初次診斷為發展遲緩兒童家長之親職壓力及生活品質探討

Parenting Stress and Quality of Life in Parents of Children Newly Diagnosed with Developmental Delays

李佳宜(Chia-Yi Lee)；蔣伊真(Yi-Chen Chiang)；黃雅鈴(Ya-Ling Huang)；李興中(Hsing-Chung Lee)；李國鳳(Kuo-Feng Lee)

發展遲緩 ； 親職壓力 ； 生活品質 ； Developmental delay ； parenting stress ； quality of life

身心障礙研究季刊

13卷3期（2015 / 09 / 01）

153 - 169

繁體中文

過去許多研究顯示有醫療診斷兒童之家長的親職壓力較高且生活品質較差，但較少研究探討孩童尚未接受醫療資源時，家長的親職壓力及生活品質狀態。本研究目的為瞭解家長在發展遲緩子女未接受醫療介入時之親職壓力及生活品質，檢視兩者之相關性及探究可能的預測因子。本研究為橫斷面研究設計，採立意取樣，採用親職壓力量表及生活品質問卷臺灣簡明版做為評量工具，統計方法包括，利用單一樣本平均數t檢定與台灣常模比較生活品質，利用皮爾森相關、獨立樣本T檢定、變異數分析探討親職壓力、生活品質及其他因素之相關性，最後利用逐步迴歸分析探索親職壓力及生活品質的預測因子。有效樣本為58位發展遲緩兒童之家長，研究結果顯示，與過去研究相比，初次診斷為發展遲緩兒童之家長親職壓力之平均分數與一般家長相近，未達到顯著差異；與台灣一般民眾的生活品質相比，生理健康、心理、社會關係及環境四大範疇均低於一般民眾，尤其在生理健康及社會關係範疇顯著較低。進一步分析親職壓力及生活品質之預測因子，語言發展遲緩及孩童整體問題行為是影響家長親職壓力家長分量表的預測因子，孩童外化問題行為及孩童性別是影響家長親職壓力兒童分量表的預測因子，孩童內化問題行為是影響家長生活品質心理範疇的預測因子，語言發展遲緩及家庭收入是影響家長生活品質環境範疇的預測因子，至於生理健康及社會關係範疇之預測因子則未被發現。本研究所發現之預測因子可應用於臨床工作，提升臨床醫療人員之敏感度，對家長及孩童提供個別化的介入服務，不但可維持主要照顧者之長期身心健康，同時有效地促進孩童的發展。

Previous studies showed that parents of children with diagnosis have higher levels of parenting stress and poorer quality of life (QOL). There were few studies investigating the status of parenting stress and QOL in parents when their children with developmental delay (DD) have not received early intervention. The aims of this study were to explore the status and factors associated with parenting stress and QOL in parents in caring children with DD, and find predictors of parenting stress and QOL. This was a cross-sectional study by using purposive sampling method. Parenting Stress Index and World Health Organization Quality of Life-BREF were used as major measurement. Participants were 58 parents of children newly diagnosed with DD. One-sample t-test, Pearson correlation analysis, independent-sample t-test, analysis of variance (ANOVA), and stepwise multiple regression analyses were used. The results showed that compared with previous studies, parents of children with DD had similar levels of parenting stress as those of children with typical development. Parents of children with DD reported to have a poorer QOL than general population in Taiwan, statistically poorer in the physical health and social relationships domains. Based on further analysis, speech delay and total problematic behaviors were the predictors of parent subscale of parenting stress, and externalizing problematic behaviors were the predictors of children subscale of parenting stress; internalizing problematic behaviors were the predictors of psychological domain of QOL, speech delay and household income were the predictors of environmental domain of QOL, and the predictors of physical health and social relationship domains were not found in our study. The findings of this study highlighted the importance of clinical implications of these predictors. Healthcare clinicians should provide more individualized parenting skills training services and family-centered intervention for both parents and children with DD, which could further help parents' well-beings and children development.

1. Chung, Y. Y.,Pan, Y. C.,Chen, Y. C.,Kuo, H. T.(2010).Study on the factors regarding the parental stress for mothers of children with developmental disabilities.Journal of Disability Research,8(2),83-98.
   連結：
2. Huang, Y. P.,St John, W.,Tsai, S. W.,Chen, H. J.(2011).Taiwanese fathers' experiences of having their child diagnosed with a developmental disability.Journal of Nursing Research,19(4),239-249.
   連結：
3. 鍾燕宜、潘雨辰、陳冠蘭、郭煌宗(2012)。發展遲緩兒童主要照顧者之生活品質研究。身心障礙研究，10(1)，20-39。
   連結：
4. Abidin, R. R.(1995).Parenting stress index.Odessa, FL:Psychological Assessment Resources, Inc..
5. Anastropoulos, A. D.,Guevremont, D. C.,Shelton, T. L.,DuPaul, G. J.(1992).Parenting stress among families of children with attention deficit hyperactivity disorder.Journal of Abnormal Child Psychology,20(5),503-520.
6. Cui, Z.,Hardy, L. L.,Dibley, M. J.,Bauman, A.(2011).Temporal trends and recent correlates in sedentary behaviours in Chinese children.The international Journal of Behavioral Nutrition and Physical Activity,8(93)
7. Dabrowska, A.,Pisula, E.(2010).Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome.Journal of Intellectual Disability Research,54(3),266-280.
8. Guillamón, N.,Nieto, R.,Pousada, M.,Redolar, D.,Muñoz, E.,Hernández, E(2013).Quality of life and mental health among parents of children with cerebral palsy: The influence of self-efficacy and coping strategies.Journal of Clinical Nursing,22(11-12),1579-1590.
9. Haimour, A. I.,Abu-Hawwash, R. M.(2012).Evaluating quality of life of parents having a child with disability.International Interdisciplinary Journal of Education,1(2),37-43.
10. Hsieh, R. L.,Huang, H. Y.,Lin, M. I.,Wu, C. W.,Lee, W. C.(2009).Quality of life, health satisfaction and family impact on caregivers of children with developmental delays.Child: Care, Health and Development,35(2),243-249.
11. Huang, C. Y.,Yen, H. C.,Tseng, M. H.,Tung, C. L.,Chen, Y. D.,Chen, K. L.(2014).Impacts of autistic behaviors, emotional and behavioral problems on parenting stress in caregivers of children with autism.Journal of Autism and Developmental Disorders,44(6),1383-1390.
12. Lee, C. F.,Hwang, F. M.,Chen, C. J.,Chien, L. Y.(2009).The interrelationships among parenting stress and quality of life of the caregivers and preschool child with very low birth weight.Family Community Health,32(3),228-237.
13. Leung, C.,Leung, S.,Chan, R.,Tso, K.,Ip, F.(2005).Child behavior and parenting stress in Hong Kong families.Hong Kong Medical Journal,9(5),375-380.
14. Marchal, J. P.,Maurice-Stam, H.,Hatzmann, J.,van Trotsenburg, A. S.,Grootenhuis, M. A.(2013).Health related quality of life in parents of six to eight year old children with Down syndrome.Research in Developmental Disabilities,34(11),4237-4239.
15. Mugno, D.,Ruta, L.,D'Arrigo, V. G.,Mazzone, L.(2007).Impairment of quality of life in parents of children and adolescents with pervasive developmental disorder.Health and Quality of Life Outcomes,5,22-31.
16. Neece, C. L.,Green, S. A.,Baker, B. L.(2012).Parenting stress and child behavior problems: A transactional relationship across time.American Journal on Intellectual and Developmental Disabilities,117(1),48-66.
17. Neece, C.,Baker, B.(2008).Predicting maternal parenting stress in middle childhood: The roles of child intellectual status, behavior problems and social skills.Journal of Intellectual Disability Research,52(12),1114-1128.
18. Paley, B.,O'Connor, M. J.,Frankel, F.,Marquardt, R.(2006).Predictors of stress in parents of children with fetal alcohol spectrum disorders.Developmental and Behavioral Pediatrics,27(5),396-404.
19. Plant, K. M.,Sanders, M. R.(2007).Predictors of care-giver stress in families of preschool-aged children with developmental disabilities.Journal of Intellectual Disability Research,51(2),109-124.
20. Pozo, P.,Sarriá, E.,Brioso, A.(2013).Family quality of life and psychological well-being in parents of children with autism spectrum disorders: A double ABCX model.Journal of Intellectual Disability Research,58(5),442-458.
21. Smith, T. B.,Oliver, M. N. I.,Innocenti, M. S.(2001).Parenting stress in families of children with disabilities.American Journal of Orthopsychiatry,71(2),257-261.
22. Trevo, R.(2011).Developmental and behavior problems predicting parenting stress in young children with global delay.Journal of Child Neurology,27(3),296-2911.
23. Wang, P.,Michaels, C. A.,Day, M. S.(2011).Stresses and coping strategies of Chinese families with children with autism and other developmental disabilities.Journal of Autism and Developmental Disorders,41(6),783-795.
24. Xiang, Y. T.,Luk, E. S.,Lai, K. Y.(2009).Quality of life in parents of children with attention-deficit-hyperactivity disorder in Hong Kong.Australian and New Zealand Journal of Psychiatry,43(8),731-738.
25. Yang, P.,Jong, Y. J.,Hsu, H. Y.,Tsai, J. H.(2007).Psychiatric features and parenting stress profiles of subtypes of attention-deficit/hyperactivity disorder: Results from clinical referred Taiwanese sample.Journal of Developmental & Behavioral Pediatrics,28(5),369-375.
26. 姚開屏(2005)。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊第二版。台北:世界衛生組織生活品質問卷發展小組。
27. 翁毓秀(2003)。親職壓力量表指導手冊。新北市:心理出版社。
28. 陳怡群、黃惠玲、趙家琛(2009)。阿肯巴克實證衡鑑系統：計分手冊。新北市:心理出版社。
29. 蕭小菁、羅鈞令(2007)。腦性麻痺幼兒母親的日常職能活動與生活品質之探討。職能治療學會雜誌，25(1)，1-11。

1. 古思潔(2016)。家庭復原力與父母身心健康狀況之相關研究:以發展遲緩兒童家庭為例。長榮大學社會工作學系（所）學位論文。2016。1-101。