Maternal acceptance–rejection, self-compassion and empathy in mothers of children with intellectual and developmental disabilities

Abstract

Objective This study aimed to determine the link between Parental Acceptance-Rejection (PAR) and empathy and self-compassion in mothers of children with intellectual and developmental disabilities (IDDs). Method: The sample consists of 161 mothers who received pre-school education with children diagnosed with IDDs in Iran. The parental acceptance-rejection questionnaire, empathy questionnaire, and self-compassion scale were used as the data collection instruments, which have been analyzed through canonical correlation test. Results: There is a positive correlation between children's self-empathy and self-compassion and the PAR, and there is no significant relationship between mother's affection levels and empathy levels, but there is a significant negative relationship between mother's affection levels and child's self-compassion levels. Conclusion: when the PAR level increases, self-compassion level decreases. It provides support to predict a significant relationship between the mothers’ acceptance-rejection variables who have an IDD child and empathy and self-compassion.

Introduction

The current study aimed to highlight the role of empathy and self-compassion in parents with children with Intellectual and Developmental Disabilities (IDDs). These disorders usually used to describe a situation with limited mental ability, adaptive behavioral impairments and even social interactions, which affect the cognitive abilities (American Psychiatric Association 2013). Over the last decade, as an important observation, a birth with a disabled child has been a traumatic event in families. From this point of view, the families with children with IDDs encountering this condition often begin with some sense of questioning, and experience stress and challenge on certain realms of their lives. Furthermore, the mothers with children with Intellectual and Developmental Disability must spend a major part of their lives taking care of the child. They usually receive negative reaction from the society, it elicits different responses in their parents, e.g. denial or neglect (Gusrianti et al. 2018), Parents with these groups of children indicated higher levels of distress than other parents (Leung et al. 2016). Notably, parenting skills training could extend the mental health of mothers with children with ID. In addition, attitude and acceptance rate of the parent, knowledge rate and parenting skill, self-confidence, interactional and multilayer of parent-children relationship are some factors originated from the mental health of mothers (Ashori et al. 2019). While parents' acceptance for child's disability brought a positive impact in families (Blacher 1984, Kandel and Merrick 2005).

PART attempts to predict the outcomes of parental acceptance and rejection on the behavioral, cognitive and emotional developments of children as unconditional love and acceptance from parents (Khaleque and Rohner 2002). When this condition is not met, attachment to negative self-empathy results in acceptance-rejection syndrome (Rohner 2004). Indeed, it could affect all the developmental areas of childhood and other periods of life (MacDonald and Jensen-Campbell 2011). On the other hand, parental rejection attitudes of parents decrease the psychological resiliency levels of children, and brings about a sense of shame, guilt, and self-criticism in these who grow up in negative conditions. The rejected children exhibit emotional unresponsive and unstable behavior and often develop a mistrustful and negative worldview. Therefore, Early childhood experiences and attachment could have an influence on the development of self-compassion; external positive outcome and mental health (Neff 2003) happiness, optimism, and positive effect were highlighted (Neff and Vonk 2009).

In respect of self-compassion, empathy has a critical role in the relationship between parents and the child, that is able to affect all the developmental areas. A better conceptualization of empathy is not only the effective experience of the other persons, but it will also help to identify the emotional, cognitive, and behavioral process. Behavioral problems might be referred to as impermanence of empathy.

It is worthy to notice that empathy investigates the possible intersubjective induction process of understanding others’ emotional state in terms of a sense of positive-negative feeling and emotional security (Decety and Jackson 2004, Decety and Meyer 2008). It provides an emotional bridge to promote prosocial behavior in them as an exquisite interplay of neural networks, and understanding people’s emotions could be addressed to distinguish between own and others' distress (Riess 2017). It plays a key role in intimate relationships, or in the situation with more complexity than it would appear first (Bloom 2017).

To sum up, previous research suggests that, first, empathy and self-compassion enhances psychological well-being with a greater sense of interpersonal connection and improves behavior in parents with a child with Intellectual and Developmental Disability makes it possible for parents to reduce the negative feelings and behaviors in these children using the capacity of teamwork and managing behavioral problems in their life.

As a new research topic, we hoped that our study provides an initial glimpse into the nature which opens a new road toward a better understanding of the role of empathy, and self-compassion in parental acceptance-rejection in mothers with children with IDDs in Iran. It is considerable to examine and to solve the challenges and problems in a positive and healthy psychosocial realm in relation to these mothers. Lastly, empathy, self-compassion, and PART may help us to the extent of our psychological and experimental viewpoints to reduce harmful aspect of child rejection consequences.

Method

Participants

All 161 of mothers who participated in the current study completed questionnaires. The mothers completed a Parental Acceptance-Rejection Questionnaire (PARQ) (Mother Form), and for the rest of questionnaires they completed Self-Compassion Scale (Short Form), and Empathy questionnaire, which was for obtaining the information about the parents in diagnosed groups of individuals. In addition, the demographics characteristics of mothers are specified based on population, Education and age variables for each condition in Table 1.

Table 1.

The demographics characteristics of mothers with children with ID and ASD

	N %		Population		Education level		Age range
Mothers	ID	ASD	Village	City dweller	Illiterate	Master	20–60
	98%	2%	32.9%	67.1%	3.7%	1.9%

Procedure

After receiving permission from the ethical committee approval of the Education Department in Tabriz, Iran, the consent forms were sent to the parents (mothers) to sign, which explained the procedure and informed participants about data confidentiality as well as their ability to withdraw from the study at any point without consequences. They were also informed that all data and information would be kept anonymous and is used by coding, not specific personal information. Meanwhile, it was explained to each participant that the company would not have a bad psychological and emotional impact on them.

We selected mothers with children with these disorders for entry and attendance to do the tests by referral to different schools. After finishing the procedure, the participants were asked to turn in the completed questionnaires to the school or examiner within one week.

In addition. It is important to keep in mind that some inclusions criteria were included having reading and writing skills and having children with intellectual and developmental disabilities. Exclusions criteria were mothers with children with other diagnostic disorder or illiteracy. After follow-up, from our initial sample (N = 170) 9 participants were excluded because they had incomplete questionnaires.

Instruments

Parental acceptance-rejection questionnaire (PARQ) (mother form)

Rohner, Saavedra, and Granum in 1980 (Rohner et al., 2005): The questionnaire assesses acceptance-rejection by mothers. It consists of 60 items measuring four scales: A) Parental warmth and affection (20 items), B) Aggression and hostility (15 items), C) Neglect and indifference (15 items), and D) Undifferentiated rejection (10 items) for controlling behaviors with their children (Yıldırım-Ekmekçi 2008). However, Likert scale with 4 standing for ‘almost always true’, and 1 stand for ‘almost never true’, higher scores indicate higher perceived rejection. Also, the scores which were obtained from the scale were summed after reverse scoring of warmth, and affection questions, then the other three factors have reverse scoring for items (Aggression and hostility, undifferentiated rejection, indifference and Neglect). The negative aspects of each component were reverse-coded in 49, 42, 35, 28, 21, 14, 7 Questions. The alpha coefficient for the total PARQ was between 0.78, 0.88 for the maternal version and 0.84 for the paternal version (Rohner and Khaleque 2005). In an Iranian study; Social Skills Inventory, Cronbach's alpha values ranged from 0.68 to 0.89 and in the PARQ they ranged from 0.62 to 0.70 (Yazdkhasti 2011). This scale has been shown to have good psychometric properties, such as PAR reliability (r = 0.69).

Empathy questionnaire, Davis (1983)

The questionnaire was developed by Davis in 1983 (it is defined as the reactions of one individual to the observed experiences of another person). The scale consists of 21 items answered on a 5-point Likert scale (such as ‘Does not describe me well’ to ‘Describe me very well’). The reliability of this questionnaire is between 0.68 and 0.89 (Davis 1983). To our knowledge, a study to address reliability and validity tasks was not reported in the Iranian population, but in our study reliability (r=.60) were addressed

Self-compassion scale (short form, 12 items instead of 26 items, SCS-SF) (Raes et al. 2011)

In the original version of SCS included 26 items to measure six components of self‐compassion: Self‐Kindness (5 items), Self‐Judgment (5 items), Common Humanity (4 items), Isolation (4 items), Mindfulness (4 items), and Over‐Identification(4 items). These items were scored on a five‐point Likert scale from 1 (almost never) to 5 (almost always) where higher scores indicate higher levels of self-compassion. Also, the items of 1, 4, 8, 9, 11 and 12 were reverse-scored. Raes et al. (2011) in a study reported that internal consistency of this scale was around 86 percent (Raes et al. 2011). Additional results found that The SCS has shown adequate psychometric properties (Azizi et al. 2013, Raes et al. 2011). The internal consistency of the SCS was high for most of the subscales in an Iranian sample (Azizi et al. 2013): Self‐Kindness (α = .78), Self‐Judgement (α = .79), common humanity (α = .79), perceived isolation (α = .93), mindfulness (α = .90), and over-identification (α = .88) (Azizi et al. 2013). The reliability (r = .69) were documented in the current study.

Data analysis

All questionnaires analyzed with a statistical analysis were performed using SPSS 25 through the Pearson correlation coefficient and multiple regression analysis. Correlational research is used to investigate the relationships between our variables. Furthermore, it is notable that Pearson correlation coefficients and multiple regression analysis were used to determine self-compassion and PAR levels.

Results

The final participants were 161 mothers with children with intellectual and developmental disabilities, specifically 98% of whom had an intellectual disability (ID) of a type (we did not have an exact percentage in each type e.g. mild, moderate, severe, etc.) and around 2% had shared a diagnosis of autism spectrum disorder (ASD) from Iran (Tabriz city) and were diagnosed by the psychiatry service following DSM-5 criteria. To assess more information about the diagnostic data, specialist doctors or clinical psychologists carried out the procedure concerning the disorders. All mothers were from villages (32.9%), and city dwellers (67.1%) and were between 20 to 60 years old, and also their the average of education level were from illiterate (3.7%), to master (1.9%).

The demographic characteristics of mothers with children with intellectual and developmental disabilities were between 20 to 60 years old including age, and educational levels were illiterate to master.

Table 1 illustrates the Mean and Standard Deviations to the analysis of our variables. Pearson correlation coefficients and multiple regression in the analysis to assess the relation between PAR Theory, Empathy and Self-compassion in mothers with children with intellectual and developmental disabilities were documented to predict mothers’ Acceptance-Rejection by effect of empathy and self-compassion variables.

The effect of parental acceptance-rejection and self-compassion on these mothers showed significant differences with r = -0.331, p < 0.01. So, there was a significant relationship between those mothers’ scores and self-compassion. It is considered as a negative reverse relationship, and by increased parental acceptance-rejection level the self-compassion level decreased while there was not a significant relationship between the scores in the mother’s acceptance-rejection and empathy (r = 0.052, p > 0.05).

Table 2 illustrates the results of the basic linear regression analysis between empathy, self-compassion and parental acceptance-rejection variables. Inasmuch coefficient of multiple correlations in independent and dependent variables were around 0.332 to indicate children’s self-empathy and self-compassion, and parental acceptance-rejection’ variance (R squared) was around 0.110 (11%) (see Table 3). In parental acceptance-rejection with children with IDD self-compassion was negative and significant (p < 0.01, β = −0.328) while for empathy was not documented (p < 0.05, β = 0.030).

Table 2.

Correlation matrix between empathy and self-compassion with PAR variables

Variables	M	SD	Self-empathy	Self-compassion	PAR
Self-empathy	88.72	7.91	1
Self-compassion	40.39	7.34	−0.069	1
Parental acceptance-rejection’s parents	121	22.48	0.052	−0.331**	1

Note: M = Mean; SD = Standard Deviation; PAR = Parental acceptance-rejection’s parents.

^* p < .05.

^** p < . 001.

Table 3.

Regression analysis to predict parental rejection and acceptance through the empathy and self-compassion

Variables	B	SE	$\mathrm{\beta }$	t	p	R	R 2	F	P
Constant	154.815	18.641	0.030	8.305	0.001	0.332	0.110	9.788	0.001
Self-empathy	0.084	0.214	–	0.394	0.694
Self-compassion	−1.006	0.230	0.328	−4.367	0.001

Note. B = unstandardized beta, SE = standard error, β = standardized Beta; t = t test statistic; p = probability value; R = quantity r; R² = R-squared; F = F distribution, P = Sig.

Discussion

We have presented results align strongly with evidence with previous studies who suggesting that there is a negative significant relationship between the scores obtained through mothers’ acceptance-rejection and self-compassion levels, and also, there was no significant relationship between the scores in the mother’s acceptance-rejection and empathy. In summary, our study presents new evidence for the existing literature of evaluation of social and psychological differences in children with IDDs as a substantial issue.

Due to significant aspects of these phenomena in development of parental behavior, these parents need to be cautious about child rejection which could have harmful psychological consequences for them. The process of variables has begun to emerge as a new path in the psychology realm.

Our study is not exempt from limitations. Hence, our population sample was limited to Tabriz province only. Thus, it is hard to realize to what extent and how far its results can be generalized. It could be helpfully administered to a larger sample size in a larger area to allow us to have a more detailed investigation of the current relationships. A common limitation in the psychological field, an important task for future researches, is to examine these relationships among other groups of people, or another social-economic group.

How several subcomponents of self-compassion and empathy might predict well-being in people’s life is controversial. For instance, in future studies the role of the environmental conditions and cultural differences in parental acceptance-rejection remains as interesting questions. Also, besides these environmental factors religious belief would be take into account in future studies. Importantly, longitudinal studies could clarify the effects of possibility of parental acceptance-rejection through their interaction. So, the current findings provide preliminary support to predict a significant relationship between empathy and self-compassion in the mothers acceptance-rejection with IDDs children.

Disclosure statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.