Arab grandmothers of children with/without an intellectual disability: The contribution of personal and interpersonal characteristics to their mental health and personal growth

The crises and difficulties which are part of raising a child with an intellectual disability are not temporary; they accompany the family throughout the life course (Bernier, 1990). Some families cope and function well while others experience difficulties and may feel overburdened (McCubbin & Patterson, 1983). Formal and informal sources of social support play an important role in reducing stress and increasing emotional wellbeing at times of crisis and distress, in general (Sarason, Pierce, & Sarason, 1990), and when raising a child with disability, in particular (Minnes & Nachshen, 1997; Smith, Oliver, & Innocenty, 2001). Grandmothers are one of the main sources of family support though may often experience stress and distress themselves. The current study focuses on grandmothers of children with intellectual disabilities in the Arab society in Israel. Despite the strong inter-generational relationships in Arab families, and despite the important role of grandmothers, little research has been dedicated to the experiences of these grandmothers and the impact of having grandchildren with intellectual disabilities on their lives.

This study aims:

1. To examine the contribution of stress, personal resources (self-esteem), interpersonal resources (emotional and instrumental support, perceived role of grandparenthood) and emotions (shame and guilt) to personal growth and wellbeing as perceived by the grandmothers.
2. To examine the similarities and differences in all study variables and their associations between grandmothers of children with intellectual disabilities and grandmothers of typically developed children in the Arab society.

The sample for this study was composed of 101 Arab grandmothers of children with intellectual disabilities (aged 3-14), and 100 grandmothers of typically developed children. Grandmothers of children with intellectual disabilities were approached through local social services and Akim organization, while the comparison grandmothers were identified as residing in the same areas as grandmothers from the research group. All grandmothers completed the following questionnaires: Stress Related Growth Inventory (Tedeschi & Calhoun, 1996); Mental Health Inventory (Veit & Ware, 1983); Self Esteem - RSE (Rosenberg, 1965); Support Functions Scale (Dunst, Trivette and Deal, 1988); Perceived Stress Scale - PSS (Cohen, Kamarck, & Mermelsteim, 1983); State Shame and Guilt Scale (Tangney, Dearing, Tangney, & Dearing, 2002); Multidimensional Experience of Grandparenthood Set of Inventories - MEG (Findler, Taubman-Ben-Ari, Nuttman-Shwartz, & Lazar, 2013).

After completing all questionnaires, seven grandmothers continued to describe their personal experiences of being grandmothers of a child with an intellectual disability in semi-structured interviews. These interviews were recorded and transcribed, and quotes obtained during these interviews are presented in the discussion to illustrate and highlight some of the issues that were raised in the quantitative part of the study.

Of all the variables examined, only self-esteem and investment in the grandparent role differed between grandmothers of children with intellectual disabilities and grandmothers of typically developed children. The self-esteem of grandmothers of children with intellectual disabilities was higher than that of grandmothers of typically developed children. It is possible that the special role these grandmothers have in their children’s families, and their feeling that they are valued and capable grandmothers, alongside the appreciation and gratitude from their families, contribute to their self-esteem. The findings also suggest that grandmothers of children with intellectual disabilities invest more in their role as a grandparent than grandmothers of typically developed children. Naturally, the demands that are involved in raising children with disabilities require the grandmothers to be more active and perform more tasks within the family.

Stress, self-esteem and guilt contributed to the emotional wellbeing of all grandmothers. Lower levels of stress and guilt and higher self-esteem contributed to greater wellbeing. As is likely to happen, especially with older women, stress that caused a sense of lack of control, sadness, irritation and frustration from the mounting problems upset the grandmothers, increased their distress and made it harder for them to experience emotional wellbeing. Guilt is naturally accompanied by an intrapersonal conflict between internal commands and behavior (O'Brien et al., 2007) and thus may be detrimental to one’s adaptation processes. Additionally, higher self-esteem was associated with greater wellbeing, as recognition of the fact that the grandmothers are valued and needed contributed to their wellbeing. Finally, the interaction between stress and the experience of grandparenthood also contributed to emotional wellbeing. Among grandmothers with low levels of meaning in grandparenthood lower stress levels were associated with greater emotional wellbeing. 

Stress, self-esteem, a non-linear level of guilt, support, burden and positive emotions all contributed to personal growth among grandmothers. Lower levels of stress were associated with greater personal growth. Stress that was described by the grandmothers as accumulating difficulties, a sense of inefficiency, distress and irritability contributed to lower levels of meaningful activity, desire for change and for the development of new opportunities – all expressions of personal growth. As for self-esteem, the findings suggest that higher self-esteem is associated with greater growth. It is possible that with the passing of the years, and after providing their children and grandchildren with continued support, grandmothers require internal strength and resources that will enable them to move forward and continue developing a sense of personal growth. The non-linear association between guilt and growth suggests that this association is only evident when there are high levels of guilt, which probably motivate the grandmothers to re-examine and change things, eventually leading to personal growth. 

Additionally, low burden and positive emotions contributed to personal growth among grandmothers. It is plausible that when grandparenthood is perceived as less difficult and burdensome, and as a more positive experience, this role fills the grandmothers with a sense of vitality and a feeling that they are contributing to the family, which in turn contributes to personal growth. Two interactions contributed to personal growth: Cost and stress; cost and self-esteem. The finding suggest that among grandmothers who report higher levels of cost in their grandparenthood role and among grandmothers with low self-esteem - lower levels of stress are associated with greater personal growth.

Taken together, the findings of this study suggest that Arab grandmothers attribute great importance to their role and, thus, they are a unique potential resource for their families. Their experience, free time and motivation to provide emotional and instrumental support, alongside their sense of commitment to their family, position them as the main source of their children’s support system. Despite their active role and contributions, little attention has been attributed by professionals to their experiences and needs. In order to benefit from the potential of their support, grandmothers require unique intervention programs that will support them. Such programs should include the provision of emotional support for the grandmothers. In addition, such programs should include knowledge and information on disabilities, on communication skills and channels within the family, and on caring and playing skills that are relevant to children with disabilities.