The effect of families’ alexithymic status and social skill levels on directing their children with intellectual disabilities to sports

Abstract

The aim of this study was to investigate the social skill levels of families who have children with mild intellectual disabilities and the effect of alexithymic status on their orientation to sports. The study group consisted of 194 families who have children with mild intellectual disabilities. Personal Information Form, Toronto Alexithymia Scale and Social Problem Solving Inventory-Short Form (SPSI-R/SF) were used as data collection tools. The families’ alexithymic status and social problem solving skills were moderate. There was a relationship between alexithymia levels of families and positive orientation to the problem (r = 0.147; p < 0.01) and avoidance of problem solving sub-dimension and directing their children to sports (r = 0.145; p < 0.01). The total alexithymia levels and their sub-dimensions of the families whose children were engaged in sports were significantly higher than the children who did not do sports (p < 0.05). In conclusion; families’ alexithymic status and social skill levels may affect their children’s orientation to sports. As the alexithymia levels of the families increase, their children’s orientation to sports shows a moderate increase.

Introduction

Regular participation in physical activity has a positive effect on physical fitness (LeMura and Maziekas 2002, Top et al. 2015), bone health (Bradney et al. 1998), psychological health (Wilkinson 1983), and social participation (Jobling 2001). In terms of development, health, and quality of life, the participation of children with intellectual disabilities in physical activity is important (Shields and Synnot 2016, Top and Akıl 2017, Top and Akıl 2018, Kao and Wang 2018). Because children with disabilities have less physical activity compared to their peers (Carlon et al. 2013), they hinder the development of children in underactive physical activity (Shields et al. 2012). Motor development, balance, coordination, and cardiovascular adaptation do not develop in people with disabilities who do not have sufficient participation in physical activity (Horvat et al. 1997, Top 2017). The physical fitness levels of the individuals with intellectual disabilities are lower than their peers without any disabilities (Pitetti et al. 2009). Individuals with disabilities have a risk of health because of their sedentary lifestyle (Ayvazoglu et al. 2004).

Although there has been an increase in sport participation of individuals with intellectual disabilities in recent years (Harada and Siperstein 2009), this number is still not sufficient (Blick et al. 2015). The reasons for children with disabilities to participate in less physical activity than their peers are multifaceted and complex (Heah et al. 2007). Scientists have argued that the most important part of being human is the problem-solving skill. The reason for this is that problem solving skills contribute positively to social competence, coping with stress, social activity, and general psychological situation (Nezu 2004). Problem-solving skills consist of cognitive and behavioral activities in which a person tries to understand problems and find effective solutions (D’Zurilla et al. 2011). The alexithymia situation affects the self-definition of individuals and their self-expression and adaptation in social environments (Aydın and Saraç 2014). Alexithymia is defined as the difficulty of recognizing, distinguishing, and expressing people’s emotions (Marches et al. 2000) and is seen as lack of skill (Koçak 2002). In the general population, alexithymia rates have been reported to be 9–17% for men and 5–10% for women (Mattila et al. 2007). In special cases this rate can be up to 70% (Bourke et al. 1992).

The parents are the most important people that affect the behavioral characteristics of the child. One of the characteristics that can be effective in parents’ socializing their children is alexithymic states (Aydın and Saraç 2014). Because alexithymia causes problems in organizing and managing emotional expressions that are important in interpersonal relationships (Way et al. 2007). When the barriers to participation in physical activity are examined, lack of knowledge and skills and parental behavior are considered as important factors (Shields et al. 2012). When the studies are examined, it is stated that families who have children with disabilities have more advanced health problems such as depression, anxiety, emotional distress, and stress compared to families with typically developmental children (Pelchat et al. 1999, Hastings and Brown 2002).

According to the World Health Organization, the disability rate in developing countries is 12%. In Turkey, it is stated that 6 million people with disabilities live (Yildiz et al. 2016). The main purpose of the researches and studies is to help parents better help children with disabilities, to allow them to enjoy their own personal lives and to try to help their children with disabilities to enjoy more than their own lives (Milgram and Atzil 1988). In the literature, many studies on depression and quality of life were found in the families of children with disabilities. However, the number of studies evaluating alexithymia, social skills, and physical activity in children is negligible. The psychological conditions and skills of the families are important for the children to overcome their disabilities and to support their families in the long term (Yildiz et al. 2016). Previous research (Cuzzocrea et al. 2015) have already verify the relationship between Alexithymia, Parenting style, and Parental control in families with typically developmental children, but few researchers focused on this relation in families with a disable child. It is already confirmed the important rule of family and parenting functioning in order to guarantee the development of adequate social skills in children with mental retardation (Cuzzocrea et al. 2013) and in their siblings (Cuzzocrea et al. 2014), such as the importance to control the parental stress increasing theirs coping skills through greater social support (Cuzzocrea et al. 2016), but less studies were conduct in order to verify the rule of sport and haw parents can promote the sport attitude in their children with intellectual disabilities.

The aims of this study: (1) The first research question was to verify whether there are significant correlation between levels on the Toronto Alexithymia Scale (TAS) and on directing their children with intellectual disabilities to sports. (2) The second research question was to investigate whether there are significant correlation between levels of SPSI-R/SF and on directing their children with intellectual disabilities to sports. (3) The third research question was to examine the levels of TAS and SPSI-R/SF according to the sport variable. The aim of these research questions was to investigate whether there is a relationship between the sport’s that contribute to children’s development socially and physically and their families’ alexithymic status and social skill levels.

Method

Participants

The study group consisted of 194 families who have children with mild intellectual disabilities. Families were ages 33–50 years. The research group was selected from the families of children with intellectual disabilities who came to rehabilitation centers. Parents were informed about the research before taking part in the study and their verbal consent was obtained. The data were obtained by face-to-face interview technique by four interviewers from mothers and fathers of children. When the family education and occupation status was examined, 35.1% of fathers were primary school, 37.1% were middle school, 20.1% were high school and 4.1% were university graduates. 66.5% of the fathers were workers, 4.1% were civil servants, 15.5% were retired and 10.3% were self-employed. 51% of the mothers were primary school, 35.6% were middle school, 11.9% were high school graduates and 1% was university graduates. 93.3% of mothers were housewives, 6.2% were workers and 1 mother was civil servant. When income levels were analyzed, 61.9% of the families were in low income group (less than 1600 ₺), 31.4% in middle income group (1600–3000 ₺) and 6.7% in high income (3000 ₺). 41.2% of the children (N = 80) were male to whose families scales were applied and 58.8% of them (N = 114) were male. 93 of the children (M = 16.90 ± 3.26 years) did sports and 101 (M = 14.90 ± 2.61 years) did not do sports. The participants intelligence quotients (IQ) was within a range for individuals with mild intellectual disability (50–70 IQ).

Toronto alexithymia scale (TAS)

TAS was developed by Taylor et al. (1985). It consists of four sub-dimensions: “Ability to Distinguish and Recognize People’s Feelings,” “The Way of Thinking About External Events,” “The Ability to Talk About Emotions” and “The Ability to Imagine.” Articles 3, 6, 7, 19, 22, and 23 of the scale are the first dimension; the second dimension of items are 1, 4, 8, 10, 12, 14, 17, 20, 25, and 26; the third dimension of items are 2.5, 15, 16, and 18; articles 9, 11, 13, 21, and 24 constitute the fourth dimension. Toronto Alexithymia Scale (TAS) consists of 26 items in likert type (between I completely agree (5) – and score between 1 (I strongly disagree) and scored between 1 and 5 (Taylor et al. 1985). The total lowest score to be taken from the scale is 26 and the highest score is 130. The reliability and validity of the scale for measuring the level of alexithymia in people was done by Dereboy (1990) (consistency coefficient r: 0.65 and test-retest coefficient r = 0.71 distinctive validity is z: −2.17, p < 0.05). The high scores indicate that the severity of alexithymia is high. The study states that TAS is a valid measurement tool (Dereboy 1990). In our study, Cronbach α internal consistency coefficients of TAS measurement tool were examined and the total score was 0.736 and the score of the subtests was between 0.675 and 0.372.

Social problem solving inventory-short form (SPSI-R/SF)

SPSI-R/SF was developed by D’Zurilla and Goldfried (1971) and updated by D’Zurilla and Nezu (1990). In our study, SPSI-R/SF which was adapted to Turkish by the short form of Çekici (2009) was used. SPSI-R/SF consists of 2 dimensions “Positive Orientation” and “Problem Solving Styles.” The Problem Orientation has two subscales in itself; “Positive Orientation to the Problem and “Negative Orientation to the Problem” Problem Solving Styles have three sub-scales. These are; “Rational Problem Solving Style,” “Inattentive/Impulsive Style Problem Solving” and “Avoidance Problem Solving.” There are five subscales in total. There are five questions for each subscale. The scale is scored between 0 (Not Suitable) and 4 (Completely Suitable). The overall score of each scale can be calculated, as well as the overall total score. The lowest score to be taken from the test is 0 and the highest score is 100. High score indicates that social problem solving ability is at good level; whereas low scores show that social problem solving skills are low. To obtain the total score for each subscale, it is sufficient to collect the scores of the items entering the subscale. The reliability coefficient of the scale was found to be 0.85 as a result of the reliability analysis performed by the test-re-test method (Çekici 2009). In our study, Cronbach α internal consistency coefficients of SPSI-R/SF were analyzed with a total score of 0.758 and a score of sub-tests as 0.715 to 0.309.

Statistical method

SPSS 21.0 statistical package program was used to analyze the data. Cronbach α internal consistency coefficients were evaluated to measure the reliability of the scales. The data obtained from the study were analyzed by normality tests to see if they had normal distribution or not. The results showed that the data were distributed normally. To describe the data about the personal characteristics of the participants; percentage standard deviation and frequency were used. Pearson Correlation Coefficient was evaluated and linear Regression analysis was performed to determine whether there was a relationship between TAS and SPSI-R/SF and children’s being directed to sports. The differences between the scales and whether the participants did sports or not were evaluated by independent samples t-test.

Results

Means, standard deviations, minumum, maximum TAS, and SPSI-R/SF scores of the participants are summarized in Table 1.

Table 1.

TAS and SPSI-R/SF scores of the participants

Scales	N	Min	Max	X̅
TAS Total	194	42	110	78.92 ± 11.95
Lack of recognition, acknowledgement, and discourse of emotions	194	8	30	18.77 ± 3.91
Lack of discrimination between emotions and bodily sensations	194	17	43	28.72 ± 5.65
Imagination, fantasy in life	194	7	25	14.40 ± 3.51
Lack of recognition, recognition, and discourse of emotions	194	6	25	17.03 ± 4.09
SPSI-R/SF Total	194	34	83	59.71 ± 10.08
Imagination, fantasy in life	194	1	19	11.77 ± 3.88
Lack of recognition, recognition, and discourse of emotions	194	0	20	9.08 ± 3.72
Lack of discrimination between emotions and bodily sensations	194	1	20	12.45 ± 4.25
Imagination, fantasy in life	194	0	18	7.44 ± 3.22
Lack of recognition, recognition, and discourse of emotions	194	0	18	7.98 ± 3.96

There was a moderate positive correlation between alexithymia levels of the participants and their children’s orientation to sports (r = 0.501; p = 0.000). Lack of recognition and acknowledgment of emotions and lack of verbalization (r = 0.286; p = 0.000); there was a positively weak relationship between inadequacy of feelings and bodily sensations (r = 0.394; p = 0.000) and cognitive structure for external centered adaptation (r = 0.190; p = 0.000). On the other hand, there was a moderate positive (r = 0.533; p = 0.000) relationship in the dimension of limitation in dreaming and fantasy in life) (Table 2).

Table 2.

Relationship between participants' TAS levels and children’s orientation to sports

Does he/she do sports?		TAS total	1. Sub dimension	2. Sub dimension	3. Sub dimension	4. Sub dimension
		r	0.501**	0.286**	0.394**	0.533**	0.190**
		p	0.000	0.000	0.000	0.000	0.008
		N	194	194	194	194	194

1. Dimension: Recognition of emotions, acknowledgement and lack of verbalization. 2. Dimension: Lack of discrimination of emotions and bodily sensations. 3. Dimension: Limitation in imagination, fantasy. 4. Dimension: Cognitive structure for external center adaptation.

**Correlation is significant at bidirectional 0.01.

There was no statistically significant relation between SPSI-R/SF levels of the participants and their orientation to sports (r = 0.066; p = 0.362). When the sub-dimensions of the social skill levels of the families were examined, a weak relationship was found between is positive orientation to problem (r = 0.147; p = 0.041) and avoiding style problem solving (r = 0.145; p = 0.044) sub-dimensions and directing children to sport. The other sub-dimensions were not statistically significant (p > 0.05; Table 3).

Table 3.

The relation between (SPSI-R/SF) and children’s orientation to sports

Does he/she do sports?		SPSI-R/SF	1. Sub dimension	2. Sub dimension	3. Sub dimension	4. Sub dimension	5. Sub dimension
		r	0.066	0.147*	0.101	0.020	0.115	0.145*
		p	0.362	0.041	0.161	0.780	0.111	0.044
		N	194	194	194	194	194	194

^*Correlation is significant at bidirectional 0.05. 1. Dimension: Positive orientation to the problem. 2. Dimension: Negative orientation to the problem. 3. Dimension: Rational style problem solving. 4. Dimension: Careless/Impulsive problem solving. 5. Dimension: Avoiding problem solving.

When the TAS and SPSI-R/SF levels of the participants were examined according to their children's doing sports or not status, a statistically significant difference was found in TAS total score and all sub-dimensions (p < 0.05). According to this; TAS levels of the families whose children are engaged in sports are significantly higher than the children who do not do sports (p < 0.05). When we look at SPSI-R/SF; the social skill levels of the families whose children did sports are found to be significantly higher than those families whose children did not do sports in terms of positive orientation to problems and avoidance style problem solving (p < 0.05; Table 4).

Table 4.

Examination of TAS and SPSI-R/SF levels according to sports variable

	Does he/she do sports?	N	X̅	t	p
TAS Total	Yes	93	85.15 ± 7.50	8.026	0.000*
	No	101	73.19 ± 12.44
1. Sub dimension	Yes	93	19.94 ± 2.73	4.131	0.000*
	No	101	17.70 ± 4.50
2. Sub dimension	Yes	93	31.03 ± 5.21	5.944	0.000*
	No	101	26.58 ± 5.21
3. Sub dimension	Yes	93	16.34 ± 3.24	8.726	0.000*
	No	101	12.61 ± 2.71
4. Sub dimension	Yes	93	17.84 ± 3.64	2.679	0.008*
	No	101	16.29 ± 4.36
SPSI-R/SF Total	Yes	93	59.02 ± 10.55	−0.914	0.362
	No	101	60.35 ± 9.64
1. Sub dimension	Yes	93	12.37 ± 3.39	2.057	0.04*
	No	101	11.23 ± 4.23
2. Sub dimension	Yes	93	9.47 ± 3.55	1.406	0.161
	No	101	8.72 ± 3.86
3. Sub dimension	Yes	93	12.54 ± 3.13	0.280	0.780
	No	101	12.37 ± 5.08
4. Sub dimension	Yes	93	7.83 ± 3.43	1.601	0.111
	No	101	7.09 ± 2.99
5. Sub dimension	Yes	93	8.58 ± 3.56	2.028	0.044*
	No	101	7.44 ± 4.24

^*p < 0.05 means significant difference.

Discussion

The mean total score obtained from the responses given to the alexithymia scale by the families who have children with mild intellectual disabilities was X̅ = 78.92 ± 11.95 and an alexithymia above the middle level was detected (Table 1). A positive relationship was found between alexithymia and children’s participation in sports (Table 2), as the alexithymia levels of families increased, their children’s orientation to sports increased (Tables 2 and 4). With the birth of a disabled child, parents experience mixed feelings (Quine and Pahl 1987), resulting in psychological problems with these mixed feelings (Kazak and Marvin 1984, Seligman 1985, Tomkiewicz 1987) The high depression scores of 35–53% of the parents of children with disabilities can be accepted as a result (Veisson 1999). Similar studies in our study show that parents who have children with intellectual disabilities had high levels of alexithymia (Szatmari et al. 2008, Al-Eithan et al. 2012). Given the emotional impact that high stressful events may have, alexithymia can effectively prevent individuals from coping with such events (Orejuela-Dávila et al. 2017). Previous studies have also established a relationship between alexithymia and posttraumatic stress symptoms (Chung and Hunt 2014, Frewen et al. 2008). This relationship shows that alexithymia may occur due to the emotional distress caused by a stressful situation (Parker et al. 1998). In our study, high alexithymia in the families who have children with mild intellectual disabilities shows the stress of the family is coping with. Alexithymia hinders extraversion and sociability (Espina 2003, Luminet et al. 2001). The fact that they Show avoidance style problem solving behaviour in terms of social skill level may be the result of this families may want to move away from their problems by directing their children to sports and spend a comfortable time when their children do sports. Therefore, the social and psychological support provided by governments should be given not only to children but also to their families.

The mean total score obtained from the responses of the participants to the SPSI-R/SF was found to be 60% with X̅= 59.71 ± 10.08 (Table 1). There was also a significant relationship between positive orientation to the problem and avoiding style problem solving sub-dimensions and directing children to sports (Tables 3 and 4). Research suggests that children with disabilities have lowered their social skills depending on their low level of social interaction (Baker and Donelly 2001, Coster and Haltiwanger 2004, Curtin and Clarke 2005). To develop and maintain social relations, problem solving skills should be improved (Nassau and Drotar 1995). It is also stated in the studies that the family’s advanced features towards the outside world contribute to the social skill acquisition of children (Hauser-Cram et al. 2001, Marfo et al. 1992). Parental attitudes can change the development of social skills in children (Bennett and Hay 2007, Baker and Donelly 2001). Gavidia-Payne and Stoneman (1997) state that families with good problem-solving skills are better able to cope with problems in many ways. In addition, the family characteristics and the wide and enriched environment of the child affect the social skills of children (Innes and Diamond 1999). In our study, about half of the children of the families are engaged in sports and participate in a social environment. This can explain why the social skill levels of the families are intermediate. When the social skill levels of the families whose children do not play sports are examined, it is clear that these families have lower social problem solving skills than the families whose children do sports (Table 4). This may be due to the fact that they have a lower social problem solving ability in terms of directing their children to sports.

In our study, it was determined that alexithymic characteristics and social problem-solving skills of the family who have children with mild intellectual disabilities had an effect on their children's orientation to sports. The most important finding obtained from our study is that healthy family function plays an important role in the participation of children in social life. However, it should be taken into consideration that our study is limited to 194 families and the questionnaires used. In addition, the control group was not used in the study. The study is a cross-sectional study and examined variables may not be sufficient to produce a complete result. Further studies may be conducted with a larger group of participants and with a control group. Therefore, intervention programs targeting the whole family can be more beneficial if studies on children with mild intellectual disabilities are planned. Take in account many variables that could influenced their results, such as: Family and parental functioning (Cuzzocrea et al. 2013), the role of parental stress and parents coping skills (Cuzzocrea et al. 2016); the effect of parents’ competences on the social skills even in siblings of disabled children (Cuzzocrea et al. 2014). In addition, longitudinal intervention studies are needed to fully evaluate the relationships in this study.