Intervention with siblings of children with developmental disabilities from economically disadvantaged families

Abstract

The goal of this study was to evaluate the effectiveness of a community-based Intervention for economically disadvantaged African American children who had siblings with a developmental disability. The children were randomly divided Into two groups: one group was Involved In an after-school program designed to support siblings of children with developmental disabilities and provide a positive environment with rewarding experiences; the other group did not participate in the program. The socioemotional functioning of the two groups was compared. The results indicated that the group who participated In the after-school program showed significantly Improved socioemotional adjustment compared to the other group. Implications for providing services to families of children with developmental disabilities are discussed.

SOCIOECONOMIC DISADVANTAGE IS consistently associated with poor outcomes for children (DuBois, Felner, Meares, & Krier, 1994; McLoyd, 1990). Specifically, children in poverty are likely to show low academic performance and poor socioemotional adjustment. When examining the relationship between poverty and children's poor outcomes, several authors (DuBois, Felner, Meares et al., 1994; McLoyd, 1990) have pointed out that poverty is so detrimental to children because of its negative effects on their everyday lives. Specifically, economic disadvantage is linked to increased amounts of chronic stress and large numbers of negative life events (Felner et al., 1995; Seidman & Rapkin, 1983).

It is important to examine the impact of economic disadvantage on family functioning because the family is a child's primary influence (Bronfenbrenner, 1986). Much of the research suggests that children's negative experiences come about because of the negative experiences that happen to the family as a whole. For example, socioeconomic disadvantage is associated with less family recreation and less family support (Felner et al., 1995). There is further evidence that socioeconomic disadvantage can have particularly negative effects on parents' interaction with their children. In one study, economically disadvantaged children reported more maternal rejection (Felner et al., 1995). Another study found that economically disadvantaged mothers used harsher discipline (McLoyd, 1990).

Poverty is not the only factor that has been found to put children at risk. In addition to poverty, there are a number of other known risk factors that affect families and children within families. For example, one of the factors that is thought to put children at additional risk is race (McLoyd, 1990). McLoyd points out that, even when social class is taken into account, African Americans report more psychological distress than European Americans do.

Another condition that has been found to contribute to familial stress and, therefore, put children at risk for poor socioemotional adjustment is the presence of a child with a developmental disability (Turnbull & Turnbull, 1984). In studies of children whose siblings have a variety of disabilities, the findings suggest that they are more likely to have problems with adjustment. For example, studies of children with emotional disabilities have found that their siblings have poor socioemotional adjustment (Deal & MacLean, 1995; Hoover & Franz, 1972) and negative perceptions of family satisfaction (Novak & van der Veen, 1970).

Although several studies have pointed out the positive aspects of having a sibling with a developmental disability (Boyce & Barnett, 1993; Crnic & Leconte, 1986; Hannah & Midlarsky, 1985), many studies find evidence that the presence of a family member with a developmental disability is a significant stressor (Begun, 1989; Breslau, Weitzman & Messenger, 1981; Valentine, McDermott & Anderson, 1998). Specifically, studies have documented that families of children with disabilities have unique responsibilities that tax their emotional, social and, material resources, and that these responsibilities have significant effects on family functioning (Turnbull & Turnbull, 1990). Lonsdale (1978) found that families with members who have disabilities had difficulty enjoying recreational activities. In addition, Turnbull and Turnbull (1984) reported that the presence of a family member with disabilities can result in increased spending, and for a significant number of families, limits the amount of income generated. Further, some families' ability to socialize and become part of their community may be hindered as a result of children's special needs. McAndrew's (1976) study found that a substantial number of parents felt that their social relationships were affected by their children's disabilities, and some parents felt that even the opportunities to socialize were sometimes limited by the special needs of their children. Finally, one of the most significant effects of having children with special needs is the stress that increased caregiving demands produces for parents (Quine & Paul, 1985). Again, all of these findings suggest that the presence of a sibling with a developmental disability influences the social development and adjustment of children because of the effects it has on families' everyday lives (DuBois, Felner, Meares, et al., 1994).

Although the stressful conditions of poverty, inequities due to race, and a family member with a disability all have significant effects, the combination of them can have profound effects. In other words, families who already face multiple stressful conditions, such as poverty and racial inequities, may be at increased risk when a child with a developmental disability is present. In fact, numerous studies have shown that, although poverty has often been identified as the primary risk factor, the worst outcomes are associated with multiple-risk factors (McLoyd, 1990; Rutter, 1978; Shaw et al., 1994). These findings are especially important for the current study because the children in this study are faced with multiple challenges.

In the same way that negative factors, such as too much stress in children's day-to-day lives, are detrimental to children, positive factors, such as social support from peers and adults, are associated with less psychological distress and more positive academic and socioemotional outcomes for children (DuBois, Felner, Sherman et al., 1994). These positive experiences can come from various places such as home or settings outside the home such as school and involvement in extracurricular activities. (DuBois, Felner, Meares, et al., 1994). Furthermore, the beneficial effects provided by settings outside the home are even more pronounced when the family environment is stressful and less supportive (DuBois, et al., 1992). In other words, positive experiences in places like schools and community centers are especially important for children whose family life is stressful (DuBois, Felner, Sherman et al., 1994; Felner, Silverman & Adix, 1991).

This study is about families in an urban, economically disadvantaged, predominantly African American community. The first goal of this study was to answer the questions of parents in this community about "how the children were doing and feeling." We approached their questions from an ecological framework, which means that we wanted to examine the different sources of positive and negative experiences in their daily lives (Bronfenbrenner, 1986). Another goal was to address the parents' concerns that there were not enough recreational opportunities or other kinds of services for their children without developmental disabilities. We thought that the best way to address the concerns of these particular families was by implementing an after-school program in a community center. The intent was to provide the children with a rewarding and supportive environment with opportunities for positive interactions with peers and adults in their community. We hoped that the positive experiences of the program would serve to buffer the effects of the stress and, as a result, help the children to "do and feel better" (O'Donnell et al., 1995). A third goal was to measure, as carefully as possible, the effectiveness of the after-school program. We wanted to know if participation in this community-based, after-school program would lessen the impact of the multiple stressors the children were experiencing. Our approach to measuring the effectiveness of the program involved two strategies. The first strategy was comparing children who participated with a similar group of children to those who did not; the second strategy was to measure the socioemotional functioning of the children before the program with their socioemotional functioning after the program. Some of the variables we measured were self-esteem, anxiety, depression, chronic stress, and social support. Because we consider the pre- and post-program assessment of the children to be one of the most important contributions made by this study, detailed information about the participants, program and program evaluation is provided in the next section.

Method

Participants

Participants in the study were 180 African American children who ranged from nine to twelve years of age (mean age = 11.3). All participants were from an East Coast inner city, predominantly African American community and came from low-income families based on their reported eligibility for Medicaid benefits and public housing subsidies. There were more females (n = 108, 60%) than males (n = 72, 40%). The children were siblings of children with identified developmental disabilities who were recruited by distributing letters and announcements at an after-school program for developmentally delayed children held at a community center. The developmental disabilities of their siblings included mild mental retardation and moderate mental retardation. (The distribution of mild and moderate mental retardation was not significantly different for the two groups.)

Procedure

The children were randomly divided into two groups: one group was involved in an after-school program specifically designed to support siblings of children with developmental disabilities (intervention group); the other group was placed on a list to participate in a subsequent afterschool program (control group). Both groups were required to attend an orientation program on the same day. On that day, consent from the parents and assent from the children was obtained, and a series of self-report measures (Time 1 battery) were administered in a group setting with instructions and items being read aloud. The intervention group was administered the same battery of instruments (Time 2 battery) one week before the end of their program. The control group was administered the Time 2 battery approximately a week later. The Time 2 battery was comprised of the same self-report measures as administered at the beginning of the program.

Rationale

Before discussing the details of the intervention, it seems important to acknowledge that the program came about because the professionals connected to the community center where the program took place listened to and valued the opinions of the families with whom they work. The parents of children with developmental disabilities who were participating in a program at the community center voiced their concerns that the children in their homes they were most concerned about were the children without the developmental disability. The parents talked about how the frequent meetings, appointments, and activity required for the child with the developmental disability needed so much time and energy that they did not feel as if they had enough "left over" for their other children. In addition, they talked about the increased pressures placed on the siblings because of the child with the developmental disability. Many parents stated that the children without the disability were forced to "pick up the slack" or grow up too fast. One mother of two girls, the older of whom has mental retardation said that the grandmother of the girls expects the younger one to be everything the older one is not. Finally, the overwhelming sentiment of the parents was that now that they had finally secured adequate services for their child with the disability, they were finding it almost impossible to find services for their other children.

The professionals listened and did many of the things people in the helping professions want to do but do not have the opportunity or resources to do. They identified existing resources and created others that were not yet available. The existing resources included the facility (the community center was an ideal place because many of the children already frequented the center for unstructured recreational activities), the staff, and a good relationship and understanding of the people they were serving.

What the professionals lacked was specific knowledge of the unique issues and special needs of siblings of children with developmental disabilities. They did several important things. First they conducted literature searches for relevant research findings and writings on the families, particularly siblings, of children with developmental disabilities. Secondly, they combined the information obtained from related literature with their own thoughts about the people they work with, and with the consultation from the parents and families themselves. Finally, the most important thing they did was to establish a mechanism for monitoring the progress and evaluating the effectiveness of the intervention. Their commitment to developing a program that would meet the needs articulated by the parents, enhance the lives of the youths and be a model for other community-based professionals demanded a careful and comprehensive program evaluation. Too often, programs are implemented, and there is no real way of determining why they succeeded or failed. A lack of evaluation can result in the duplication of unhelpful programs. Another consequence of the failure to document and evaluate programs is that it is difficult for others to replicate the program because the reasons for its success are unclear. Finally, it is often impossible to acquire funding to implement or expand programs unless their effectiveness can be shown in a way that is meaningful to potential funding agencies. Again, it is for these reasons that the intervention and program evaluation are described in detail below.

Intervention1

Overview. The intervention group participated in a fifteen-week after-school program that included group discussions about developmental disabilities, recreational activities, and homework assistance (see below). The program met every weekday from 3:00 p.m. to 5:30 p.m. at a community center. The children were separated into teams of fifteen for the group discussions and the homework assistance, while the whole group participated in the recreational activities together. The goals of the program were to alleviate the stress caused by having a sibling with a disability by providing information about, and facilitating understanding of, developmental disabilities and by creating a context that provided social support from peers and adults.

Staff. The program was staffed by six team leaders and seven volunteers. The six team leaders were paid community-center staff, two of whom had a high school education and four of whom had associates' degrees. All had a minimum of three years' experience working with children with developmental delays and their families. The volunteers included community residents, high school students, and community-center staff from other programs. The six team leaders were each responsible for a team of fifteen children who had been randomly assigned to them. The volunteers interacted with all of the children as requested by the team leaders.

Group discussions. The fifteen to forty-five-minute group discussions (check-in) were facilitated by the team leader. Check-in began with the team leader asking each team member if they had anything "important" or "troubling" occur that day. Children were encouraged to discuss any concerns including those regarding school, family, and friends. In addition to the unstructured group discussion, a different topic was addressed each week. The topic was introduced on the first day of each week, and a short "lesson" was presented, followed by a brief group discussion of the topic with team leaders soliciting comments from the team members. On the subsequent days of the week, in addition to the concerns presented by the team during check-in, team members were asked specifically about any incidents or problems related to the topic of the week. The issues discussed were all relevant to being the sibling of someone with a developmental disability and included topics such as "What are disabilities?", "Why do people stare?" The length of the discussion varied and was determined by the number and nature of the concerns raised by the team members. The length of each session was recorded by the team leaders.

Recreation. The children participated in a variety of structured and unstructured recreational activities including computer games, videos, dance contests, theater arts, sports, gardening, and crafts. The length of time devoted to recreational activities ranged from forty to ninety minutes.

Homework assistance. Each day seventy-five minutes were devoted to assisting children with homework. Tutoring was provided by the team leaders and volunteers. When children came without homework or finished homework before the other team members, they were allowed to read books or magazines available at the center.

Measures

Socioemotional adjustment. Socioemotional adjustment was measured using three instruments assessing the children's depression, anxiety, and self-esteem. The Children's Depression Inventory (CDI), a widely used and wellvalidated instrument (Kovacs, 1985), was used to measure depressive symptoms. For the twenty-seven items on the CDI the child was asked to choose one of three statements, which were later assigned a numerical value ranging from 0 to 2 with the higher number representing greater severity of depressive symptoms.

Anxiety was measured using the Children's Manifest Anxiety Scale-Revised (CMAS-R) (Reynolds & Richmond, 1985). The CMAS-R contains thirty-seven items and yields a general anxiety score as well as subscales for physiological anxiety, worry/oversensitivity, concentration anxiety. For each statement, the child indicates whether the item is true for himself or herself. A higher score indicates more anxiety. The CMAS-R has demonstrated good reliability and validity (Reynolds & Richmond, 1985). For the current sample, the coefficient alphas for the subscales ranged from .85 to .90, and the general anxiety score was used in the analyses.

Self-esteem was measured using the Self-Esteem Questionnaire (SEQ) (DuBois, Felner, Brand, Phillips, & Lease, 1996). The SEQ is a forty-two-item instrument that was based on a developmental-ecological framework. The measure yields separate scale scores for self-esteem specific to five domains (peers, school, family, body image, and sports/athletics) as well as global perceptions of self-worth. Each item is scored on a four-point scale from "Strongly Disagree" to "Strongly Agree." Each item is scored from 1 to 4 in the direction of higher self-esteem. The subscales of the SEQ have strong internal consistency with coefficient alphas ranging from .81 to .92. This instrument also has strong test-retest reliability (two-week test-retest correlations ranged from r = .77 to r = .84). The internal consistency for this sample was similar to that which has been reported with coefficient alphas ranging from .79 to .89.

Social support. A modified version of the Perceived Social Support Scale-Revised (PSSS-R) (DuBois et al., 1996; Procidino & Heller, 1983) was used to measure social support. The PSSS-R is a thirty-item instrument that yields separate scores for levels of perceived social support from family members, peers and school personnel. Studies using this version of the measure report alpha coefficient for the subscales of above .85 and test-retest correlations ranging from .70 to .87. For purposes of this study, ten additional items were added regarding social support from community center staff. The wording of these additional items parallels the wording of the PSSS-R items pertaining to school personnel. For example included with PSSS-R items such as "School personnel are good at helping me solve problems" were new items such as "Community center staff are good at helping me solve problems." For this sample, the alpha coefficients for the subscales ranged from .82 to .89. The coefficient alpha for the new "community center staff" subscale was .85.

Stress. The amount of family-related, chronic stress that the children were experiencing was measured using items from the Daily Hassles Questionnaire (DHQ) (Rowlison & Felner, 1988). The DHQ was designed to measure the everyday stressors and is modeled after the original Daily Hassles Scale (Kanner et al., 1981). It presents a list of stressful events, and the child is asked to indicate whether the event occurred and, if so, how much of a hassle it was on a scale ranging from 0 (not at all a hassle) to 3 (a very big hassle). The items used for this study were twenty-nine items relating to everyday family concerns in three areas: Home life ("No good place at home to do schoolwork") Parents ("Pressure or expectations from parents") Siblings ("Having to take care of brothers or sisters"). In addition to the sibling-related items present on the DHQ, ten new sibling-related items ("Being teased about my brother/sister"; "Not being able to do something I wanted to do because of my brother/sister") were added to create an instrument that would be more sensitive to the possible stress associated with having a sibling with a disability. It should be noted that, although the additional items were designed to detect stress associated with siblings' disabilities, none of the items refers specifically to the sibling's disability, and all of the items could apply to siblings without disabilities. In this sample, the coefficient alphas for the subscales ranged from .80 to .89.

Family functioning. Family functioning was assessed using the Family Environment Scale (FES) (Moos & Moos, 1986). On the FES the child is asked to indicate whether the statements presented are "True" or "False." The FES consists of ninety items and yields ten subscales. This is a widely used measure with reported test-retest reliability ranging from .68 to .86 (Moos & Moos, 1986). For the purposes of this study, the following five subscales were analyzed: Cohesion, Conflict, Active Recreational Orientation, Organization, and Control. The coefficient alphas for these subscales ranged from .65 to .85.

Sibling relationship. To assess the quality of the children's relationship with their sibling who had a developmental disability, the Sibling Relationships Questionnaire (SRQ) was administered (Buhrmester & Furman, 1990; Furman & Buhrmester, 1985). The SRQ contains fortyfive items and yields fifteen three-item subscales. A fivepoint scale (1 = hardly at all to S = extremely much) is used for all subscales except the parent partiality scale. On this scale, the child is asked to indicate who is most favored, ranging from 1 = "almost always him/her" (favored) 5 = to "almost always me" (favored) with a mid-point of 3 = "about the same." The coefficient alphas for the subscales are reported to be above .70 with the exception of competition subscale that was .63. Test-retest reliability for the subscales ranged from .58 to .86 (Buhrmester & Furman, 1985). The coefficient alphas for this sample ranged from .60 to .85. The children in both groups completed this questionnaire and were asked to make their ratings about their sibling who had a disability.

Results

The data collected from both groups of children, (those who participated in the program and those who did not) at both time points (before the program and after the program) were analyzed. These results indicate that before the after-school program, the socioemotional functioning, amount of stress, and amount of social support for children in both groups was the same; but after the program, the children who participated in the program showed improved socioemotional functioning, experienced less stress, and reported more social support. The children who did not participate in the program did not show significant changes. The specific results are discussed in further detail below.

Time 1 Group Comparisons

A series of multivariate analyses of variance (MANOVAs) was conducted to examine group differences in the intervention and control groups. At Time 1, there were no significant differences on any of the measures of socioemotional adjustment, stress, social support, family functioning, or sibling relationship quality. These results indicate that before the after-school program, the socioemotional functioning of children in both groups was about the same.

Time 2 Group Compsons

A series of 2 X 2 (group X assessment time) repeated-measure multivariate analyses of variance (MANOVAs) was conducted to assess intervention effects. Intervention effects were reflected in significant group X assessment time interactions.2 A summary of significant group differences at Time 2 is presented in Table 1.

Socioemotional adjustment. The results showed that the children who participated in the program showed decreased depression and anxiety and improved self-esteem. The children who did not participate in the program showed no improvement. The details of this analysis are discussed below. A MANOVA conducted on the intervention and control groups with depression (CDI), anxiety (CMAS-R) and self-esteem (SEQ) as the dependent variables revealed significant interaction effects. Subsequent ANOVAs revealed significant intervention effects for all three socioemotional measures. Analyses of simple effects revealed that the intervention group showed significant decreases in depression and anxiety and increased self-esteem. The control group showed no significant changes.

Stress. A MANOVA using parent-related, home-life, and sibling-related subscales revealed a significant intervention effect. Analyses of simple effects revealed that the intervention group reported significantly less sibling-related stress at the posttest assessment. The parent-related and home-life subscales failed to yield significant results.

Social support. The MANOVA conducted on the subscales of the PSSS-R showed a significant intervention effect. ANOVAs showed significant differences for the peers, school personnel, and community-center staff subscales.

Family functioning. The analysis of the FES failed to show significant intervention effects.

Sibling relationship. There were no significant differences in the quality of the sibling relationships for the intervention and control groups.

Limitations

One of the goals of this study was to demonstrate the effectiveness of a comprehensive and integrated intervention. The results indicate that such an intervention was indeed effective. Still, there are some limitations of the study that should be discussed. Because all children in the intervention group were exposed to all three components of the intervention, it is impossible to determine which aspects of the program were most beneficial. While there is enough evidence to suggest that the most effective programs are comprehensive and integrated (Felner, Silverman & Adix, 1991), in future research it will be important to design studies to help understand the contribution of each component. As more children participate in this program it may be possible to vary their participation in the different components. Also, given the benefits of the intervention with these children who are experiencing multiple stressful conditions, it will be important for future research to determine if a community-based intervention of this kind would be appropriate and beneficial to children with less challenging backgrounds. Finally, although the number of participants in this study is comparable to other studies in the area of families of children with developmental disabilities, it will be important for future replications to include a larger number of children.

Discussion

Overall, the findings of this study seem to suggest that the children benefited from their participation in the program. The decrease in sibling-related stress for the intervention group suggests that the intervention was successful at providing a buffer for the stress of having a sibling with a disability. What this means is that even when the children continued to report that they experienced stressors, they were not as affected by them. One boy reportedly told his leader that, "People still make fun of my sister, but I don't feel so much like getting into fights that much anymore." Further, the fact that the children in the intervention group reported increased social support from peers and community center staff seem to suggest that the program succeeded in creating opportunities for the children to receive support from peers and adults. This is illustrated by the comments of a girl who said, "I have friends at school, but none of them has a brother who is mentally retarded, so it feels different in a good way because, here, people always know what I mean when I talk about my brother." The increase in perception of social support from school personnel is difficult to interpret because the intervention did not include the school environment. A possible explanation is that their interaction with the community center staff persuaded the children to view other adults in their community as sources of support; or perhaps participation in the program taught the children the necessary skills for seeking social support when they needed it.

In addition to the decreases in their stress and increases in their perceived social support, the results show that the children had less depression and anxiety and higher self-esteem. These findings are consistent with other studies that have demonstrated that it is possible to create environments that provide children with rewarding experiences, support from peers, positive interactions with adults, and recreational opportunities. It is then, in this context, that children shape positive perceptions of themselves and the world around them. Another promising aspect of this intervention is that there appears to be substantial benefits to the children even though no direct intervention with the parents or family was provided. Although interventions that involve the entire family are most desirable, they are often scarce, are met with resistance, or can take time to implement. Programs similar to the one described here can be offered to children while other resources and services are being sought. Overall, planning, implementing, and evaluating alternative ways to deliver services are essential to being able to provide the most effective interventions to the widest array of populations.

1 The Leaders Manual and all other program materials are available from the author.

2 The data were also analyzed using analyses of covariance and multivariate analyses of covariance with the Time I scores used as a covariate. The results did not differ from the ANOVA and MANOVA results that are reported here.

References

Begun, A. L. (1989). Sibling relation ships involving developmentally disabled people. American journal on Mental Retardation, 93, 566574.

Boyce, G. C., HC Barnett, W S. (1993). Siblings of persons with mental retardation: A historical perspective and recent findings in Z. Stoneman & P. W. Berman (Eds.), The effects of mental retardation, disability, and illness on sibling relationships: Research issues and challenges (pp. 145-184). Baltimore, MD: Paul H. Brooks.

Breslau, N., Weitzman, M., & Messenger, K. (1981). Psychological functioning of siblings of disabled children. Pediatrics, 67, 344-353. Bronfenbrenner, U. (1986). Ecology of the family as a context for human

development. Developmental Psychology, 22, 723-742. Buhrmester, D., & Furman, W (1990). Perceptions of sibling relationships during middle childhood and adolescence. Child Development, 61, 1387-1396.

Crnic, K. A., & Leconte, J. M. (1986). Understanding sibling needs and influences. In R. R. Fewell Sr P. E Badasy (Eds.), Families of handicapped children: Needs and support across the life span. Austin, TX: Pro-ed.

Deal, S. N., & MacLean, W E., Jr. (1995). Disrupted lives: Sibling of disturbed adolescents. American Journal of Orthopsychiatry, 65, 274281.

DuBois, D. L., Felner, R. D. , Brand, S., Adan, A. M., & Evans, E. G. (1992). A prospective study of life stress, social support, and adaptation in early adolescence. Child Development, 63, 542-547.

DuBois, D. L., Fetner, R. D., Brand, S. , Phillips, R. S. C., & Lease, A. L. (1996). Early adolescent self-esteem: A developmental framework and assessment strategy. Journal of Research on Adolescence, 6, 543-579.

DuBois, D. L., Felner, R. D., Meares, H., & Krier, M. (1994). Prospective investigation of the effects of socioeconomic disadvantage, life stress, and social support on early adolescent adjustment. Journal of Abnormal Psychology, 103, 511-522

DuBois, D. L., Felner, R. D., Sherman, M. D., & Bull, C. A. (1994). Socio-environmental experiences, self-esteem, and emotiona/behavioral problems in early adolescence. American Journal of Community Psychology, 22, 371-397.

Felner, R. D., Brand, S., DuBois, D. L., Adan, A. M., Mulhall, P E, & Evans, E. G. (1995). Socioeconomic disadvantage, proximal environmental experiences and socioemotional and academic adjustment in early adolescence: Investigation of mediated effects model. Child Development, 66, 774-292.

Felner, R. D., Silverman, M. M., & Adix, R. A. (1991). Prevention of substance abuse and related disorders in childhood and adolescence: A developmentally based, comprehensive ecological approach. Family and Community Health, 14, 12-22.

Furman, W., & Buhrmester D. (1985). Children's perception of the qualities of sibling relationships. Child Development, 56, 448-461.

Hannah, M. E., & Midlarsky, E. (1985). Siblings of the handicapped: A literature review for school psychologist. School Psychology Review, 14, 510-520.

Hoover, C. F., & Franz, J. D. (1972) Siblings in the families of schizophrenics. Archives of General Psychiatry, 26, 334-342. Kanner, A. D., Coyne, J. C., Schaefer, C., & Lazarus, R. S. (1981). Com

parison of two models of stress measurement: Daily hassles and uplifts versus major life events. Journal of Behavioral Medicine, 4, 139.

Kovacs, M. (1992). Manual for the children's depression inventory. Available from Multi-Health Systems Inc., 908 Niagara Falls BLVD., North Tonawanda, NY 14120.

Lonsdale, G. (1978). Family life with a handicapped child: The parents speak. Child: Care, Health and Development, 4, 99-120. McAndrew, 1. (1976). Children with a handicap and their families. Child:

Care, Health and Development, 2, 213-237.

McLoyd, V. C. (1990). The Impact of economic hardship on black families and children: Psychological distress, parenting, and socioemotional development. Child Development, 61, 311-346.

Moos, R. H., & Moos, B. A. (1986). The Family Environment Scale manual (2nd ed.). Palo Alto: Consulting Psychologist Press. Novak, A. L., & van der Veen, E (1970). Family concepts and emotion

al disturbance in the families of disturbed adolescents with normal siblings. Family Process, 9, 157-171.

O'Donnell, J., Hawkins, D. J., Catalano, R. E Abbott, R. D., & Day, E. (1995). Preventing school failure, drug use, and delinquency among low-income children: Long-term intervention in elementary schools. American Journal of Orthopsychiatry, 65, 87-100.

Parker, S. (1988). Effects of mentally ill and physically handicapped children on their siblings. Journal of Personality, 48, 342-350. Procidino, M. E., & Heller, K. (1983). Measures of perceived social sup

port from friends and from family: Three validation studies. American Journal of Community Psychology, 11, 1-24.

Quine, L., & Paul, J. (1985). Examining the causes of stress in families with severely mentally handicapped children. British Journal of Social Work, 15, 501-517.

Reynolds, C. R., & Richmond, B. 0. (1985). Revised Children's Manifest Anxiety Scale (RCMAS). Los Angeles, CA: Western Psycholog

ical Services.

Rowlison, R. T., & Felner, R. D. (1988). Major life events, hassles, and adaptation in adolescence: Confounding in the conceptualization and measurement of life stress and adjustment revisited. Journal of Personality and Social Psychology, 55, 432-444.

Rutter, M. (1978). Family, area, and school influences in the genesis of conduct disorders. In L. A. Hersov & D. Schaffer (Eds.), Aggression and anti-social behavior in childhood and adolescence (pp. 95-114). Oxford: Pergamon Press.

Schacter, E F., & Stone, R. K. (1987). Comparing and contrasting siblings: Defining the self. Journal of Children in Contemporary Society, 19, 55-75.

Seidman, E., & Rapkin, B. (1983). Economics and psychosocial dysfunction: Toward a conceptual framework and prevention strategies. In R. D. Felner, L. A. Jason, J. N. Moritsugu, & S. S. Farber (eds.), Preventive psychology: Theory research and practice (pp. 175-198). New York: Pergamon.

Shaw, D.S., Vondra, J. I., Hommerding, K. D., Keenan, K., & Dunn, M. (1994). Chronic family adversity and early child behavior problems: A longitudinal study of low income families. Journal of Child Psychology and Psychiatry, 35, 1109-1122.

Turnbull, A. P, & Turnbull, H. R. (1984). Developing independence in adolescents with disabilities. Journal of Adolescent Health Care, 6, 108-124.

Turnbull, A. P, & Turnbull, H. R. III (1990) Families, professionals, and exceptionality: A special partnership (Rev. ed.). Columbus, OH: Merrill.

Valentine, D. P., McDermott, S. & Anderson, D. (1998). Mothers of adults with mental retardation: Is race a factor in perceptions of burdens and gratification? Families in Society, 79(6), 577-584.

Ruby S. C. Phillips is assistant professor at Lehman College, City University of New York 250 Bedford Park Blvd West Bronx, NY 10468. Correspondence concerning this article should be addressed to the author at this address.

Original manuscript received: December 1998

Revision received February: 1999

Manuscript accepted: April 1999

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