Stigma and parenting a child with an emotional or behavioural disorder

Studies in Australia, America, and China, to name a few, consistently show that a large majority of parents experience stigma. Kim Eaton (Registered Psychologist and PhD Candidate) and Dr Jeneva Ohan (Registered Psychologist and Senior Lecturer) in the School of Psychological Science at The University of Western Australia have been studying the stigma experiences and coping strategies of parents caring for children with behavioural disorders. They have found that the way parents think about themselves as parents, and the way they talk to others about their child’s behavioural disorder, can make a real difference.

What is stigma?

Stigma can be overt, such as when others criticise or exclude the parent or the child.  It can also be subtle, showing itself in veiled comments and stares.  Parents experience stigma in these key ways:

• Blame and bad-parent stigma: Parents feel blamed for their child’s problems, and that they are seen as bad parents.
• Courtesy stigma: Parents experience stigma because they are related to their child, who has a problem. Being stigmatised because the child is, can create feelings of shame and embarrassment.

Not only do strangers stigmatise, but also family members, friends, acquaintances, and even the child’s school teacher and helping professionals.

Stigma increases caregiver burden and disliking for the caregiving role.  It can result in poorer parent psychological wellbeing and reduced quality of life.  Parents might conceal the child’s difficulties or isolate themselves and their child to avoid stigma.  Sometimes this is protective, but it also potentially limits access to social and professional support.

What is self-stigma?

Experiencing stigma can affect a parent in many different ways. Parents might come to believe that the stigma is true and start to think of themselves in negative ways.  This is known as ‘self-stigma’. We think that there are three key aspects to parents’ self-stigma:

• Self-blame: Parents feel responsible for causing their child’s disorder.
• Shame: Parents feel ashamed or embarrassed to be a parent of a child with a disorder.
• Bad-parent beliefs: Parents feel like an inadequate or bad parent.

In our recent study, we surveyed 607 parents in Australia and New Zealand who had a child with an emotional or behavioural problem. We found that about 72% of parents blamed themselves, often to almost all the time, for causing their child’s disorder, although 97% felt often to almost all the time that they did not deserve to be blamed by others.

About 46% of parents, often to almost all of the time, felt ashamed. About 69%, often to almost all the time, felt that they were bad parents, and 53%, often to almost all of the time, felt guilty. Self-stigma was higher the closer the biological relationship between the parent and the child (for example, mothers experienced self-stigma more than aunts or grandmothers).

Also, parents of children with behavioural problems (e.g. conduct disorder) experienced about the same levels of self-stigma as parents of children with emotional problems (e.g. an anxiety disorder or depression).  But self-stigma was higher for parents whose child experienced greater distress as a result of his/her disorder.

What parents experiencing self-stigma can do

In one of our studies, parents described strategies that they used to help them tackle their feelings of self-stigma. Drawing from their suggestions, parents might like to consider the following:

1. Is this person’s opinion important? Often, others’ opinions are based on little knowledge of your circumstances. They may have picked up their attitudes from others without reflecting on them, or how they affect others. They may not have witnessed your many struggles or triumphs. Ask yourself what value you place on this person’s judgments or criticisms.
2. Believe that you are good enough: Remember that the good parent ideal is exactly that – an ideal. Holding yourself to what is ultimately an undefinable and possibly unattainable standard leads to disappointment. Being ‘good enough’ and trying to improve is more attainable, and hence more satisfying. You do your very best in what can be very trying circumstances.
3. Access information that will help you avoid the self-blame game: In this regard, knowledge is power. Childhood disorders are complex and there is usually no one distinguishable cause. Speaking to a mental health professional can help increase understanding about your child’s disorder and may help you to take action and allay self-blame. They might also help you find ways to deflect others’ criticisms.
4. Build a tool-kit of strategies: Having options to help you support your child can help you feel better informed. This might build your belief in yourself and your parenting abilities. Speak to those helping your child and find out what you can do to support him/her.
5. Access support for you: Sharing your concerns with empathic and understanding others (particularly those who are in a similar situation to yourself) can help alleviate the effects of stigma. Parent support groups may be a good place to start. So, too, reaching out to a close friend or family member can help. You might also find more formal support such as counselling beneficial.

The disclosure debate

To obtain support, though, others will need to know (at least in part) about the child’s disorder. Concerns that telling others will result in stigma can hold parents back in this regard. This is usually based on prior experiences where telling others has not gone well.  However, parents also report that more often than not others’ responses are usually quite positive.

There may be real benefits to sharing. Telling others opens the door to accessing support, empathy, and understanding for both parent and child. It also allows parents to advocate on behalf of their child (e.g. for extra support in the classroom). Sharing can be empowering and rewarding. Each parent needs to decide for himself/herself whether sharing their child’s emotional or behavioural disorder and/or their struggles as a parent is right for them and their family. There are no right or wrong answers here.

Being more open does not have to mean telling everyone everything. That is because telling others is not an all-or-nothing decision.  One helpful strategy is to selectively tailor what information is revealed depending on the situation (e.g., what the child’s grandparents are told might be different to what the child’s teacher is told).  Practising what is to be said beforehand can increase confidence in the delivery of the information.

Summary

• Most parents whose children experience emotional or behavioural disorders experience stigma from other people and self-stigma (i.e. blaming themselves).
• Experiencing stigma, from friends, family members and/or professionals, affects a parents’ emotional wellbeing.
• Parents experiencing stigma might find it useful to have realistic expectations, get information and support from professionals and develop strategies for supporting their child.
• Telling other people about their child’s disorder can help parents access support, but each parent needs to decide for themselves who and what they disclose about their child’s condition.

Articles for the interested reader

1. Corrigan PW, Miller FE. Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. J Ment Health. 2004; 13(6): 537-48. [Abstract]
2. Dempster R, Wildman B, Keating A. The role of stigma in parental help-seeking for child behaviour problems. J Clin Child Adolesc Psychol. 2013; 42(1): 56-67. [Abstract]
3. Eaton K, Ohan JL, Stritzke WGK, et al. Failing to meet the good parent ideal: Self-stigma in parents of children with mental health disorders. J Child Fam Stud. 2016; 25(10): 3109-23. [Abstract]
4. Eaton K, Ohan JL, Stritzke WGK, et al. Mothers’ decisions to disclose or conceal their child’s mental health disorder. Qual Health Res. 2017. Epub ahead of print. [Abstract]
5. Frigerio A, Montali L. An ethnographic-discursive approach to parental self-help groups: The case of ADHD. Qual Health Res. 2015; 26(7): 935-50. [Abstract]
6. Moses T. Exploring parents’ self-blame in relation to adolescent’s mental disorders. Fam Relations. 2010; 59(2): 103-20. [Abstract]