Carers' expressed emotion, appraisal of behavioural problems and stress in children attending schools for learning disabilities.
Carers who see high expressed emotion in themselves rate more child actions as problems and feel less supported—screen appraisal and support, not just behavior counts.
01Research in Context
What this study did
The team gave carers of kids with learning disabilities a short survey. They asked how often carers felt critical or over-involved toward the child. They also asked how many child behaviors the carer saw as problems and how much support the carer got from friends or family.
All answers went into one model to see which mix best explained carer stress.
What they found
Carers who scored high on expressed emotion rated more child actions as serious problems. These same carers also said they had less social support. Together, negative appraisals and low support explained most of the carer stress.
In plain words, how carers think about behavior matters as much as how often it happens.
How this fits with other research
Johnson et al. (1994) saw the same link earlier in teens with ID. They added that high expressed emotion also hurt carer mental health and marriage quality. Rutherford et al. (2003) widened the age range and showed appraisal is the key lever.
Lovell et al. (2012) later added biology. They found that more social support gave parents of kids with autism or ADHD healthier morning cortisol. The story stayed the same—support lowers stress—but now we know the body feels it too.
Ahlborn et al. (2008) went a step further. They tracked families over time and learned that parenting-specific help (like advice on handling meltdowns) protects against later stress better than general emotional support. This sharpens the takeaway: give carers concrete child-focused help, not just sympathy.
Why it matters
When you meet a new family, ask how they view the child’s behavior, not just how many behaviors occur. A brief appraisal scale takes two minutes and flags carers at risk. Pair this with a support map: who gives hands-on help, respite, or school advocacy. Target these social gaps first. You may lower stress faster than by teaching a new behavior program alone.
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Add two questions to your intake: ‘What behaviors worry you most?’ and ‘Who helps you with these?’ Use answers to plan respite or parent coaching before starting child interventions.
02At a glance
03Original abstract
BACKGROUND: Expressed emotion (EE) has been found to be high in families with children suffering from conduct disorder as well as a variety of childhood psychiatric disorders. Expressed emotion has been associated with high levels of stress in carers. However, behavioural problems in children do not automatically lead to stress in carers. Carers' beliefs and behaviour could affect how they appraise and cope with their child's behaviour. Furthermore, the perceived adequacy of social support can also be an important factor in determining the family's level of stress. The study investigates the relationship between EE variables and carers' appraisal and coping with the child's behaviour, stress and social support. METHODS: Forty-seven carers were recruited from schools for moderate to severe learning disabilities. Carers filled in questionnaires and took part in the Camberwell Family Interview for EE status. Carers' EE status was determined by a rater blind to the carers' questionnaires scores. RESULTS: There was no difference between high and low EE groups in the descriptive information of the child's independence, communication skills, or the frequency of behavioural problems. However, high EE carers appraised more of their children's behaviour as definite problems and their available social support to be less adequate. High warmth was found to relate to more positive reappraisal and less escape-avoidance coping. A multiple regression analysis indicated that carers' EE, psychological well-being, appraisal of their children's behaviour, their children's communication skills and respite usage predicted 62% of the variance in their perceived stress scores. CONCLUSION: It is important to consider optimal use of respite care and psychosocial intervention to encourage positive appraisal and problem solving.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.2003.00512.x