Carers expressed emotion, appraisal of behavioural problems and stress in children attending schools for learning disabilities

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. Carersʹ beliefs and behaviour could affect how they appraise and cope with their childʹs behaviour. Furthermore, the perceived adequacy of social support can also be an important factor in determining the familyʹs level of stress. The study investigates the relationship between EE variables and carersʹ appraisal and coping with the childʹs 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. Carersʹ EE status was determined by a rater blind to the carersʹ questionnaires scores. Results There was no difference between high and low EE groups in the descriptive information of the childʹs independence, communication skills, or the frequency of behavioural problems. However, high EE carers appraised more of their childrenʹs 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 carersʹ EE, psychological well-being, appraisal of their childrenʹs behaviour, their childrenʹs 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.