affecting stress:-1. Mothers' vs Fathers -The mothers experience higher stress than the fathers when it comes to daily care, emotional and social stress as mothers are usually directly involved in child care. Father's stress is attributed from disturbed behavior and decreased leisure time. Regarding financial stress, there were no differences between the parents15. 2. Siblings -Effect on siblings such as that of adjustment creates stress on both the parents but absence of normal siblings in the family of mentally challenged children does not make significance difference in stress experienced by the parents16. 3. Gender of the child -Gender and age of the child influences the stress in parents. Tangri and Verma17report higher stress in parents of female retarded children. When the child with disability is female, marital stress among parents is also seen and affinity is compromised 18. 4. Age -Lower age of the mentally challenged individual is associated with an increase in stress.14,19Lesser the parents age higher is the parental stress, probably due to reduced experience and restrictions involved20. 5. Severity of retardation: It is observed that parents of severe and profoundly retarded children have higher stress21 but in Indian scenario parents of mildly retarded group also exhibit higher stress13. 6. Educational level of parents -Educational level of parents does show clear influence on parental stress and higher stress is reported in educated group, which may be due to the additional social stress involved22. Prabhu23 found that mental retardation is not considered as a serious problem especially in the agricultural communities, which may due to impaired sense of competence, less restrictions in their lifestyles, etc. Higher stress among educated parents may exist because of increased expectations of their children, higher sense of humiliation, annoyed at incapable of not being able to rehabilitate the state of the child and more limitations on their community and professional actions24-25. Increased stress was encountered in parents who worked as professionals and managers as compared to parents who were employed as laborers and assistants. Impaired sense of ability, limitations put on other lives, insufficient social assistance and depression can be the reasons 26. 7. Support and resources -The studies reveals that knowledge on the value of informal support by extended family is inconsistent. Parents in joint families have support from grandparental and other family members thus reducing parental stress27. But it has been reported that family support can be a troublesome because of morebehaviorissues or excessive demands. Family adaptation has been encouraged and a decrease stress has been found by the assistance from the spouse and nearby relatives28.Most of the parents in India do not use 1767 formal resources such as social support groups or family counselling due to the disgracelinked to disability and the harm to the family's prestige and this may further increase the stress.

Burden reported29-32:-
The kind of burdens reported by family members vary from a. Difficulties in transportation of thechild to the place of service delivery b. Management of behavior problems c. Disruption of their daily routine d. Economic, physical and social burden.
Parental Coping mechanisms:-Trust in God, spirit and self-belief to the external aids such as assistance from family members, relatives, professionals, and Governmental policies are various coping resources33. Parenting stress is found to be reduced by religious coping34,35. It is also intriguing to be aware that music and television has been used by the parents to decrease the stress of handling with the situation.

Conclusion:-
Stress may also interfere in parent's ability to provide good oral health care. It is therefore necessary not only to educate parents but also to understand, assess and counsel parental stress related issues. Most of the time importance is given only to the difficult areas associated with children with special needs such as soft diet high in carbohydrates, lack of muscle movement and coordination making it difficult to effectively brush the teeth predisposing these children to a higher risk for dental caries and gingival diseaseetc, but the parental stress is totally ignored.36 Formation of dental teams with knowledge, empathy and providing education keeping in mind the associated stress involved, is what parents need. The dental community has to increase its effort for providing full support to parents and these children in the form of continuous encouragement apart from providing oral health education and dental care facilities.