Quality of Life of SpLD Children and Quality of Life of SpLD Children and Their Parents at Time of DiagnosisTheir Parents at Time of Diagnosis

Dr. Sunil KarandeDr. Sunil Karande MD, DCH, FIAPMD, DCH, FIAP

Professor of PediatricsProfessor of Pediatrics

Department of PediatricsDepartment of Pediatrics

Seth G.S. Medical College & K.E.M. HospitalSeth G.S. Medical College & K.E.M. Hospital

Mumbai 400 012, INDIAMumbai 400 012, INDIA

BackgroundBackground

• SpLD is a SpLD is a hidden disabilityhidden disability in an in an otherwise normalotherwise normal child child

• SpLD children fail to achieve school grades matching SpLD children fail to achieve school grades matching with their intelligencewith their intelligence

• The same dysfunctions that interfere with normalThe same dysfunctions that interfere with normallearning processes also impact on:learning processes also impact on:

self-imageself-image

peer and family relationshipspeer and family relationships

social interactionssocial interactions

BackgroundBackground

• Due to lack of awareness SpLD often detected lateDue to lack of awareness SpLD often detected late

• ~20% SpLD children have associated ADHD (persistent ~20% SpLD children have associated ADHD (persistent hyperactivity, impulsivity, inattention)hyperactivity, impulsivity, inattention)

• ADHD further impairs learningADHD further impairs learning

• At time of diagnosis:At time of diagnosis:

child has child has alreadyalready experienced chronic poor school experienced chronic poor school performance / class detainmentperformance / class detainment

Parents are under tremendous stress Parents are under tremendous stress

Quality of Life (QOL)Quality of Life (QOL)

World Health Organization definition:World Health Organization definition:

QOL is an individual’s perception of his / her position inQOL is an individual’s perception of his / her position inlife in context of culture and value systems in which he / life in context of culture and value systems in which he / she lives, and in relation to his / her goals, expectations, she lives, and in relation to his / her goals, expectations, standards, and concernsstandards, and concerns

Broad-ranging concept which incorporates person’s:Broad-ranging concept which incorporates person’s: physical healthphysical health psychological statepsychological state level of independencelevel of independence social relationshipssocial relationships personal beliefspersonal beliefs relationship to salient features of environmentrelationship to salient features of environment

QOL of SpLD Children at DiagnosisQOL of SpLD Children at Diagnosis

HypothesisHypothesis::QOL of children with newly diagnosed SpLD would be QOL of children with newly diagnosed SpLD would be poorer than the QOL of a general pediatric populationpoorer than the QOL of a general pediatric population

AimsAims of studyof study::i.i. to measure and analyze parent-reported QOL of to measure and analyze parent-reported QOL of

children with newly diagnosed SpLDchildren with newly diagnosed SpLD

ii.ii. to evaluate impact of clinical and socio-demographic to evaluate impact of clinical and socio-demographic characteristics on their QOLcharacteristics on their QOL

• September 2005 to March 2006September 2005 to March 2006

• Consecutive 150 parents (either mother or father) Consecutive 150 parents (either mother or father) enrolled (power of analysis of study > 95%)enrolled (power of analysis of study > 95%)

• Child Health Questionnaire-Parent Form 50 (CHQ-PF50)Child Health Questionnaire-Parent Form 50 (CHQ-PF50)

• CHQ-PF50 has 50 items and it measures 12 domains CHQ-PF50 has 50 items and it measures 12 domains (scales) of health(scales) of health

• 4-week4-week recall period recall period

• CHQ-PF50 extensively validatedCHQ-PF50 extensively validated

• Can be used in any country where parents can read and Can be used in any country where parents can read and understand Englishunderstand English

CHQ-PF50: 12 domains of healthCHQ-PF50: 12 domains of health

1.1. Physical functioning Physical functioning 2.2. Social limitations due to physical health Social limitations due to physical health 3.3. General health perceptions General health perceptions 4.4. Bodily pain/discomfort Bodily pain/discomfort 5.5. Limitations in family activities Limitations in family activities 6.6. Social limitations due to emotional–behavioral problems Social limitations due to emotional–behavioral problems 7.7. Time impact on parents Time impact on parents 8.8. Emotional impact on parents Emotional impact on parents 9.9. Self-esteem Self-esteem 10.10. Mental health Mental health 11.11. General behavior General behavior 12.12. Family cohesion Family cohesion

CHQ-PF50 Summary ScoresCHQ-PF50 Summary Scores

• Two summary scores derived:Two summary scores derived:

1)1) Physical Summary (PhS) Score: an ‘overall’ measure of Physical Summary (PhS) Score: an ‘overall’ measure of physical well-beingphysical well-being

2)2) Psychosocial Summary (PsS) Score: an ‘overall’ measure Psychosocial Summary (PsS) Score: an ‘overall’ measure of psychosocial well-beingof psychosocial well-being

Analysis of dataAnalysis of data

• Data analyzed using SPSS 11.0 versionData analyzed using SPSS 11.0 version • CHQ-PF50 mean scores (±SD) for study children CHQ-PF50 mean scores (±SD) for study children

computed using SPSS syntax computed using SPSS syntax

• Mean scores of study children compared with USMean scores of study children compared with USchildren normschildren norms

• Effect sizes computedEffect sizes computed • Cohen’s guidelines for interpretation of ‘Cohen’s guidelines for interpretation of ‘effect size’effect size’ 0.2 to <0.5 = small0.2 to <0.5 = small 0.5 to <0.8 = medium0.5 to <0.8 = medium ≥≥0.8 = large0.8 = large

Analysis of dataAnalysis of data

• Impact of each clinical and socio-demographic variable on Impact of each clinical and socio-demographic variable on PhS and PsS scores evaluatedPhS and PsS scores evaluated

• Independent samples t-test or ANOVA test usedIndependent samples t-test or ANOVA test used

• Multivariate analysis performed to determine ‘independent’ Multivariate analysis performed to determine ‘independent’ impact that each clinical and socio-demographic variable impact that each clinical and socio-demographic variable had on a poor PhS or PsS score outcomehad on a poor PhS or PsS score outcome

• A score of 1 SD below US children mean score used asA score of 1 SD below US children mean score used ascut-off value for determining a poor HRQL score outcome cut-off value for determining a poor HRQL score outcome (viz. score <40) (viz. score <40)

Results of StudyResults of Study

• Mean age of children 12.2 yrs (±SD 2.2, Mean age of children 12.2 yrs (±SD 2.2, rr 7.01–17.03) 7.01–17.03)• Boys : Girls ratio 1.9 : 1Boys : Girls ratio 1.9 : 1• 93 (62.0%) were first-borns93 (62.0%) were first-borns• 131 (87%) belonged to upper / upper middle 131 (87%) belonged to upper / upper middle

socioeconomic strata of societysocioeconomic strata of society• 123 (82.0%) had LD123 (82.0%) had LD1+2+31+2+3 • 31 children detained once; 7 detained twice31 children detained once; 7 detained twice• 38 (25.3%) had co-occurring ADHD38 (25.3%) had co-occurring ADHD• 5 (3.0%) had co-morbid psychiatric disorders:5 (3.0%) had co-morbid psychiatric disorders:

(1 adjustment disorder, 3 generalized anxiety disorder(1 adjustment disorder, 3 generalized anxiety disorder

1 conduct disorder)1 conduct disorder)

Results of StudyResults of Study

• 109 (72.7%) had ≥1 assoc. non-academic problems:109 (72.7%) had ≥1 assoc. non-academic problems: behavioral problems in 56behavioral problems in 56 speech problems in 37speech problems in 37 anxiety problems in 36anxiety problems in 36 chronic allergies in 25chronic allergies in 25 depressive thoughts in 24depressive thoughts in 24 sleep disturbances in 18sleep disturbances in 18 nocturnal enuresis in 8nocturnal enuresis in 8 recurrent URTI/ joint pains in 4 eachrecurrent URTI/ joint pains in 4 each asthma/ epilepsy/ congenital hypothyroidism on treatment asthma/ epilepsy/ congenital hypothyroidism on treatment

in 2 eachin 2 each encopresis/ recurrent headaches/ rheumatic heart disease/ encopresis/ recurrent headaches/ rheumatic heart disease/

obesity/ psoriasis/ medulloblastoma in remission in 1 eachobesity/ psoriasis/ medulloblastoma in remission in 1 each

Results of StudyResults of Study

Clinically significant deficits (effect size≥-0.5) detected in:Clinically significant deficits (effect size≥-0.5) detected in:

9 out of 12 domains9 out of 12 domains Limitations in family activities (-1.65)Limitations in family activities (-1.65) Emotional impact on parents (-1.62)Emotional impact on parents (-1.62) Social limitations due to emotional–behavioral problems (-1.47)Social limitations due to emotional–behavioral problems (-1.47) Time impact on parents (-1.45)Time impact on parents (-1.45) General behavior (-1.19)General behavior (-1.19) Physical functioning (-1.18)Physical functioning (-1.18) Social limitations as a result of physical health (-1.16)Social limitations as a result of physical health (-1.16) General health perceptions (-0.92)General health perceptions (-0.92) Mental health (-0.78)Mental health (-0.78)

BBoth summary scoresoth summary scores PsS (-1.32) > PhS (-1.19)PsS (-1.32) > PhS (-1.19)

CHQ-PF50: 12 domains of healthCHQ-PF50: 12 domains of health

1.1. Physical functioning Physical functioning 2.2. Social limitations due to physical health Social limitations due to physical health 3.3. General health perceptions General health perceptions 4.4. Bodily pain/discomfort Bodily pain/discomfort 5.5. Limitations in family activities Limitations in family activities 6.6. Social limitations due to emotional–behavioral problems Social limitations due to emotional–behavioral problems 7.7. Time impact on parents Time impact on parents 8.8. Emotional impact on parents Emotional impact on parents 9.9. Self-esteem Self-esteem 10.10. Mental health Mental health 11.11. General behavior General behavior 12.12. Family cohesionFamily cohesion

Multivariate analysis resultsMultivariate analysis results

Predictors of poor PsS score:Predictors of poor PsS score: having ≥ 1 non-academic problems (having ≥ 1 non-academic problems (PP<0.0001)<0.0001) co-morbid ADHD (co-morbid ADHD (PP=0.005) =0.005) first-born status (first-born status (PP=0.009)=0.009)

Predictors of poor PhS score:Predictors of poor PhS score: having ≥1 non-academic problems (having ≥1 non-academic problems (PP=0.006)=0.006) first-born status (first-born status (PP=0.035)=0.035)

Impact of Co-occurring ADHDImpact of Co-occurring ADHD

Co-morbid ADHD Co-morbid ADHD adverselyadversely impacts QOL of SpLD children impacts QOL of SpLD children in:in:

4 domains4 domains related to their related to their psychosocialpsychosocial functioning functioning Emotional impact on parents (Emotional impact on parents (PP=0.006)=0.006) General behavior (General behavior (PP=0.002)=0.002) Time impact on parents (Time impact on parents (PP=0.038)=0.038) Self esteem (Self esteem (PP=0.020)=0.020)

PsS scorePsS score ( (PP=0.001)=0.001)

Information Study AddsInformation Study Adds

1.1. QOL of SpLD children is already significantly compromisedQOL of SpLD children is already significantly compromised

2.2. They very often exhibit aggressive, immature, delinquent They very often exhibit aggressive, immature, delinquent behavior and have feelings of anxiety / depressionbehavior and have feelings of anxiety / depression

3.3. They have severe limitations in school work / activities with They have severe limitations in school work / activities with friends as a result of their emotional / behavioral friends as a result of their emotional / behavioral problemsproblems

4.4. They have lots of limitations in their physical activities, They have lots of limitations in their physical activities, including self-care; and in doing school work / activities including self-care; and in doing school work / activities with friendswith friends

5.5. Their problems have significant impact on parents’ Their problems have significant impact on parents’ emotional health / personal time; and also very often limit / emotional health / personal time; and also very often limit / interrupt activities or generate tension for entire family interrupt activities or generate tension for entire family

Co-morbid ADHD worsens QOLCo-morbid ADHD worsens QOL

““SpLD with ADHDSpLD with ADHD” children:” children: more often exhibit aggressive, immature, delinquent more often exhibit aggressive, immature, delinquent

behaviorbehavior

are more dissatisfied with their abilities, family and are more dissatisfied with their abilities, family and peer relationships, and their overall lifepeer relationships, and their overall life

their problems have a significant impact on their their problems have a significant impact on their parent’s emotional health and personal timeparent’s emotional health and personal time

have significantly lower psychosocial summary scores,have significantly lower psychosocial summary scores,indicating clinically and socially relevant decreasedindicating clinically and socially relevant decreasedpsychosocial well-beingpsychosocial well-being

How To Improve SpLD Children’s QOL?How To Improve SpLD Children’s QOL?

• ““The The onlyonly disability in life is a bad attitude” disability in life is a bad attitude” Scott HamiltonScott Hamilton

• ““Nothing diminishes anxiety faster than Nothing diminishes anxiety faster than actionaction””Walter AndersonWalter Anderson

• ““There is no elevator to success. You There is no elevator to success. You have tohave to take the take the stairs”stairs”

AnonymousAnonymous

Key MessagesKey Messages

Early diagnosis importantEarly diagnosis important

Pediatricians should enquire about Pediatricians should enquire about poor schoolpoor school performanceperformance whenever they come across any child whenever they come across any child having behavioral problems, speech problems, anxiety having behavioral problems, speech problems, anxiety problems, depressive thoughts, or chronic allergiesproblems, depressive thoughts, or chronic allergies

Important to Important to treat co-morbid ADHDtreat co-morbid ADHD to improve to improve psychosocial health of these childrenpsychosocial health of these children

First-born SpLD child: experiences a lot more stress at First-born SpLD child: experiences a lot more stress at home ? due to parental expectations for good school home ? due to parental expectations for good school gradesgrades

Maternal Anxieties At DiagnosisMaternal Anxieties At Diagnosis

• AimAim: To measure levels of anxiety and find out cause of : To measure levels of anxiety and find out cause of anxiety in mothers of SpLD children at time of diagnosisanxiety in mothers of SpLD children at time of diagnosis

• 100 mothers of SpLD children (70 boys, 30 girls) 100 mothers of SpLD children (70 boys, 30 girls) interviewed using Hamilton anxiety rating scale interviewed using Hamilton anxiety rating scale and a semi-structured questionnaireand a semi-structured questionnaire

• Their mean total anxiety score 5.65 (±SD 4.75, Their mean total anxiety score 5.65 (±SD 4.75, rr 0-21); 0-21); mean psychic anxiety score 3.92 (±SD 3.11, mean psychic anxiety score 3.92 (±SD 3.11, rr 0-13); & 0-13); & mean somatic anxiety score 1.76 (±SD 2.05, mean somatic anxiety score 1.76 (±SD 2.05, rr 0-10) 0-10)

• Levels of anxiety absent in 24%, mild in 75%, and Levels of anxiety absent in 24%, mild in 75%, and moderate in 1% of mothersmoderate in 1% of mothers

• Mean age of children 12.01 ± SD 2.32

• Their common worriescommon worries were related to: child’s poor school performance (95%) child’s future (90%) child’s behavior (51%) visits to LD clinic (31%)

• MostMost mothers of SpLD children have already developed mild anxiety levels by the time this hidden disability is diagnosed

• These anxieties should be addressed by counseling to ensure optimum rehabilitation of these children

Key MessagesKey Messages

• Counsel mothers in Counsel mothers in depthdepth over a few sessions over a few sessions

• Allay anxieties about child’s future by informing that Allay anxieties about child’s future by informing that school performance will school performance will improveimprove with remedial with remedial education and provisions / accommodationseducation and provisions / accommodations

• Advice mothers about Advice mothers about parenting techniquesparenting techniques to to prevent / lessen behavioral problemsprevent / lessen behavioral problems

• Reassure mothers that co-morbid ADHD eminently Reassure mothers that co-morbid ADHD eminently treatabletreatable by behavioral therapy / medications by behavioral therapy / medications

• Inform mothers that assessment is done by a team of Inform mothers that assessment is done by a team of professionals and professionals and multiple visitsmultiple visits are necessary are necessary

QOL of Parents of SpLD ChildrenQOL of Parents of SpLD Children

Aims of studyAims of study::

i.i. to analyze QOL of parents having a child with newly to analyze QOL of parents having a child with newly

diagnosed SpLDdiagnosed SpLD

ii.ii. to evaluate impact of clinical and socio-demographic to evaluate impact of clinical and socio-demographic

characteristics on their QOLcharacteristics on their QOL

• June 2006 to February 2007June 2006 to February 2007

• Consecutive 150 parents (either mother or father) Consecutive 150 parents (either mother or father) enrolled (power of analysis of study > 95%)enrolled (power of analysis of study > 95%)

• Parent’s QOL was measured by WHOQOL-100 instrumentParent’s QOL was measured by WHOQOL-100 instrument

• WHOQOL-100 has 25 facets of QOL organized in 6WHOQOL-100 has 25 facets of QOL organized in 6domainsdomains

• 2-week recall period2-week recall period

• WHOQOL-100 extensively validatedWHOQOL-100 extensively validated

• Can be used in any country where parents can read and Can be used in any country where parents can read and understand Englishunderstand English

WHOQOL-100: 6 domains of healthWHOQOL-100: 6 domains of health

1.1. PhysicalPhysical

2.2. PsychologicalPsychological

3.3. Level of independenceLevel of independence

4.4. Social relationshipsSocial relationships

5.5. EnvironmentEnvironment

6.6. SpiritualSpiritual

& & Overall quality of life and general health (Overall)Overall quality of life and general health (Overall)

Analysis of dataAnalysis of data

• Data analyzed using SPSS 11.0 versionData analyzed using SPSS 11.0 version • WHOQOL-100 mean scores (±SD) for study parents WHOQOL-100 mean scores (±SD) for study parents

computed using SPSS syntax computed using SPSS syntax

• Independent samples t-test or ANOVA test used to Independent samples t-test or ANOVA test used to evaluate impact of clinical and socio-demographic evaluate impact of clinical and socio-demographic variables on scores of significant WHOQOL-100 domains variables on scores of significant WHOQOL-100 domains and facetsand facets

• WHOQOL-100 pilot study: mean “overall” facet score WHOQOL-100 pilot study: mean “overall” facet score 6060

• Accordingly, each “significant” WHOQOL-100 domain Accordingly, each “significant” WHOQOL-100 domain and facet score dichotomized into:and facet score dichotomized into:

i.i. good QOL (score of >60)good QOL (score of >60), , or ii.ii. poor QOL (score of ≤60)poor QOL (score of ≤60)

• Multiple regression analysis performed for determining Multiple regression analysis performed for determining ““independent” impact that each clinical and socio- independent” impact that each clinical and socio-

demographic variable had on a poor QOL score of ≤60demographic variable had on a poor QOL score of ≤60

Results of StudyResults of Study

• Mean age of parents 42.6 yrs (±SD 5.5, Mean age of parents 42.6 yrs (±SD 5.5, rr 30.12-66.03) 30.12-66.03)

• Mothers to Fathers ratio 1.3:1Mothers to Fathers ratio 1.3:1

• 142 were currently married142 were currently married

• 19 (12.7%) parents were “currently ill”19 (12.7%) parents were “currently ill”

• Parents of SpLD children regard four domains Parents of SpLD children regard four domains (psychological > environment > social relationships > (psychological > environment > social relationships > spiritual)spiritual) as significant contributors to “ as significant contributors to “overall QOLoverall QOL””

• Spiritual domain least contributory and that too in a Spiritual domain least contributory and that too in a negative way negative way

Table: Multiple regression model using overall QOL facet as dependent variable & domains as Table: Multiple regression model using overall QOL facet as dependent variable & domains as predictor variablespredictor variables

ModelModel CoefficientsCoefficients

BB SESE ββ PP value* value* 95% CI for B95% CI for B

(Constant)(Constant) -0.470-0.470 5.85.8 -- 0.9330.933 -11.498 – 10.559-11.498 – 10.559

I PhysicalI Physical 0.0220.022 0.10.1 0.0200.020 0.7750.775 -0.131 – 0.175-0.131 – 0.175

II PsychologicalII Psychological 0.6410.641 0.10.1 0.4920.492 <0.001<0.001 0.420 – 0.8630.420 – 0.863

III IndependenceIII Independence -0.123-0.123 0.10.1 -0.094-0.094 0.2420.242 -0.330 – 0.084-0.330 – 0.084

IV SocialIV Social 0.3230.323 0.10.1 0.2710.271 <0.001<0.001 0.156 – 0.4900.156 – 0.490

V EnvironmentV Environment 0.3910.391 0.10.1 0.2880.288 <0.001<0.001 0.189 – 0.5930.189 – 0.593

VI SpiritualVI Spiritual -0.176-0.176 0.10.1 -0.165-0.165 0.0060.006 -0.300 – -0.051-0.300 – -0.051

B - Regression coefficient; SE - Standard error; β – Standardized coefficient; CI - Confidence interval; B - Regression coefficient; SE - Standard error; β – Standardized coefficient; CI - Confidence interval; Adjusted R Square = 0.635; *Adjusted R Square = 0.635; *PP<0.05 significant (two-tailed)<0.05 significant (two-tailed)

Multivariate analysis resultsMultivariate analysis results

• Being a Being a mothermother is an independent predictor of “poor”is an independent predictor of “poor”psychological and social relationships domain scorespsychological and social relationships domain scores

• Being Being currently illcurrently ill is an independent predictor of a is an independent predictor of a ““poor” social relationships domain scorepoor” social relationships domain score

Results of StudyResults of Study

• Five WHOQOL-100 Five WHOQOL-100 facetsfacets contributed significantly to their contributed significantly to their ‘overall QOL’‘overall QOL’

• (leisur > pfeel > energy > esteem > sex)(leisur > pfeel > energy > esteem > sex)

DomainDomain Facet (abbreviation)Facet (abbreviation)

EnvironmentEnvironment Participation in and opportunities for recreation/ leisure activities (leisurleisur)

PsychologicalPsychological Positive feelings (Positive feelings (pfeelpfeel))

PhysicalPhysical Energy and fatigue (Energy and fatigue (energyenergy))

PsychologicalPsychological Self-esteem (Self-esteem (esteemesteem))

Social Social RelationshipsRelationships

Sexual activity (Sexual activity (sexsex))

Table: Multiple regression model using overall QOL facet as dependent variable & facets as Table: Multiple regression model using overall QOL facet as dependent variable & facets as predictor variablespredictor variables

ModelModel CoefficientsCoefficients

BB SESE ββ PP value* value* 95% CI for B95% CI for B

(Constant)(Constant) -9.708 9.19.1 -- 0.287 -27.673 – 8.256-27.673 – 8.256

leisurleisur 0.319 0.10.1 0.320 <0.001<0.001 0.195 – 0.444

pfeelpfeel 0.2960.296 0.10.1 0.262 <0.001<0.001 0.140 – 0.453

energyenergy 0.203 0.10.1 0.226 0.0010.001 0.089 – 0.318

esteemesteem 0.193 0.10.1 0.209 0.0090.009 0.049 – 0.336

sexsex 0.147 0.10.1 0.159 0.0160.016 0.028 – 0.266

B - Regression coefficient; SE - Standard error; β – Standardized coefficient; CI - Confidence interval; B - Regression coefficient; SE - Standard error; β – Standardized coefficient; CI - Confidence interval; Adjusted R Square = 0.635; *Adjusted R Square = 0.635; *PP<0.05 significant (two-tailed)<0.05 significant (two-tailed)

Multivariate analysis resultsMultivariate analysis results

• Being Being currently illcurrently ill is an independent predictor of “poor” is an independent predictor of “poor” leisur and energy facet scoresleisur and energy facet scores

• Being Being in paid workin paid work is another independent predictor of a is another independent predictor of a ““poor” leisur facet scorepoor” leisur facet score

• Being a Being a mothermother is an independent predictor of “poor” pfeel is an independent predictor of “poor” pfeel and energy facet scoresand energy facet scores

• Child being Child being malemale is an independent predictor of “poor” is an independent predictor of “poor” energy facet scoreenergy facet score

Information Study AddsInformation Study Adds

• Identifies domains / facets that need to be addressed by Identifies domains / facets that need to be addressed by counselors right at the time SpLD is diagnosed for counselors right at the time SpLD is diagnosed for improving ‘overall QOL’ of parentsimproving ‘overall QOL’ of parents

• For exampleFor example:: MothersMothers in particular have significantly poor psychological in particular have significantly poor psychological

health and social relationshipshealth and social relationships ParentsParents who are currently ill have significantly poor social who are currently ill have significantly poor social

relationshipsrelationships

• CounselorsCounselors should spend more time and have follow up should spend more time and have follow up visits especially for all mothers in general and for parents visits especially for all mothers in general and for parents who are ill who are ill

Information Study AddsInformation Study Adds

• For exampleFor example:: ParentsParents who are working or currently ill get significantly who are working or currently ill get significantly

less opportunities for recreation and leisure activitiesless opportunities for recreation and leisure activities

• CounselorsCounselors should therefore advice such parents to make should therefore advice such parents to make efforts to keep time aside each week for such activitiesefforts to keep time aside each week for such activities

Information Study AddsInformation Study Adds

• For exampleFor example:: Mothers Mothers experience experience significantlysignificantly less feelings of less feelings of

contentment and have a negative view of the future, have contentment and have a negative view of the future, have less energy, enthusiasm, endurance to perform necessary less energy, enthusiasm, endurance to perform necessary tasks of daily livingtasks of daily living

ParentsParents who are currently ill and parents having a male who are currently ill and parents having a male SpLD child have less energy, enthusiasm, endurance to SpLD child have less energy, enthusiasm, endurance to perform necessary tasks of daily livingperform necessary tasks of daily living

• Apart from counseling sessions, such mothers / parents Apart from counseling sessions, such mothers / parents may benefit by doing regular may benefit by doing regular ‘yoga’ exercises‘yoga’ exercises or other or other relaxation techniquesrelaxation techniques

Key MessageKey Message

• Important to improve QOL of parentsImportant to improve QOL of parents

• Improving QOL of parents would eventually improve home Improving QOL of parents would eventually improve home

environment and help rehabilitation of SpLD childrenenvironment and help rehabilitation of SpLD children

Thank YouThank YouFor Your AttentionFor Your Attention