What is this?

This review looked at two interventions to support parents with a learning disability to parent more effectively – one which taught parenting skills, and one which aimed to make social relationships stronger.

Parents with a learning disability may face additional difficulties in parenting effectively. This may be due to limited cognitive abilities, smaller support networks, the negative attitudes of other people. Other factors may include being at higher risk of experiencing poverty, living in inadequate housing, or struggling with physical or mental health difficulties, compared to parents without a learning disability.

It is suggested that an estimated 40-60% of parents with a learning disability fail to meet the standards required for ‘good enough parenting’, and most referrals to Children’s Services for these parents relate to emotional abuse or neglect.

How is it meant to work?

Research has found that mothers with larger, more helpful social networks report better psychological wellbeing. This suggests that social support has a key role in improving parenting.

It is also suggested that supportive behaviour-based interventions in the home may help parents to learn and apply parenting skills in practice, improving their parenting.

What are the evaluated outcomes?

• Social relationships
• Parenting skills

How effective is it?

Improved social support networks

Overall, the review found that the evidence relating to the impact of interventions focused on strengthening of social relationships on social relationships was mixed – there was not enough evidence to determine whether or not the intervention was effective. This is based on weak evidence from two studies looking at improving social support networks.

Improved parenting skills

Overall, the teaching of parent skills had a mixed effect on improving parenting skills. This is based on weak evidence from five studies on improving parenting skills.

Strength of Evidence

The evidence base for both interventions is fairly weak. The average sample size across projects was 22 participants (ranging from 4-45 between projects).

For both interventions the strength of research was also limited by, varied definitions of learning disability, and in one study all participants had previous contact with Children’s Services which affects whether the findings could be applied more generally.

The review also highlighted the limitations of existing studies relating to their  lack of comparison to groups who weren’t offered the intervention. These weaknesses in the studies mean that no definitive conclusions can be drawn from the studies reviewed. However, initial findings suggest there may be positive changes in social relationships and that some but not all behavioural interventions may be effective in improving parenting skills for parents with learning disabilities, but stronger evidence is needed before these findings could be considered reliable.

Where has it been studied?

The majority of studies were conducted in Australia, followed by Canada and the USA. Only one of the seven studies took place in the UK – which looked at improving social support networks.

Who does it work for?

Most studies focused primarily, or solely, on mothers. Across all seven studies, 138 participants were mothers, whereas only 19 fathers were included across the studies.

One study found that single parents had a more negative view of themselves, which may lead to interventions for social relationships being less effective for this group.

Two of the studies also suggested that learning ability can also have an effect on how successful the intervention is, and reading ability and comprehension levels may impact the effectiveness of interventions based on the use of pictorial manuals to help improve parenting.

When, where and how does it work?

Due to differences between the studies, it is difficult to provide general findings. However individual studies gave some insight to this question.

One pilot study in the UK of a group intervention aimed at improving the self-concept of parents and the quality of relationships showed a significant improvement in how parents saw themselves. No significant differences were found regarding feelings about their children or their thoughts about their child’s abilities.

One study from Australia found that using behaviour-based skills may be more effective than lesson booklets or other less intensive methods. Successful parts included increased ability to recognise dangers in the home, recognising illness symptoms, and increasing knowledge of how to manage emergencies and medication. Findings shows that improvements for safety in the home and knowledge of health seen at the end of the intervention had decreased by three months afterwards.

One Canadian study found that childcare skills increased as a result of using illustrated manuals, with a significant increase in test scores from before the project was set up and afterwards.

One study found that parents had already received a similar intervention around improving social relationships, making it difficult to understand the impact of the intervention. Another study also noted that it was difficult to ensure how consistently the intervention was implemented which may have affected the success of the intervention.

One study from Australia found participating in the programme led to small but positive effects on mothers’ social support networks.

What are the costs and benefits?

No economic analysis was included in the study.

Case study

The only study from the UK in this review used a group intervention to try and reduce social exclusion and dependence on statutory services for parents with an intellectual disability. The group intervention was provided to 12 parents with borderline or mild learning disabilities over 14 weeks. They also received a home‐based teaching programmes during this period.  There was another group of parents who only received the home-based teaching programme.

Parents were assessed before the intervention, afterwards, and again 27 weeks later. The group who received both the group sessions and home-based teaching found that their view of themselves improved significantly. Although, the ‘feel good factor’ which came from improvements in parents’ view of themselves did not immediately benefit their children.

The quality of relationship between these parents and their children, as well as parents’ expectations of their children’s abilities did not improve as a result of group sessions.  Follow‐up data revealed that group training did result in all of the parents making new friends and other positive social and practical changes taking place within their families.

Single parent status and attending multiple groups were identified as important factors affecting parents’ perception of themselves and the quality of their relationships.

• The study above was run in Cornwall, where the Special Parenting Service to support parents with a learning disability is run by Cornwall NHS Foundation Trust. Further details of the project and contact details can be found here.
• Working Together with Parents Network at Bristol University – provide advice and best practice guidance for professionals working with parents with learning disabilities or learning difficulties
• Best Beginnings provide information and advice – including the Baby Buddy app, which can help provide clear and simple advice and guidance for parents with a learning disability
• CHANGE has created a range of resources specifically to support parents with a learning disability through the stages of pregnancy and early childhood
• BILD provides advice, and links to a number of helpful resources for parents with a learning disability
• Supporting parents with a learning disability through the child protection system – guide for professionals

In summary...

• There is a lack of robust studies of interventions aimed at social support and parenting skills of parents with a learning disability
• Existing studies are limited by their small size, the difficulty of applying results more generally, lack of results in the long-term, limited information on how intensive the intervention was, and a lack of detail about how children were affected
• Findings relating to social support are inconclusive although there was some evidence that positive change may be possible.
• There are initial findings that behavioural interventions may be more effective for improving parenting skills than less intensive interventions such as normal service provision or lesson booklets.
• Large-scale studies are needed to determine what is most effective, who benefits most, and what parts of each intervention are most helpful.