Académique Documents
Professionnel Documents
Culture Documents
First received
Blackwell June 23,
Publishing Inc2006; Revision received December 27, 2006; Accepted for publication May 27, 2007.
Disabled Children
PURPOSE. This study was designed to determine Esine Sen, RN, MSc, is a pediatric nurse, Pediatric Clinic,
Mersin University School of Medicine Research and
the difficulties experienced by families with Administration Hospital; and Sabire Yurtsever, PhD, RN,
is Assistant Professor, School of Health, Mersin University,
disabled children. Mersin, Turkey.
study was carried out in one public and two The World Health Organization has defined dis-
ability as an inability or handicap that interferes with an
private rehabilitation centers. A questionnaire individual’s ability to have a lifestyle that is considered
normal for their age, gender, and social and cultural
was used for data collection. state (Ocakçı, 2002b; Turkey Prime Minister Administra-
tion for Disabled People, 2002). The American Health
RESULTS. Families did not have enough knowledge Association also defined a disabled child as a child
who cannot play, cannot learn, or cannot do things that
about their child’s condition. Mothers felt severe children at his or her age can do, or, said another way, a
child who cannot fully use all of his or her physical,
sadness, and they indicated that after having a mental, and social abilities for various reasons (Urhan,
2002). In general, disability in children can be seen
disabled child, their social life, working life, and individually or together as several physical, develop-
mental, cognitive, or affective disabilities.
family relationships were all affected. Families also Today, intellectually, physically, or emotionally
disabled individuals comprise a significant portion
have financial problems. of the world population. According to World Health
Organization statistics, it is estimated that disabled
PRACTICE IMPLICATIONS. Parents with a disabled
individuals comprise 10% of the population of developed
countries and 12% of developing countries (Baykan,
child need support from professionals. Nurses have
2003). An estimated 12% of children, ages 5–17 years
(Hogan, Msall, Rogers, & Avery, 1997), or approxi-
a vital role in providing support for these families.
mately 6.6 million children in 2000 (U.S. Census Bureau,
2001) had disabling conditions. In Turkey, it is estimated
Search terms: Nursing, parents of disabled
that there are 9 million children, ages 0–18 years, who
are disabled or have special needs. Every seven to eight
children, support
families has one child or adult member with a disability
(Aytaç, 2000; Gökcan, 2002; Ocakçı, 2002a).
The birth of a child with an abnormality or the pres-
entation of a handicap being diagnosed as a disability
is a crisis in which the parents’ expectations are turned
upside down. When parents learn that their child is
First received June 23, 2006; Revision received December 27, 2006; disabled, they experience mixed emotions. The general
Accepted for publication May 27, 2007. reactions of parents can be grouped under three main
Tertiary Reactions ment for their child’s healthy growth and development.
The parents of a disabled child, however, in addition
Bargaining. The important thing for a family is for to these responsibilities, are also burdened with addi-
their disabled child to be like a healthy child. The family tional responsibilities, such as teaching the disabled
may bargain with anyone who can make this happen. child skills and doing physiotherapy. For this reason,
People who are bargained with may be healthcare pro- the parents of a disabled child need additional money
fessionals, mediums, or others who think they have and time (Emerson, 2003; Roberts & Lawton, 2001).
magical powers, or even God. For the majority of the Because parents need extra time for their disabled child,
time, parents will not easily accept that their child is they do not have enough time for themselves, each
disabled even if they receive information and help from other, or their other children. For this reason, families
professionals (Abidoglu & Gümüsçü, 2000). may need to make changes in their social lives. Having
Acceptance and adaptation. In this phase, the family a disabled child may also have a negative effect on
tries to get to know the disabled child and understand marital relationships. The birth of a disabled child may
and solve their problems; however, the negative feel- cause tension as spouses blame each other.
ings that are experienced in the other phases never Families with disabled children may also experi-
completely disappear. Adaptation is an extension of ence economic difficulties. Studies have reported that
the acceptance phase transformed into action. Adapta- families of disabled children have financial difficulty
tion is a process that never completely ends. The adap- (Christina & Patrica, 1992; Gökcan, 2002; Mutlu, Demir,
tation process is significantly affected by the personal Kerem, & Livanelioglu 2003; Urhan, 2002). In addition,
characteristics of the parents. This process begins after because one parent may be responsible for the care of
a family accepts that they cannot change the fact that the disabled child, that parent may have to stop work-
they have a disabled child. ing, which causes loss of income and financial diffi-
The child’s disability may make it necessary for all culty for the family (Çavusoglu, 2002; Karancı, 1997;
the members of the family to sacrifice for the sake of Taanlia, Syrjala, Kokkoken, & Jarvelin, 2002; Yurdakul,
the disabled child. Having one disabled family mem- Gırlı, Özekes, & Sarısoy, 2002).
ber may affect the relationships within the family, As stated above, the family who has a disabled
the family’s economic situation, the family’s daily child may be in a crisis situation. The difficulties (e.g.,
lifestyle, and the family’s plans and expectations for care, psychological, social, and economic) experienced
the future. This crisis situation may be the cause for by family members during the process of adaptation
members of the family to experience stress (Emerson, toward living with the disabled child can lead to con-
2003; Foster et al., 2004; Green, 2003; Kayhan, 1995; flict within the family; and there may be changes in
Pelchat & Lefebvre, 2004; Raina et al., 2005). In a study individual roles and functions within the family. The
conducted by Brinchmann (1999), a high level of stress quality of life for family members is negatively affected
was found in the parents of disabled children. Among by these problems. As can be seen here, a holistic
the most significant factors creating stress in the fam- approach to care in families with disabled children is
ily of a disabled child were the child’s developmental gaining importance. However, studies conducted on
difficulties, health problems, and difficulties with this subject show that healthcare personnel have been
care because of the child’s dependency (Harden, 2005; seen to be inadequate in providing support and guid-
Özsenol et al., 2003). Related to these factors was the ance to families during this extremely distressing time
family’s concern for the future of their child. (Balling & McCubbin, 2001; Fisher, 2001; Hall, 1996).
Parents of a normal child have the responsibility to Due to inadequate support from healthcare personnel,
meet the needs of and prepare an appropriate environ- families try to cope with crisis situations on their
toward living with the disabled child can The research sample was comprised of mothers
with primary responsibility for 103 disabled children,
lead to conflict within the family; and there between the ages of 3 and 18 years, registered in these
centers; 51 of the children have cerebral palsy (CP), 35
may be changes in individual roles and have an intellectual disability, and 17 have autism.
Because there were higher numbers of children with
functions within the family. CP than intellectual disability and autism in the centers
where the research was conducted, the mothers of
these children were included in the sample. The major-
ity of the mothers participating in the study were
The nurse, while working with disabled children, between 24 and 34 years old, and their mean age was
must consider the family and child as a whole and 26.2 years. The descriptive characteristics of the
support the family in coping with their crisis and the participants are presented in Table 1.
difficulties they are facing. For nurses to be effective as Five of the mothers with a child enrolled in the
an important support system, they need to adequately private centers did not agree to participate. The 10
know the child and family and be able to determine mothers who participated in the pilot test were not
the difficulties experienced by the family, including included in the study.
Table 1. Distribution of Disabled Children’s Diagnoses According to Their Mothers’ Descriptive Characteristics
Diagnoses of disabled children’s
Age
24–34 32 62.7 18 51.4 9 52.9 59 57.3
35–44 16 31.4 15 42.9 6 35.3 37 35.9
45+ 3 5.9 2 5.7 2 11.8 7 6.8
Educational status
Illiterate 7 13.7 3 8.6 — — 10 9.7
Elementary school 23 45.1 21 60.0 7 41.2 51 49.5
Secondary school 11 21.6 6 17.1 2 11.8 19 18.4
High school 7 13.7 4 11.4 5 29.4 16 15.5
University 3 5.9 1 2.9 3 17.6 7 6.8
Employment status
Employed 4 7.8 — — 2 11.8 6 5.8
Not employed 47 92.8 35 100.0 15 88.2 9 94.2
Presence of chronic illness
Yes 6 11.8 2 5.7 2 11.8 10 9.7
No 45 88.2 33 94.3 15 88.2 93 90.3
Table 2. The Distribution of the Children’s Disabilities According to the Difficulties in Home Care
Experienced by Their Caretakers
Diagnoses of disabled children’s
Table 3. The Distribution of Children’s Diagnoses According to the Feelings Experienced by Their Mothers
Diagnoses of disabled children’s
difficulties were experienced by the CP children’s 49.0% of the families with CP children, 57.1% of the
caretakers for activities such as feeding (73.8%), families with intellectually disabled children, and 23.5%
dressing–undressing (24.4%), assisting with elimination of the families with autistic children experienced
(90.2%), bathing (78.0%), and carrying (82.9%). The financial difficulties.
caretakers of the intellectually disabled and autistic It was found that 28.2% of the families received
children experienced the same percentage of difficul- financial support: almost 29% of the families with CP
ties with communicating (16.7%) and continuous children, 20.0% of the families of intellectually dis-
monitoring/attention (83.3%), which were higher than abled children, and 40.0% of the families with autistic
the caretakers for the CP children. Support for daily children received financial support.
care was received by 80.4% of the caretakers for CP Among the families who received financial support,
children, 68.6% of the caretakers for the intellectually 96.6% of them reported that they received it from close
disabled children, and 70.6% of the caretakers for the relatives (87.5% of the families with CP children and
autistic children. 100.0% of the families with intellectually disabled and
In the investigation of the individuals who gave autistic children reported that their source of financial
support in the care, it was determined that the other support was close relatives). Eighty percent of the
nuclear family members gave more support than close families stated that the support that they received was
relatives or friends. Another family member supported “somewhat sufficient.” Seventy-five percent of the
73.3% of the CP children’s caretakers, 84.6% of the CP children’s families, 100.0% of the intellectually
intellectually disabled children’s caretakers, and 62.5% disabled children’s families, and 50.0% of the autistic
of the autistic children’s caretakers. children’s families stated that the support that they
In the examination of the sufficiency level of the received was “somewhat sufficient.”
support received, 53.3% of the CP children’s caretakers As shown in Table 3, the mothers stated that they
and 61.5% of the intellectually disabled children’s experienced deep sadness (57.3%), feeling overwhelmed
caretakers stated that they had “somewhat sufficient” (54.4%), anger (36.9%), and loneliness (7.8%). In addi-
support, but only 17.6% of the autistic children’s care- tion, in response to the question, “What kind of reaction
takers stated that they received sufficient support. was given by those around you to the birth of your
Almost half of the families (47.6%) of all of the disabled child?” 22.5% of the CP children’s mothers,
disabled children experienced financial difficulties: 17.1% of the intellectually disabled children’s mothers,
and 11.8% of the autistic children’s mothers stated that mothers, and 82.4% of the autistic children’s mothers
they were blamed by their family for their children’s reported changes in their social lives. There was no
disability. In the investigation of the people who statistically significant relationship between children’s
blame the mother, 53.8% of the mothers of CP children disability and the status of change in their mothers’
were blamed by their husband’s family; 50.0% of the social lives (χ2 = .370, p > .05). Furthermore, 85.4% of
intellectually disabled and 100.0% of the autistic the CP children’s mothers, 72.0% of the intellectually
children’s mothers were blamed by their husbands. disabled children’s mothers, and 71.4% of the autistic
It was determined that 71.8% of all the mothers children’s mothers stated that they had a higher
received emotional support (68.6% of the CP children’s percentage of changes in their social lives because
mothers, 68.6% of the intellectually disabled children’s they were not able to set aside time for themselves and
mothers, and 88.8% of the autistic children’s mothers). for other members of their families.
More than half (56.8%) of the mothers who stated that A small percentage of the mothers of CP children
they received emotional support received that support (5.9%), intellectually disabled children (8.6%), and
from another family member and 9.5% from a special- autistic children (8.6%) stated that their families’ work
ist. Other members of the family provided emotional lives had been affected. Seven of the mothers had quit
support to 54.3% of the mothers of CP children, 58.3% work to care for their children.
of the mothers of intellectually disabled children, and When we investigated the status of changes in
60.0% of the mothers of autistic children. The source relationships within the family caused by having a
of emotional support was a specialist for 16.7% of the disabled child, we found that there were changes in
intellectually disabled children’s mothers and 20% 27.5% of the CP children’s families, 40.0% of the intel-
of the autistic children’s mothers; none of the CP chil- lectually disabled children’s families, and 41.2% of the
dren’s mothers reported that they received emotional autistic children’s families. These changes were the
support from a specialist. However, 43.6% of the source of arguments between spouses in 42.9% of
mothers stated that they did not receive sufficient the CP, intellectually disabled, and autistic children’s
emotional support. The emotional support received families (Table 5).
was “insufficient” by 8.6% of CP children’s mothers, As a result of the problems experienced by having
8.3% of the intellectually disabled children’s mothers, a disabled child, 77.8% of the CP children’s families,
and 26.7% of the autistic children’s mothers. 90% of the intellectually disabled children’s families,
As seen in Table 4, 80.4% of the CP children’s and 76.5% of the autistic children’s families wanted to
mothers, 68.6% of the intellectually disabled children’s receive support from nurses. It was determined that
Table 5. Distribution of Disabled Children’s Diagnoses According to Changes Made in Family Life After
Having a Disabled Child
Diagnoses of disabled children’s
62.9% of the CP children’s families, 77.8% of the intel- children are more physically dependent than intel-
lectually disabled children’s families, and 84.6% of lectually disabled and autistic children.
the autistic children’s families wanted information and Caretakers for the intellectually disabled and autistic
counseling about their children’s condition. Whereas children experienced more difficulty with communi-
54.3% of the CP children’s families and 22.2% of the cating and having to constantly monitor/give attention
intellectually disabled children’s families wanted to their disabled children than the caretakers of CP
support for home care, only 7.7% of the autistic chil- children. This can be explained by the lower intel-
dren’s families wanted support for home care. Whereas lectual ability and inadequate communication skills of
38.5% of the autistic children’s families wanted psy- intellectually disabled and autistic children. Several
chological support, only 7.4% of the intellectually studies found that the majority of disabled children
disabled and 5.7% of the CP children’s families needed supervision or extra assistance in the majority
wanted psychological support. of their activities of daily living (Emerson, 2003;
Pelchat & Lefebvre, 2004; Raina et al., 2005; Roberts &
Discussion Lawton, 2001; Taanlia et al., 2002). In one study, nearly
one third of parents reported having been denied child
Daily care for children with disabilities is different care due to their child’s disability, and 23% of parents
from that of normal children because of their special who lacked child care reported they were still seeking
care needs. Some or all of disabled children’s activities it for their disabled child (Cutler & Gilkerson, 2002).
of daily living are dependent on someone else. This Zigler and Lang (1991) have identified a host of barriers
situation may cause families of disabled children to parents face in securing child care for their disabled chil-
experience difficulty with their care (Siklos & Kerns, dren, including inadequate numbers of trained caregivers
2006). In our study, caretakers for the CP children who can effectively meet disabled children’s needs,
experienced the most difficulties with feeding, dressing– prejudice and fear about disability, limited knowledge
undressing, assistance with elimination, bathing, and regarding the nature of disabilities, and transportation
carrying. This can be explained by the fact that CP barriers for children with mobility impairments.
In this study, more than half (57.3%) of the mothers the individuals with a disabled child from a psycho-
experienced deep sadness because they have a disabled logical point of view.
child. This was also the case in the study conducted in The social lives of 76.7% of the mothers were
Turkey by Özsenol and colleagues (2003), who found affected, and this was primarily a result of their not
that the majority of mothers of disabled children being able to set aside time for themselves and other
experience intense sadness. Mothers and fathers of members of the family. Similar results were obtained
disabled children in China have been found to experi- by another study conducted in Turkey that found
ence irritation, sadness, stress, worry, anxiety, fear, mothers who were caring for disabled children did not
burnout, and loss of control (Ma, Lai, & Han Pun, 2002). have enough time to set aside for the other members
Because of the emotions that they experienced, 71.8% of the family (Mutlu et al., 2003). In addition, 6.8% of
of the mothers wanted emotional support. More than the mothers stated that they quit work to care for their
half of the mothers (56.8%) received this support child. These data may be explained by the fact that the
from another family member, but 52.7% stated that mothers were primarily responsible for the care of the
this support was not sufficient. For this reason, the disabled child and their lack of sufficient support for
support may need to be from a professional. Hassal, that care. In small-scale studies, mothers of disabled
Rose, and McDonald (2005) also found that there is a children have reported that a lack of affordable and
strong correlation between mother and father’s stress adequate child care limited their ability to maintain
and family support. employment (Brandon & Hofferth, 2003; Fink, 1988;
In this study, 20.4% of the mothers were blamed by Shearn & Todd, 2000).
the family for having a child with a disability. This may In the examination of the status of changes in internal
be a result of the cultural norm in Turkey for child family relationships, it was determined that 34.0%
care and raising to be primarily the mother’s responsi- of the families had changes and that 42.9% of the
bility, and when she has used medications, smoked changes in families of children with CP, intellectual
cigarettes, or has not had good nutrition during her disability, and autism results in arguments between
pregnancy, the presumed result is the disabled child. spouses. Also in this study, 5.7% of the families had
Additionally, mothers may be blamed for not being divorced after the birth of a disabled child. Because of
able to adequately care for their child after birth. the additional stress that a disabled child brings to
The mothers stated that they received support from family life and because of spouses blaming each other,
other members of the family for the emotions that they there may be changes in relationships within the
experienced, but more than half stated that this sup- family and in marital relationships. In a study con-
port was insufficient. The support that a family could ducted by Kulagina (2003), it was determined that
receive from a professional, however, could facilitate 77.5% of families experienced changes in relationships
the family’s adjustment to a disabled child and coping within the family, and 4.5% of the parents divorced
with the stress and difficulties the family experiences after the birth of a disabled child.
(Trulsson & Klingberg, 2003). For this reason, it is The family is the primary institution for the founda-
important that one of the supports that a family tion of a society and for maintaining its presence. The
receives be access to a professional. Nurses are the family is the primary environment for meeting basic
individuals who can give professional support to needs, such as nutrition, care, need for love, emotional
families and children because they come in contact development, education, acquiring cultural values,
with disabled children and their families in almost healthy intellectual development, etc., and holds a
every area (hospital, health clinic, school, rehabilitation very important place in the lives of individuals. In
center, etc.). These data present the need to consider particular, the family is important for being the place
The majority of families wanted support from nurses. Author contact: sabire00@yahoo.com, with a copy to the
In general, the families wanted information and Editor: roxie.foster@uchsc.edu
counseling about the child’s condition from nurses
References
and wanted to receive support for home care and
psychological support for themselves. Abidoglu, Ü., & Gümüsçü, S. (2000). Autism and autistic children (1st
ed.). Istanbul, Turkey: Özgür Publication.
Aytaç, S. (2000). Increasing importance of rehabilitation of the disabled
child. Journal of Dokuz Eylül University Social Sciences, 2(2), 21–35.
How Do I Apply This Information to Balling, K., & McCubbin, M. (2001). Hospitalised children with
Nursing Practice? chronic illness: Parental caregiving needs and valuing parental
expertise. Journal of Pediatric Nursing, 16, 110–119.
Baykan, Z. (2003). Causes and prevention of disabilities, handicaps,
The findings obtained from this study have made and defects. Journal of Continuing Medical Education, 9(9), 336–
clear the importance of providing families with profes- 338.
sional support by evaluating the family of a disabled Beresford, B. A. (1994). Resources and strategies: How parents cope
with the care of a disabled child. Journal of Child Psychology and
child as a whole and coordinating their care as a result Psychiatry and Allied Disciplines, 35, 171–209.
of this evaluation. Ensuring the continuation of family- Black, M. (1981). Impact of disabled children on the family. IIPF.
centered care may be important in decreasing the prob- Medical Bulletin, 15(5), 1–2.
Blau, D., & Tekin, E. (2001). The determinants and consequences of child
lems that they experience. This study revealed that care subsidies for single mother (Discussion paper 383). Bonn,
mothers may be blamed by their husbands and their Germany: Institute for the Study of Labor.
husbands’ families for the birth of a disabled child. For Brandon, P. D., & Hofferth, S. L. (2003). Determinants of out-of-
school childcare arrangements among children in single-mother
this reason, accepting the mother and father together and two-parent families. Social Science Research, 32, 129–147.
with the birth of a disabled child and ensuring they Bright, J. A., & Hayward, P. (1997). Dealing with chronic stress: Coping
receive necessary counseling and support may be strategies self-esteem and service use in mothers of handicapped
children. Journal of Mental Health, 6(1), 67–75.
important in helping to solve this problem. Nurses have Brinchmann, B. S. (1999). When the home becomes a prison: Living
important roles in the fulfillment of all of these with a severely disabled child. Nursing Ethics, 6(2), 137–142.
responsibilities. As the nurse is very familiar with the Callery, P. (1997). Maternal knowledge and professional knowledge:
Co-operation and conflict in the care of sick children. International
healthcare system, he or she is in an excellent position Journal of Nursing Studies, 34, 27–34.
to assist the family in identifying resources and accessing Çavusoglu, H. (2002). Child health nursing (6th ed.). Ankara, Turkey:
these resources. In addition, nurses are an important sup- Bizim Company.
Çetinkaya, Z. (1997). Effect of planned education on the need for disabled
port system. Having a nurse organize and coordinate children related information of mothers with cerebral palsy. Unpublished
the disabled child and family’s care may facilitate the master’s thesis in nursing. Hacettepe University Health Sciences
resolution of problems that the family experiences. When Institute, Ankara, Turkey.
Christina, K., & Patrica, S. (1992). Stress in families of children with
nurses can carry out these functions, they will have an disability: A review of risk and resistance. Journal of Mental
important place in the protection of families and children. Health, 1(3), 32–46.
Cutler, A., & Gilkerson, L. (2002). Unmet needs project: A research,
coalition building, and policy initiative on the unmet needs of infants,
toddlers, and families. Chicago, IL: University of Illinois at Chicago,
Acknowledgment. Thanks are due to Nihat Sözmen Department of Disability on Human Development.
Disabled Child Care and Rehabilitation Center, Izem Ehrle, J., Adams, G., & Tout, K. (2001). Who’s caring for our youngest
children? Child care patterns of infants and toddlers (Occasional
Disabled Child Education and Rehabilitation Private Paper, 42). Washington, DC: Urban Institute.
Center, and Umudum Cognitive and Physically Dis- Emerson, E. (2003). Mothers of children and adolescents with intel-
abled Child Education Private Center that facilitated lectual disability: Social and economic situation, mental health
status, and the self-assessed social and psychological impact of
the work, and to all the parents with disabled children the child’s difficulties. Journal of Intellectual Disability Research,
who participated. 47(Pt 4–5), 385–399.
Shapiro, J., & Tittle, K. (1990). Maternal adaptation to child disability Taanlia, A., Syrjala, L., Kokkoken, J., & Jarvelin, M. R. (2002). Coping
in Hispanic population. Family Relations, 39(2), 179–185. of parents with physically and/or intellectually disabled children.
Shearn, J., & Todd, S. (2000). Maternal employment and family Child: Care, Health and Development, 28(1), 73–86.
responsibilities. Journal of Applied Research in Intellectual Disabili- Tekinalp, B. (2001). The effects of a coping skills hopeless and stress
ties, 13, 109–131. levels of mothers of children with autism. Unpublished master’s
Shlay, A. B., Weinraub, M., Harmon, M., & Tran, H. (2004). Barriers thesis. ODTÜ Social Sciences Institute, Ankara, Turkey.
to subsidies: Why low-income families do not use child care Trulsson, U., & Klingberg, G. (2003). Living with a child with a
subsidies. Social Sciences Research, 33, 134 –157. severe orofacial handicap: Experiences from the perspectives of
Siklos, S., & Kerns, K. A. (2006). Assessing the diagnostic experiences parents. European Journal of Oral Sciences, 111(1), 19–25.
of a small sample of parents of children with autism spectrum Turkey Prime Minister Administration for Disabled People. (2002).
disorders. Research in Developmental Disabilities, 28(1), 9 – 22. Prevention and rehabilitation. Retrieved June 25, 2007, from
Smith, K. (2000). Who’s minding the kids? Child care arrangements. http://www.zicev.org.tr/bilgiler:ozurluhakları:ozurluyasası.htm
Fall 1995. Current population reports (pp. 70–90). Washington, DC: Urhan, G. (2002). Families of children with cerebral palsy. Retrieved
U.S. Census Bureau. June 25, 2007, from http://www.sosyalhizmetuzmani.org/
Strandberg, G., Norberg, A., & Jansson, L. (2000). An examplar of a cpaileleri.htm
positive perspective of being dependent on care. Scholarly Inquiry U.S. Census Bureau. (2001). Age: 2000. Washington, DC: Author.
for Nursing Practice, 14, 327– 353. Retrieved June 25, 2007, from http://www.census.gov/prod/
Taanlia, A., & Javalin, M. (1998). Parental guidance and counselling 2001pubs/c2kbr01-12.pdf
by doctors and nursing staff: Parents’ views of initial informa- Wittert, D. D. (2002). Parental reactions to having a child with
tion and advice for families with disabled children. Journal of disabilities. Nursing Spectrum, 8(17), 12–14.
Clinical Nursing, 7(6), 505– 510. Yurdakul, A., Gırlı, A., Özekes, M., & Sarısoy, M. (2002). Stress
Taanlia, A., Jarvelin, M. R., & Kokkaun, J. (1999). Cohesion and coping methods of families with autistic and mentally disabled
parents’ social relations in families with a child with disability children: Mother-father differences. Saray Rehabilitation, 4(7), 6–17.
or chronic illness. International Journal of Rehabilitation Research, Zigler, E. F., & Lang, M. E. (1991). Child care choices: Balancing the
22(10), 101–109. needs of children, families and society. New York: The Free Press.