A Comparison of Time Use between Mothers of ... - SAGE Journals

A Comparison of Time Use Between Mothers of Children With and Without Disabilities Deborah Gevir, Sarina Goldstand, Naomi Weintraub, Shula Parush Key words: time use, occupations, children with disabilities ABSTRACT This study compared time use, perceptions regarding the meaningfulness and enjoyment of occupations, and perceptions of ability to balance time use between mothers of children with mental retardation (n = 29), motor difficulties (n = 30), attention-deficit hyperactivity disorder (n = 30), and typical development (n = 31). No significant differences were found between groups in the amount of time spent in various occupations (i.e., activities with their children, home maintenance, leisure, rest and sleep, and work), in their perceptions of meaningfulness and enjoyment of the occupations performed, or in their perceived ability to balance time use. However, mothers who were frequently helped by external caregivers reported significantly more enjoyment from “activities with their children” and “home maintenance,” and significantly less meaning from “rest and sleep” than those who did not. Moreover, mothers who reported that they received frequent help derived more satisfaction from their ability to balance time. These results highlight the importance of mothers’ receiving assistance to how they perceive their daily occupations and their ability to balance time, factors that positively affect maternal and family well-being.

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t has been suggested that the use of time can be an indicator of an individual’s quality of life (Pentland, Harvey, & Walker, 1998). Adolf Meyer alluded to the importance of time use through participation in life’s occupations, advocating that healthy performance be defined as the use of time in an organized, purposeful, and satisfactory action (Meyer, 1922). Furthermore, for participation to be meaningful, Law (2002) suggested that a need exists for both satisfaction and individually determined balance in the daily constellation of occupations. Therefore, given current conceptualizations relating the meaningfulness of participation to the individual’s health and well-being, the manner in which one uses and organizes time is of significant importance to occupational therapists (Backman, 2001).

The current study was designed to survey and compare the use of time, as well as the perceived enjoyment and meaningfulness of occupations performed, between mothers of children with and without disabilities. The satisfaction they derived from their ability to balance time use was also investigated. Individuals with too many role demands and limited time resources may perceive that they are unable to organize their use of time effectively and may experience what Mosey described as temporal dysfunction (1996). Temporal dysfunction may occur in people experiencing changes in social roles, physically disabling conditions, and psychosocial dysfunction (Mosey, 1996). Furthermore, studies have found that people who care for one or more de-

Deborah Gevir, MSc, OTR, BA, Sp Ed, is Pediatric Occupational Therapist and Student Supervisor, School of Occupational Therapy, Hebrew University, Jerusalem, Israel. Sarina Goldstand, MSc, OTR, is Pediatric Occupational Therapist and Staff Member, School of Occupational Therapy, Hebrew University, Jerusalem, Israel. Naomi Weintraub, PhD, OTR, is Assistant Head, School of Occupational Therapy, Hebrew University, Jerusalem, Israel. Shula Parush, PhD, OTR, is Head, Graduate Department, School of Occupational Therapy, Hebrew University, Jerusalem, Israel. Address correspondence to Shula Parush at [email protected].

Summer 2006, Volume 26, Number 3

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pendents, such as children, adults with disabilities, and the elderly, may be subjected to demands on their use of time that preclude their participation in valued and discretionary activities, and may result in temporal imbalance (Donovan, VanLeit, Crowe, & Keefe, 2005; Helitzer, Cunningham-Sabo, VanLeit, & Crowe, 2002; Chapman, Ingersoll-Dayton, & Neal, 1992). Mothering has been viewed as a pivotal occupation for many women that is both time- and energy-intensive (Helitzer et al., 2002; Olson & Esdaile, 2000; VanLeit & Crowe, 2002). Results of studies have indicated that the demands of mothering are even greater for mothers who care for children with disabilities (Eiser, 1993). Some believe that not only do these mothers need to spend more time in caregiving and home maintenance activities than do mothers of typical children, but that these additional demands may impose time constraints that affect their ability to participate in other discretionary occupations (Donovan et al., 2005; Helitzer et al., 2002; Henry, Costa, Ladd, Robertson, Rollins, & Roy, 1996; VanLeit & Crowe, 2002). For example, Johnson and Deitz (1985) showed that mothers of preschoolers with physical disabilities required significantly more time for childcare activities such as feeding, personal care, and transportation for physical care than did mothers of typical preschoolers. Similarly, Crowe (1993) found that mothers of children with multiple disabilities spent significantly more time performing childcare activities than mothers of children with Down’s syndrome or mothers of typically developing children. In addition, her results indicated that mothers of typically developing children were involved in more socialization activities than the mothers of children with disabilities (Crowe, 1993). Research has also indicated that mothers of typically developing children spend significantly more time on leisure, self-care, social activities, and furthering their education than do mothers of children with attention-deficit hyperactivity disorder (ADHD) (Magnezi & Parush, 2002). Thus, results of research have indicated that when a mother is faced with the additional role of parenting a child with special needs, time use and time use strategies are affected (Crowe, 1993; Crowe, VanLeit, & Berghmans, 2000; Crowe, VanLeit, Berghmans, & Mann, 1997; Helitzer et al., 2002; Kellegrew, 2000; Magnezi & Parush, 2002; McGuire, Crowe, Law, & VanLeit, 2004; Segal, 2000). However, Crowe (1993) cautioned against the tendency to automatically compare studies measuring time use, because data collection techniques and sample characteristics often vary. Moreover, as

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stated by Johnson and Deitz (1985), the consistency between study findings has not been universally demonstrated. For example, in contrast to other researchers, Breslau (1983) found that although mothers of children with disabilities spent significantly more time doing housework than mothers of typical children, no significant differences existed between them in the amount of time spent on child care. Furthermore, results of a study by Saddler, Hillman, and Benjamins (1993) revealed that families of children with disabilities perceived that it was no more difficult for them to adapt their overall family routines than did families with typically developing children. Therefore, given occupational therapists’ interest in understanding patterns of participation across time and occupations, it seems appropriate that more in-depth research be performed (Binderman, 2003; Dyck, 1992; Law, 2002). Some authors have emphasized that a comprehensive understanding of time use should include consideration of the meaningfulness and enjoyment derived from participation in specific occupations (Covey, 1990; Covey, Merrill, & Merrill, 1994; Primeau, 1996). This sentiment is echoed by Law (2002), who recommends that when measuring participation through use of time one needs to also consider “the person’s preferences and interests and how much enjoyment and satisfaction he or she finds (in the occupations performed)” (p. 642). This seems especially relevant in the case of mothers of children with a disability, because the multiple responsibilities they bear may cause them more difficulty in managing a satisfying and balanced occupational routine than mothers of children without disabilities (Donovan et al., 2005; Helitzer et al., 2002; Tetreault, Weiss-Lanbrou, & Vezina, 1994). Furthermore, it has been suggested that the inability to organize daily routines so that they are sustainable, meaningful, and congruent with the individual needs of family members represents a significant problem for families of children with disabilities (Helitzer et al., 2002). Empirical research into the time use of mothers of children with and without disabilities has often included the investigation of the amount of time they spend in the various occupations they perform. However, more research is needed to integrate this data with information regarding mothers’ perceptions as to the meaningfulness, enjoyment, and satisfaction they derive from the activities they perform. Therefore, the current study was designed with the following research hypotheses in mind: 1. There will be significant differences in the amount of time spent performing various daily occupa-

OTJR: Occupation, Participation and Health

tions (activities with their children, home maintenance, work, leisure, and rest and sleep) between mothers of typically developing children and mothers of children with various disabilities during daytime hours of a typical day (i.e., between 5 a.m. and 12 a.m.). 2. There will be significant differences between mothers of typically developing children and mothers of children with various disabilities in the meaningfulness and enjoyment they derive from the occupations they perform. 3. There will be significant differences between mothers of typically developing children and mothers of children with various disabilities in their perceived satisfaction from their ability to balance their use of time. It is hoped that surveying mothers regarding their feelings with respect to their use of time, in addition to the actual amount of time mothers spend in performing different occupations, will provide important insights that can facilitate maternal and family well-being (VanLeit & Crowe, 2002).

Method

Participants A convenience sample of 174 mothers was initially recruited for this study. The mothers of children with disabilities were recruited by occupational therapists and physiotherapists from community treatment centers and special education schools throughout the country. The therapists then asked those mothers to refer mothers of typically developing children from among their friends to the researchers. The mothers in the groups were matched according to the following demographic variables: mother’s country of origin (65% = Israeli, 25% = European American, and 10% = African Asian), education (M = 14.5 years, range = 12 to 16 years), employment status (M = 80% employed, mean days worked/week = 4.71), age (M = 36 years, range = 30 to 44 years), age of participant’s child (M = 6.25 years, range = 2 to 11 years), and total number of children in the family (M = 3.2, SD = 1.5). New immigrants to the country were excluded based on the difficulty this would present in completing the study tools (which were in the Hebrew language). After this process was completed, 120 mothers of children were left to participate in this study. All came from two-parent households. The first group consisted of 30 mothers of children with ADHD. The second group consisted of 29 mothers of children with mild to moderate mental retardation. The third group consisted of 30 moth-


ers of children with severe motor disabilities. This group of children consisted of 26 children with cerebral palsy, three children with spina bifida, and one child with arthrogryposis. The last group consisted of 31 mothers of typically developing children. A pediatric neurologist and a psychologist had previously tested all of the children in the three disability groups. The children who had typical development had no record of psychomotor or social– emotional distress and had never been referred for neurological or psychological testing. Instruments For this study, the Mothers Time Use Questionnaire (MTUQ) (Magnezi & Parush, 2002) was used. This two-part questionnaire was developed to glean quantitative information regarding mothers’ time use and their perceptions of the meaningfulness and enjoyment of the occupations they performed. In the first part of the questionnaire, mothers were asked to record their activities during any typical weekday of their choice, from 5:00 a.m. until 12 a.m., in 1-hour units. This part of the questionnaire was based on The Occupational Questionnaire (Smith & Kielhofner, 1986). After completing this phase, the mothers were asked to classify each of their listed activities into one of the following five categories of occupation: “activities with their children,” “home maintenance,” “leisure,” “rest and sleep,” and “work.” According to the instructions of the questionnaire, the time spent performing enfolded activities (e.g., folding laundry while watching television) was to be classified as time spent in two different occupational categories. To support the consistency of responses, the instrument described the occupational categories as follows. Activities with their children referred to any activities that mothers performed together with their children, such as dressing them, feeding them, and reading with them. Leisure activities referred to activities that mothers performed for their own personal pleasure without their children, such as watching television and going out with friends. Home maintenance included any activity used to care for and maintain their households, such as cleaning and cooking. Work referred to paid or volunteer work not related to home activities. Five total scores were achieved by adding the number of hours spent on each of the five separate occupations within a 19-hour time period (from 5 a.m. to 12 a.m.). The decision to report weekday versus weekend time use was made based on the fact that a weekday best represents the multiple occupational commitments of mothers.

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In the second part of the questionnaire, mothers were requested to rate their perceptions of the meaningfulness and the enjoyment derived from the performance of activities in the five occupational areas. In addition, mothers were asked to rate their satisfaction with their ability to balance their time use. The mothers’ responses to each of these questions were scaled on a 4-point Likert scale, in which 1 represented the most positive response (i.e., most meaningful, most enjoyment, greatest ability vs. time use abilities) and 4 represented the least positive perception of these qualities. Results of the two questions regarding meaningfulness and enjoyment of occupations resulted in five single scores (one for each of the occupational areas), each of which corresponded to the value of the ratings on the Likert scale that were selected by the respondent. Mothers’ ratings of their satisfaction with their ability to balance their use of time received one total score. Mothers were also asked to respond to an additional question. They were asked to document the frequency of help that they received from external caregivers, including relatives, paid helpers, and volunteers. Responses to this question were also scaled on a 4-point Likert scale, in which 1 represented “always” and 4 represented “never.” The development of the MTUQ included the study of its psychometric properties. First was a qualitative evaluation procedure in which 10 mothers of children with and without disabilities judged the items of the questionnaire to be clear and the instructions for completing it understandable, even without the presence of an examiner, and the cultural relevance of the items. Next, content validity for the questionnaire was conducted by 20 expert clinicians including occupational therapists, physical therapists, and psychologists, according to a Table of Specifications (Benson & Clark, 1982). Items that were agreed on by at least 65% of the therapists as belonging to the same category of the questionnaire were retained. Test–retest reliability for the various sections of the MTUQ ranges from r = .78 to .89 (Magnezi & Parush, 2002). The Home Situations Questionnaire (Barkley, 1990) was used to determine whether mothers perceived their children as experiencing difficulties in their day-to-day functioning and, if so, how severe they perceived their children’s difficulties were. The questionnaire is composed of 16 statements, with two response options (i.e., yes/no) regarding whether the child has a problem. A 9-point scale is used for rating the degree of severity of the problem. This questionnaire has been found to be valid and reliable (Johnston, 1996), and has been normed for children aged 4 to 5, 6 to 8, and 9 to 12 years (Barkley

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& Edelbrock, 1987; Breen, 1986). In the current study, test–retest reliability was performed, with r = .893. Procedure The study was approved by the Ethics Committee of the Hebrew University and Hadassah Hospital Faculty of Medicine. Mothers who agreed to participate in the study were given a consent form to sign. In addition, each mother was given a questionnaire describing family characteristics, the Home Situations Questionnaire, and the MTUQ. The mothers were contacted by one of the authors approximately 1 week after receiving the questionnaires and reminded to complete them and mail them out. After filling out the questionnaires, they were returned to one of the authors in a pre-addressed, stamped envelope. Data Analysis To determine whether significant differences existed for the dependent variables (time spent, perceptions of meaningfulness, and enjoyment), between and within groups, a set of 2 3 2 analysis of variance procedures was employed. The four groups of mothers constituted the between-subjects factor and the five different occupations formed the within-subjects factor. A single analysis of variance (ANOVA) was used to analyze the differences between the four groups of mothers with respect to their perceived satisfaction from their ability to balance time use. Following this, secondary analysis was performed. The t test analyses were used to compare mothers’ perceptions of meaningfulness and enjoyment derived from occupations, and their reported satisfaction with their ability to balance time use, between participants who received frequent external caregiver assistance and those who did not. The data analysis was performed through the use of SPSS software, version 10 (SPSS, Inc., Chicago, IL). An alpha level of .05 was selected for all statistical tests in this study, and only probabilities of less than .05 were reported.

Results According to ANOVA analyses, results of both sections of the Home Situations Questionnaire revealed significant differences between the responses of mothers in the four groups with respect to the amount and severity of difficulties their children experienced in their day-to-day functioning (F(3,115) 7.117, p < .001; F(3,109), p < .0001, respectively). Scheffe analysis indicated that the source of these significant differences was between the responses of the moth-


Figure 1. Percentage of hours mothers spent performing activities in occupations categories (from 5 a.m. to 12 a.m. on a typical weekday).

ers of the typical children and those of mothers of children with disabilities. No significant differences were found between the responses of the three groups of mothers of children with disabilities. Quantitative Measure of Time Use in Each Occupational Area Figure 1 represents the relative amounts of time the group of mothers of typically developing children and the three groups of mothers of children with disabilities spent on the five occupations during a typical day. Multivariate analysis of variance (MANOVA) demonstrated no significant betweengroups effect, indicating that the mothers of children with various disabilities and those of typically developing children did not significantly differ from one another in the amount of time spent in performance of activities in any of the five occupational areas (F[3,74] = .16; not significant). In contrast, a significant within-group effect was found, indicating that within each of these groups, significantly different amounts of time were spent on the various occupations (F[4,71] = 48.24, p = .000). However, no signifiSummer 2006, Volume 26, Number 3

cant interaction effect was found, indicating that no significant differences were found in the distribution of time use between the study groups. Results indicated that among all groups of mothers, the greatest amount of time was spent at work, immediately followed by the occupation activities with their children. In contrast, the least amount of time for all mothers was spent on leisure activities (Fig. 1). Measures of Mothers’ Perceptions Regarding Qualitative Aspects of Time Use Meaningfulness of Occupations. Figure 2 represents the responses of the mothers in the various groups as to the meaningfulness of the five occupations measured. MANOVA analysis, performed to compare the responses of the mothers, indicated that no significant between-group effect was found with respect to the meaningfulness of the activities performed in the five occupational areas. In fact, as can be seen in Figure 2, the mean ratings for four of the five occupational areas were 2 or less (i.e., meaningfulness of leisure activities by mothers of children

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Figure 2. Meaningfulness of occupations. The lower the data bar, the more meaning was attributed by participants to performing this occupation, and vice versa. MR = Mothers of children with mental retardation; MD = Mothers of children with motor disabilities; ADHD = Mothers of children with attention-deficit hyperactivity disorder; Typical = Mothers of typically developing children.

Figure 3. Enjoyment of occupations. The lower the data bar, the more enjoyment was attributed by participants to performing this occupation, and vice versa. MR = Mothers of children with mental retardation; MD = Mothers of children with motor disabilities; ADHD = Mothers of children with attention-deficit hyperactivity disorder; Typical = Mothers of typically developing children.

with mental retardation and motor difficulties was slightly but not significantly higher). In contrast, a significant within-group effect was found, indicating that within each group, mothers assigned significantly different meaningfulness to the various occupations (F(4,82 ) = 24.7; p < .001). However, no significant interaction effect was found, indicating that no significant differences were found in the meaningfulness assigned to various occupations between the study groups Measures of Enjoyment Derived From Occupations. Figure 3 represents the responses of the mothers in the various groups as to their enjoyment of the five occupational areas measured. MANOVA analysis indicated that no significant between-group effect was found with respect to the enjoyment derived from the activities performed in the five occupational areas. However, when univariate ANOVA was used, results indicated that mothers of children with ADHD appeared to enjoy their activities with their children significantly less than the mothers in the other groups (i.e., M(ADHD) = 2.03, SD = 0.87; means for other mothers in the other three study groups ranged from 1.54 to 1.72, SD from 0.56 to 0.65). A significant within-group effect was found, indicating that within each group, mothers experienced significantly different levels of enjoyment from their performance of the various occupations (F(4,80) = 26.35; p < .001). However, no significant interaction effect was found, indicating that no significant differences were perceived between the mothers from the enjoyment they derived from performance of the various occupations (Fig. 3).

Figure 3 demonstrates that mothers derived the least amount of enjoyment from the occupation of home maintenance, and that, with the exception of activities with their children for mothers of children with ADHD (see above), all of the respondents enjoyed their performance of the other occupations equally well (i.e., mean ratings for all but home maintenance were < 2). Reported Satisfaction From Ability to Balance Time Use. ANOVA revealed that no significant differences were found between the groups’ ratings of satisfaction from their ability to balance their time use (F = .48). The mean for each group was as follows: mothers of children with mental retardation = 2.59 (SD = 0.69), mothers of children with motor disabilities = 2.60 (SD = 0.72), mothers of children with ADHD = 2.53 (SD = 0.78), and mothers of typically developing children = 2.78 (SD = 0.94). Lower numbers represent greater satisfaction and higher numbers represent less satisfaction.

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Impact of Assistance From External Caregivers on Mothers’ Perceptions Regarding Time Use and Ability to Balance Time Use Mothers were requested to rate the frequency of assistance received from external caregivers, such as relatives, volunteers, and paid workers, on a Likert scale. The results of all four study groups were pooled and recategorized into two different groups. One group consisted of mothers who received help “every day” or “often” (n = 42), and the other group consisted of mothers who received additional help “infrequently” or “never” (n = 73). No significant


differences were found with respect to all of the sociodemographic variables between these groups (the distribution of mothers with and without children with disabilities, years of mothers’ education, or the age, gender, and number of children in the family) with the exception of mothers’ country of origin. These groups were compared through t test analyses with respect to their ratings of the following: relative meaningfulness of occupations, enjoyment derived from performance of occupations, and satisfaction with their ability to balance their use of time. Results indicated that mothers who did not receive assistance from caretakers found the occupation of rest and sleep to be significantly more meaningful than did mothers who did receive help (t = 2.31, p = .023). No significant differences were found between these groups with respect to the relative meaningfulness of the other four occupations. With respect to perceived enjoyment from occupations, mothers who received help from external caregivers rated activities with their children and home maintenance as significantly more enjoyable than those who did not receive help (t = 2.11, p = .037; t = 2.30, p = .025, respectively). In addition, mothers who received help from external caregivers rated their satisfaction with their ability to balance time significantly higher than did mothers who received minimal or no help from caregivers (t = -1.872, p < .04).

Discussion Given the current emphasis on participation in occupational therapy practice, effective intervention strategies should include an understanding of how mothers use their time and derive satisfaction from the daily occupations they participate in. It has been suggested that the mothering of children with disabilities requires more time and energy than the mothering of typical children (Crowe, 1993; McGuire et al., 2004). Despite this, findings related to the comparative patterns of time use across occupational domains between mothers of children with disabilities and mothers of typical children have not always been consistent. Moreover, the literature is relatively sparse regarding the subjective perceptions of mothers’ use of time across various occupations. Indeed, advocates of the family-centered care movement have noted the failure of research to address the subjective perspectives of family members that is needed to construct richer, more meaningful treatment strategies (Mattingly & Lawlor, 2003). Therefore, to address the needs of mothers, especially those of children with disabilities, the purpose of the current study was to compare measures of


time use and of the meaning and enjoyment derived from the performance of daily occupations between mothers of children with and without disabilities. In addition, mothers’ satisfaction with their ability to balance their use of time was examined. Quantitative Measure of Time Use in Each Occupational Area In this study, no significant differences were found between the amount of time mothers in all of the groups devoted to all five occupations (activities with their children, home maintenance, work, leisure, and sleep and rest) (Figs. 1 and 2). This is despite the fact that according to the results of the Home Situations Questionnaire, mothers of children with disabilities rated their children as experiencing a greater degree and more serious types of difficulties in their day-to-day functioning than mothers of typical children. It is not surprising that no differences were found regarding the amount of time that they devoted to work. Because we considered that significant differences in the amount of time participants worked outside of the home could impact their available time resources for other occupations, this variable was one of those used in matching the groups in the initial sample. With respect to the amount of daytime hours mothers spent in the occupation of rest and sleep, our findings were similar to those of Crowe, Clark, and Qualls (1996) in that no significant differences were found between mothers of typically developing children and mothers of children with disabilities. Findings of the current study indicate that no significant differences existed between the amount of time mothers of children with disabilities and mothers of typical children spent in leisure activities. Searches of the literature revealed few studies on this subject (Crowe, 1993; Magnezi & Parush, 2002). Although Crowe’s findings were similar to those of this study, it is difficult to compare results because Crowe included only mothers of very young children in her study, whereas mothers of children ages 2 to 11 years participated in the current study. However, Magnezi and Parush (2002) reported that mothers of typically developing children (ages 2 to 12.5 years) spent significantly more time on leisure activities than did those with children of the same age range with ADHD. Given the scarcity of research on this issue, further research seems to be warranted. Another finding of the current study was that no significant differences existed between the amount of time mothers in the different groups spent with their children. The literature findings are not always con-

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sistent on this subject. For example, Breslau (1983) found no difference between mothers of typical children and mothers of children with disabilities with respect to the time they spend on childcare activities, whereas other researchers have reported that mothers of children with disabilities spent significantly different amounts of time in childcare activities than did mothers of typical children (Crowe, 1993; Crowe et al., 1996; Harris & McHale, 1989; Johnson & Deitz, 1985). However, Crowe (1993) urges that caution be used in comparing across these studies, because methods differed with respect to the tools and the definitions used to categorize occupational activity domains such as child care. In addition, participant groups were not always homogeneous with respect to all relevant criteria, which may also serve to confound attempts to compare across studies. In fact, a study by Erickson and Upshur (1989) showed that caretaking time for mothers of children with disabilities often varied in relation to the type of the child’s disability, age, and whether behavioral problems were involved. Although no significant differences were found between groups in the time mothers spent in each specific occupation, significant differences were found in the amounts of time the respondents spent across the different occupations. For example, the greatest percentage of their daily time was spent at work (31% to 26%) and in activities with their children (25% to 23%), whereas only 12% to 13% of their time was invested in leisure activities (Fig. 1). This would seem to indicate that the participants’ routines were not “balanced” in terms of the objective number of hours devoted to these occupations. Despite this, all of the respondents reportedly were relatively satisfied with how they managed to balance their time use in their daily routines. Further research would be helpful in clarifying what mothers perceive to be a satisfactory balance in their daily routines, across different populations and cultures. Measures of Mothers’ Perceptions Regarding Meaningfulness of Occupations and Enjoyment From Occupations Similar to our findings regarding measures of actual time spent in various occupations, mothers of children with disabilities did not differ significantly from those of typical children regarding the meaningfulness and degree of enjoyment that they experienced from the performance of the five occupations examined. However, mothers within each group experienced significantly different degrees of meaningfulness and enjoyment from the various occupations, in a manner that was consistent between

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the groups of mothers. That is, although mothers experienced different amounts of meaningfulness and enjoyment across the different occupations, the patterns of variation across the different occupations on these measures were found to be similar for mothers of typical children and for mothers of children with disabilities. In general, the most meaningful of the various daily occupations for all of the mothers were activities with their children and home maintenance, and the least meaningful were leisure and rest and sleep. This result seems to suggest that the relative differences found with respect to the time spent on these occupations does not necessarily result from mothers’ inability to balance their use of time, but in fact may result from the differences in relative meanings they attributed to these occupations. The findings of this study indicated that home maintenance was rated as the least enjoyable occupation across all four groups of mothers. In general, mothers seemed to perceive the other occupations as fairly enjoyable, and they rated their enjoyment in the performance of the other occupations examined fairly consistently. The one exception was that mothers of children with ADHD enjoyed activities with their children less than the mothers in the other groups. Here, our results confirm those of Magnezi and Parush (2002). It is possible that this finding may reflect in part the stress often experienced in parenting children with ADHD, who frequently present with co-occurring oppositional-defiant behaviors (Anastopoulos, Guevremont, Shelton, & DuPaul, 1992). Unfortunately, aside from the study described by Magnezi and Parush (2002), inadequate research exists with which to compare these findings. Reported Satisfaction From Ability to Balance Time Use Contrary to our research hypothesis, our results indicated that no significant differences exist between mothers of typical children and mothers of children with disabilities in their reported satisfaction from their ability to balance their time use. Magnezi and Parush (2002) also found no significant differences between the ratings of mothers of children with ADHD and those of typical children with respect to their satisfaction with their ability to manage their time. On reflection, the fact that our initial results were not what we had expected to find seems to highlight our tendency to presume to understand the effects of illness or disability on family members without fully understanding their unique characteristics and perspectives (Mattingly & Lawlor, 2003; Raina et


al., 2004). In fact, our findings seem to indicate that mothers of children with disabilities and mothers of typical children experienced similar degrees of enjoyment and meaningfulness from their various daily occupations, and were equally adept in finding the necessary resources to satisfactorily balance their use of time. These findings prompted us to reexamine our data in an attempt to increase our understanding of possible mediating factors that could account for our results. Secondary analysis was performed, this time comparing mothers who reported receiving external help frequently and those who did not, regardless of whether their children had disabilities. First, t test analyses were performed to compare perceptions regarding the meaningfulness of the various occupations between mothers who received assistance from external caregivers and those who did not. The results indicated that mothers who felt they did not receive assistance found significantly more meaning in the occupation of rest and sleep than those who did receive assistance. Crowe et al. (1996) performed a study in which the sleep patterns of mothers of children with and without disabilities were systematically examined. Specifically, they performed quantitative comparisons of time spent in rest and sleep between study groups, finding that any differences between them had more to do with their children’s ages rather than whether the children had disabilities. That is, mothers of infants had more nighttime sleep interruptions, and therefore less sleep, regardless of whether their child was disabled. The results of our study appeal to logic, because mothers who receive little or no help in meeting their daily responsibilities could be expected to find the time spent in sleep and rest more meaningful than those who did receive assistance. Next, t test analysis indicated that mothers who reported receiving help from external caregivers experienced significantly more enjoyment from performing the occupations of activities with their children and home maintenance than did mothers who did not receive such help. These results find indirect support from theorists who have examined the relative abilities of mothers of children in general, and those of children with disabilities in particular, to derive satisfaction and enjoyment from their daily occupations. In fact, these researchers claim that whether families receive adequate external support is a more significant factor toward their ability to cope with day-to-day responsibilities than is the child’s developmental status (Esdaile & Greenwood, 2003; Krauss, 1993).


According to researchers, mothers’ ability to use trusted external resources to balance the demands on their time and practical assistance and moral support through colleagues and friends is considered to underpin effective coping strategies that contribute to the individual’s satisfaction and well-being (Donovan et al., 2005; Dyck, 1992; Helitzer et al., 2002; Wallander & Varni, 1998; Williamson & Szczepanski, 1993). Finally, in contrast to when mothers of children with and without disabilities were compared, t test analysis demonstrated that mothers who received help from caregivers were significantly more satisfied with their ability to balance time than mothers who did not. These findings seem to indicate that mothers’ perceptions regarding balanced time use are less affected by the developmental and functional status of their children than is the receipt of support from external caregivers and family members, which seems to convey to mothers a sense of competence in balancing their daily routines. A review of the literature suggests that women burdened with multiple work and family responsibilities can achieve a more satisfactory balance of their available time by delegating a greater variety of their domestic responsibilities to other family members and making use of home care and community childcare services (Chapman et al., 1992). In a study by Segal (1998), mothers of children with ADHD reported that they were more successful at managing their routines when there was another adult present to help. These results attest to the conclusion that when the mothers’ burden is alleviated through support received from significant others, the perceived feeling of adequacy in the area of time management is greater regardless of whether their child is typical or has special needs. A review of the literature reveals that in most studies examining the time use of mothers of children with disabilities, their multiple responsibilities often demand so much time and energy that they withdraw from other personally satisfying family, social, and cultural activities (Kellegrew, 2000; McGuire et al., 2004; Olson & Esdaile, 2000; Tetreault et al., 1994; VanLeit & Crowe, 2002). However, in a recent review of the evidence on this issue, several mediating factors (e.g., the existence of social supports, family functioning and spousal support, and the provision of satisfactory family-centered intervention) serve to impact the ability of caregivers to cope with their difficult circumstances (Raina et al., 2004; Wallander & Varni, 1998). It is interesting to note that mothers of children with disabilities who participated in occupa-

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tional therapy intervention programs became significantly more satisfied with their ability to use time effectively, having been taught to delegate childcare and domestic responsibilities to others while becoming better advocates for their own personal needs (Helitzer et al., 2002; McGuire et al., 2004; VanLeit & Crowe, 2002).

Conclusion The data derived from this study are relevant for professionals who work with mothers of children in general and mothers of children with disabilities. Our findings add to those of a growing body of research (Donovan et al., 2005; Erlandsson & Eklund, 2003; Larson, 2000; Raina et al., 2004; ) indicating that mothers’ satisfaction with their daily occupational routines may be enhanced when clinicians consider mothers’ specific needs and subjective experiences within the particular familial and social contexts that they live in, as well as the developmental needs of their children. Limitations Limitations of this study include the wide age range of the respondents’ children in our sample (from 2 to 11 years), because children’s ages reportedly affect time demands on their caretakers (Crowe, 1993). Another methodological limitation of this study was that the occupation of activities with their children referred to the time spent with all of the children within the family and not specifically to the child with special needs. In addition, our use of a survey format limited the nature of the mothers’ responses to rating their perceptions of “pooled” groups of activity domains or occupational areas as operationally defined by the authors, rather than rating their individual experiences of meaning or enjoyment of specific occupation. Future research using a qualitative design is recommended to enhance our understanding of mothers’ perspectives regarding their daily activity routines. In addition, as noted previously, respondents rated the meaningfulness and enjoyment of four of the five occupations in this study as 2 or less, rather than with ratings distributed across the possible range of the scale (i.e., 1 to 4). Such lack of variance may have contributed to the lack of significant differences across the groups. Future research on the MTUQ may need to include a wider range of possible responses to increase the sensitivity of the scale. Finally, our findings of significant differences between mothers who did and did not receive help from external caretakers should be interpreted with

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