The Relationship Between the Role of Parents and Self-Esteem to Acceptance Parents with Mentally Retarded Children in Extraordinary School BF Mandara Kendari Indonesia

Sri Wahyuni1* Anisa Purnamasari2, Faridah Mohd Said1, Nisha Nambiar1, Komeyni Rusba3

1Lincoln University College, Wisma Lincoln, No. 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor Darul Ehsan, Malaysia

2Faculty of Health Sciences, Mandala Waluya University, Kendari, 93561 Southeast Sulawesi, Indonesia

3Faculty of Occupational Health and Safety, Balikpapan University, 76114 East Kalimantan, Indonesia

*Corresponding Author’s Email: sriwahyuni.phd83@gmail.com

ABSTRACT

Introduction: Children and adolescents with intellectual disabilities have a higher prevalence (18.30/1000) than adults (4.94/1000). Furthermore, it is estimated that around 1% of children between the ages of 3 and 10 are affected by intellectual disability worldwide. The purpose of this study was to determine the relationship between therole of parents and self-esteem towards the acceptance of parents with mentally retarded children at the extraordinary school in Mandara Kendari, Indonesia. Methods: The research method uses quantitative research with a cross-sectional design. The population of all parents of children with mental retardation is 340. The research sample consists of 184 respondents. Data analysis using chi-square analysis. Results: Based on the chi-square test, there were 79 respondents (42.9%) in the category of good parental roles and 105 respondents in the poor parental role category, while in the class of parents with good self-esteem, there were 67 respondents (36.5%) and in the type of low self-esteem, there were 117 respondents. With a 95% confidence interval of 0.05, the result is a p-value of 0.05. Conclusion: The conclusion is that the role of parents and self-esteem have a relationship with the acceptance of parents with mentally retarded children at BF Mandara Kendari Extraordinary School, Indonesia.

Keywords: Intellectual Disability; Children; Mental Retardation; Nursing; Parental Acceptance; Self-Esteem

INTRODUCTION

Mental retardation, also known as intellectual disability, is described as a symptom that includes severe deficits or limitations in individual developmental skills in several areas or domains of function: cognitive, language, motor, hearing, language, psychosocial, moral judgment, and specific integrative adaptive (daily activities) (American Psychiatric Association, 2013). Parents crave having children who are physically and mentally healthy. But in reality, thechildren who are born are not always as expected. Parents who have mentally retarded children are in a difficult situation. This is due to the attitude of society, which makes parents feel ashamed because their child is not like other children. Parents' self-concept will then experience disturbances as a result of having a child with mental retardation (Hidayat et al., 2021). Mental retardation, according to the Diagnostic and Statistical Manual IV-TR (DSM IV-TR), is a disorder characterized by intellectual functioning accompanied by deficits in adaptive functioning in at least two areas: communication ability, self-care, fulfillment of life's necessities, social and interpersonal skills, use of community resources, independence, academic functioning ability, work, free time, and health.

The population of children and adolescents with intellectual disabilities has a higher prevalence (18.30/1000) than the adult population (4.94/1000) (Maulik et al., 2011). Furthermore, it is estimated that around 1% of children between the ages of 3 and 10 are affected by intellectual disability worldwide (Muna et al., 2022). According to WHO statistics, it is estimated that 12% of intellectual disabilities are found in developing countries. In developing countries, the population of children with mental retardation is the largest compared to the number of children with other disabilities. Of the 220 million Indonesians, as many as 3%, or 6.6 million people, are mentally retarded.

In Indonesia, the number of mentally retarded people is quite high, reaching 6.6 million people, or 3% of the total population of around 220 million people, in 2009, then increasing to 7.1 million people, or 4.1% (Departemen Sosial Republik Indonesia, 2016). In Southeast Sulawesi, the number of people with mental retardation continues to grow every year. Based on datafrom the Southeast Sulawesi Provincial Social Service in 2015, the number of mentally retarded children in Southeast Sulawesi was 956 (32.56%), with the most cases in Konawe Regency (30.01%), followed by Kendari City (Buton Regency (21.1%), Muna Regency (17.2%), and Wakatobi Regency (8.84%). Meanwhile, in 2022, there will be 340 mentally retarded students at the BF Extraordinary School (SLB) in Southeast Sulawesi (Public Health Office, 2022).

Intellectual disability is associated with multicausal risk factors, including genetic and nongenetic causes. However, in some cases, the etiology is unknown. Genetic factors such as chromosomal abnormalities, inherited genetic traits, and single-gene disorders are the main causes, accounting for 30% to 50% of all cases of intellectual disability. Nongenetic causes consist of prenatal, perinatal, postnatal, and environmental factors (Nemerimana et al., 2018). Parents encounter notable challenges when it comes to discerning the cognitive and emotional manifestations of anxiety in children and adolescents who have intellectual disabilities (Fynn, Porter, & Pellicano, 2023). The process of parent’s adaptation to their children's mental retardation will experience several stages in their acceptance of their children. Parents' self- concept is very influential at each stage. The parents' reaction that first appeared when they found out that their child had a disorder was a feeling of shock, experiencing inner shock, being shocked, and not believing the reality that had befallen their child. The public's negative response to mentally retarded children creates a reaction in parents; the pride of parents is the reason for isolating their children or not wanting to acknowledge their children's existence. Parents' self-concept is also disturbed as a result of having a child with mental retardation (Hidayat et al., 2021).

Mental retardation in children is a complex condition that significantly impacts their cognitive, social, and adaptive functioning. Nursing care for children with mental retardation requires a multidimensional approach, focusing on both the physical and emotional well-being of the child. Nurses play a crucial role in assessing the specific needs of each child, designing individualized care plans, and providing supportive interventions to promote optimal development and quality of life. They collaborate closely with the interdisciplinary team, including psychologists, educators, and caregivers, to create a nurturing and inclusive environment that fosters the child's overall growth and development. Additionally, nurses provide guidance and education to the families, empowering them to effectively manage the challenges associated with caring for a child with mental retardation while also promoting acceptance and understanding within the community (Wahyuni et al., 2022).

The purpose of this study was to determine the relationship between the role of parents and self-esteem in the acceptance of parents with mentally retarded children at BF Mandara Kendari in Extraordinary School, Indonesia.

METHODOLOGY

This type of research uses quantitative research with a cross-sectional design. The population in this study was all parents of children with mental retardation at Extraordinary School BF Mandara, totaling 340 respondents. The research sample consists of 184 respondents. The inclusion criteria in this research were as follows: (a) parents of children are willing to be respondents; (b) have a child with mental retardation status in a BF Mandara extraordinary school; and (c) have no fewer than two limitations in ADLs or equivalent. The research instrument used was a questionnaire. Data analysis using chi-square analysis. The analysis carried out in this study, namely univariate analysis, was conducted to describe each variable, namely parental roles and self-esteem (independent variable) and acceptance of parents with children with mental retardation (dependent variable), which were tabulated for frequency distribution (Islaeli et al., 2020). While the bivariate analysis was used to determine the relationship between the role of parents and self-esteem towards the acceptance of parents with children with mental retardation at BF Mandara Extraordinary School Kendari.

Ethical Consideration

This research received ethical approval from the Research Ethics Committee of Mandala Waluya University, Indonesia with Reference No. 031/KEP/UMW/VI/2022 dated June 6th, 2022.

RESULTS

1. Respondent Characteristics

   Table 1: Distribution of Respondents by Gender, Age, and Education Level

   
   

   Gender	Total (n)	Percentage (%)
   Male	70	38.05

   Female	114	61.95
   Age
   25-40 years	122	66.3
   41-55 years	62	33.7
   Education
   Junior High School	10	5.4
   Senior High School	83	45.1
   College	91	49.5
   Total	184	100

   
   

   
   

   Table 1 shows that of the 184 respondents, the highest number was based on gender, namely women compared to men: 114 female respondents (61.95%) and 70 male respondents (38.05%). Based on age, of the 184 respondents, the highest number were aged 25–40 years, amounting to 122 people (66.3%), and aged 41–55 years, amounting to 62 people (33.7%), and based on education, of the 184 respondents, the highest number was based on education, namely 91 people from college (91%), 83 people from high school (45.1%), and the lowest number of respondents, 10 people (5.4%).

   
   

2. Univariate Analysis The Role of Parents

   The number of respondents based on the role of parents is divided into 2 categories, as seen in Table 2 below:

   
   Table 2: Distribution of Respondents: Variable Role of Parents

   
   

   No	The role of parents	Total (n)	Percentage (%)
   1	Well	79	42.9
   2	Not Enough	105	57.1
   Total		184	100

   
   

   Table 2 shows that of the 184 respondents, the highest number were based on the role of parents, namely 79 people (42.9%) who were good and 105 people (57.1%) who were lacking.

   
   

   Self-esteem

   The number of respondents based on self-esteem is divided into several categories. That is seen in the following table:

   
   Table 3: Distribution of Respondent's Variable Self-esteem

   
   

   No	Pride	Total (n)	Percentage (%)
   1	Well	67	36.5
   2	Not Enough	117	63.5
   Total		184	100

   
   

   Table 3 shows that of the 184 respondents, the highest number is based on self-esteem, namely 67 people (36.5%) are good and 117 people (63.5%) are poor.

   
   

   Parental Acceptance

   The number of respondents based on parental acceptance is divided into several categories. That is seen in the following table:

   
   Table 4: Distribution of Respondent's Variable Parents' Acceptance

   
   

   No	Parental Acceptance	Total (n)	Percentage (%)
   1	Well	89	48.4
   2	Not Enough	95	51.6
   Total		184	100

   
   

   Table 4 shows that of the 184 respondents, the highest number of respondents was based on parental acceptance, namely 89 people (48.4%) were good and 95 people (51.6%) were poor.

3. Bivariate Analysis

Table 5: The Relationship between the Role of Parents and the Acceptance of Parents and Children with Mental Retardation at BF Mandara Kendari, Indonesia

Based on the table above, it can be seen that 79 respondents (42.9%) have good parental roles, consisting of 38 respondents (21.1%) with good category acceptance and 41 people (21.8%) in the poor category, while the poor role category totals 105 respondents, consisting of 51 respondents (27.3%) with good category acceptance and 54 people (29.8%) in the less category.

Table 6: The Relationship between Self-Esteem and Acceptance of Parents and Children with Mental Retardation at BF Mandara Kendari, Indonesia

Based on the table above, it can be seen that among respondents who have good self-esteem, 67 respondents (36.5%) consisting of 28 respondents (11.4%) have good category acceptance and 39 people (25.1%) are in the poor category, while the self-esteem category is lacking, totalling 117 respondents consisting of 61 respondents (37%) who have good category acceptance and 56 people (26.5%) are in the less category.

DISCUSSION

A role is a set of patterns of behavior, values, and goals expected by society associated with individual functions in social groups. Everyone is occupied by several roles related to their position at each time throughout the life cycle. High self-esteem is the result of a role that fulfills needs and fits the ideal self. Many factors do not depend on either the role, behavior, or development of the child, so they are associated with a low or high mother's response. For example, low maternal education correlates strongly with low maternal responsiveness, and high maternal education correlates with high responsiveness in caring for children with special needs (Bilqis Wuraola et al., 2023). Acceptance makes parents aware of the child's condition as it is, as well as paying attention to the child's growth and development, so parents will feel comfortable with the child's presence without showing excessive parenting and not rejecting children, even though in their development they are very dependent on their parents (Sansuwito et al., 2023). So, guiding and educating children in their daily lives, is crucial for parents to carefully determine the parenting styles they employ, particularly when dealing with children who have intellectual disabilities. Inappropriate parenting approaches can exacerbate the challenges these children face and have a detrimental impact on their psychological development (Muna et al., 2022).

The results of other studies show that the description of the self-concept of parents with children with mental retardation is mostly in the poor category of self-concept. The results of this study explain that families still treat children like normal children in general; families always encourage children, care for children with love, and provide opportunities for children to enjoy everyday life, as well as acceptance by parents who still feel proud and happy to be parents. Even though they have children with mental retardation, parents still try to be the best for their children (Hidayat et al., 2021). Meanwhile, the self-esteem of parents with mentally retarded children is related to their acceptance of their children. Parents who feel insecure, depressed, and ostracized by society because of the perception that their child's disorder is a curse of their parents' mistakes will experience a decrease in self-confidence in social relations and will not accept the child's condition as usual (Sansuwito et al., 2023). Numerous studies corroborate that there is a substantial correlation between a mother's educational attainment and parenting self-efficacy. Parenting self-efficacy refers to parents' belief in their capacity to positively impact their children's behavior and development. When parents have confidence in their ability to nurture and guide their children, it is anticipated that the child development process will likewise result in positive outcomes (Pratiwi et al., 2023).

However, despite this, little has changed in the family situation of those raising children with disabilities. According to one study, it is mothers who bear the burden of responsibility for household chores and are the ones who care for most children with disabilities. In nearly 72% of families, this responsibility rests with the woman, while both parents share this responsibility in 27.5% of families. Families of persons with disabilities are also usually forced to bear the costs of diagnosis, treatment, and rehabilitation (99.2%). All of this greatly lowers material status and forces family members to make sacrifices and yield. This is increasingly burdening parents, so the acceptance of children with intellectual disabilities is decreasing (Niedbalski, 2022).

Children with intellectual disabilities are more vulnerable to physical or mental disorders (Sappok et al., 2022), so the level of understanding of parents about the needs of children with mental retardation is very important, which will determine the level of acceptance of parents in caring for children who have mental retardation (Lloyd et al., 2022). One of the tasks of parents that must be achieved by children with mental retardation is independence. The independence that must be taught to children, especially those with special needs, is the ability to do daily activities without the help of others. However, teaching independence is not easy, especially for children with special needs such as mental retardation, so good parental acceptance of their children is very necessary (Wahyuni et al., 2022).

Families with mentally retarded children have experienced many difficulties in daily life adjusting to the demands of society, so the role of parents greatly influences the next child's life (Purnamasari et al., 2020). Thus, the researchers assume that the role of parents with children with mental retardation is closely related to their acceptance of the child. Parents will play a good role in raising mentally retarded children if they can accept the child's presence well and if there is no difference from other normal children.

The role of parents is crucial in the comprehensive care of children with mental retardation, particularly in the context of nursing care provided by pediatric nurses. Parents serve as primary caregivers, actively participating in the planning and implementation of their child's nursing care. They collaborate closely with pediatric nurses to comprehend the specific health needs and requirements of their child, ensuring effective adherence to medical regimens and therapies at home. Additionally, parents contribute significantly to the emotional support and well-being of their child, fostering a nurturing and stable environment that complements the nursing interventions provided. Through open communication and active involvement in their child's healthcare journey, parents facilitate a seamless continuum of care, promoting the child's overall development and ensuring the successful implementation of the nursing care plan.

CONCLUSION

Based on this study, it can be concluded that the role of parents and self-esteem have a relationship with the acceptance of parents with mentally retarded children at BF Mandara Kendari Extraordinary School, Indonesia. Further research is needed to confirm and elaborate on the findings of this study. Research related to the acceptance of parents with children with mental retardation of this kind is also needed to also use qualitative methods to gain access to the understanding of parents and even children with mental retardation themselves regarding their social behavior.

Conflict of Interest

The authors declare that they have no conflict of interests.

ACKNOWLEDGMENT

The authors are thankful to all respondents for giving their valuable time for this research and to Lincoln University College for their academic support.

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