The Relationship Between Behavior Problems Of Preschoolers With Developmental Disabilities And Parents’ Anxiety And Depression And Feasibility Study Of Self-help Mindful Parenting Intervention

Background:Anxiety and depression of parents of children with developmental disabilities(DD)are more severe than that of parents of typical developmental children.Behavior problems of children with DD are the main predictors of the anxiety and depression of parents.Parenting stress may be a mechanism underlying the relationship between the behavior problems of children with DD and their parents’ anxiety and depression.To my best knowledge,there is little research on the relationship between behavior problems,parenting stress,and anxiety and depression of parents in preschool children with DD,and few studies on self-help mindful parenting intervention on parenting stress among parents of children with DD.This study was divided into two parts.The purpose of the first part was to examined the mediation role of parenting stress in the relationship between behavior problems of children with DD and parents’ anxiety and depression.The purpose of the second part was to explored the feasibility of a self-help mindful parenting intervention program delivered using the WeChat Rain Classroom platform among parents of children with DD and the potential effect on reducing parenting stress.Methods:Part one:A convenient sample of 178 parents of preschool children with DD were recruited from August 2021 to August 2022 in four special children’s rehabilitation institutions in Jinan,Shandong Province and Wenzhou,Zhejiang Province.The children’s behavior problems,parents’ parenting stress,anxiety,and depression were evaluated by the Aberrant Behavior Checklist(ABC),the Parenting Stress Index Short Form(PSI-SF),the General Anxiety Disorder-7(GAD-7),and the Patient Health Questionnaire(PHQ-9).Mplus 8.0 was used to construct the mediation path model,and the significance of the mediation effect was tested by the non-parametric percentile Bootstrap with bias-corrected.P<0.05 was considered statistically significant.Part two:The 30 parents of children with DD were recruited from part one and randomly divided into the intervention group and the waiting list group with a 1:1 ratio.The intervention group was given a self-help mindful parenting intervention program for 6 weeks delivered using the WeChat Rain Classroom platform.The number and duration of parents participating in the intervention were obtained from the background of WeChat Rain Classroom.At the end of the intervention,the subjective feasibility and self-perceived improvement of the intervention were evaluated using the self-made subjective feasibility questionnaire and self-perceived improvement questionnaire.In addition,PSI-SF,GAD-7,and PHQ-9 were used to evaluate the parents’ parenting stress,anxiety,and depression at three-time points including before the intervention(T1,i.e.,the time of data collection of the part one),the end of the intervention(T2),and one month after the intervention ended(T3).The objective feasibility,subjective feasibility,and self-perceived improvement of the intervention were statistically described.The t-test and Wilcoxon rank-sum test were used to compare the differences of parenting stress,anxiety,and depression in intergroup between the intervention group and the control group,and intra-group before and after the intervention,and the Hedges’g effect was calculated.Results:Part one:There were significantly positive correlations between the behavior problems of preschool children with DD and parenting stress,anxiety,and depression of parents(rs=0.391～0.817,P<0.001),and the mediation effects of parenting stress between the behavior problems of children with DD and parents’ anxiety(the mediation effect accounted for 77.5%,Bootstrap 95%CI=0.028～0.063)and depression(the mediation effect accounted for 62.9%,Bootstrap 95%CI=0.037～0.076)were statistically significant.Part two:The completion rate of intervention among participants in the intervention group was 66.7%.In addition to the fifth week’s theme course and sitting meditation,the completion rate of theme courses per week was close to or greater than 65%,and the number of mindfulness practices per week was more than one time.Additionally,participants of the intervention group self-perceived a significant improvement after the intervention(x=46.27,s=8.3).There was a moderate improvement in parenting stress after the intervention(t=3.46～4.08,P=0.003～0.006,Hedges’ g=0.50～0.82).Anxiety and depression were improved after intervention but did not reach a statistically significant level(t/Z-1.54～1.89,P=0.080～0.148,Hedges’ g=0.32～0.77).Conclusions:Parenting stress can mediate the relationship between behavior problems of preschool children with DD and parents’ anxiety and depression.The application of the self-help mindful parenting intervention program delivered using the WeChat Rain Classroom platform in parents of children with DD is feasible and has the potential to effectively improve the parenting stress,anxiety,and depression of parents of children with DD.