Introduction
Raising a child with a disability presents a unique set of challenges and adaptations for parents, impacting their psychological well-being, stress levels, and coping mechanisms [1, 2, 3]. The emotional and practical demands of caregiving can significantly affect parents’ mental health, leading to heightened levels of stress, anxiety, and depression, as evidenced by research findings [4-7]. This phenomenon addresses the necessity of exploring the psychological adaptations of parents in the face of childhood disabilities, a subject that remains critically important for enhancing support mechanisms and interventions [4-6].
Parenting a child with disabilities is not a monolithic experience; it varies widely depending on the nature of the child’s disability, the family’s socioeconomic status, and the availability of social support systems. For instance, studies have shown that parents of children with intellectual disabilities [5, 6, 7] report higher levels of stress and mental health challenges compared to parents of non-disabled children [8]. These challenges are compounded by societal stigmatization and the pervasive lack of understanding about disabilities [1, 2]. However, it is not solely the negative aspects that define the caregiving experience. Research also highlights the capacity for growth, resilience, and the development of robust coping strategies among these parents [9].
The psychological well-being of caregivers is intricately linked to their social support networks and coping strategies [3, 7]. Aunos, Feldman, and Goupil (2008) emphasize the pivotal role of social support in improving the health and well-being of mothers with intellectual disabilities, thereby positively influencing parenting and child behavior outcomes [10]. Similarly, the coping mechanisms adopted by parents, ranging from seeking information to engaging with professional support services, play a crucial role in mitigating the impact of stress and facilitating adaptation [11]. The relationship between parental stress and the behavioral management of children with disabilities is complex [5, 6, 12-15]. Parents often face difficulties in managing their children’s behavior, which can exacerbate feelings of stress and isolation [16]. Yet, engagement in positive coping strategies and the acquisition of relevant knowledge can empower parents, fostering a sense of competence and reducing stress levels [17].
The socioeconomic and cultural context also significantly influences the parental experience. For instance, Wang, Michaels, and Day (2010) explore the specific stresses and coping strategies of Chinese families with children with autism and other developmental disabilities, highlighting the role of cultural expectations and family dynamics [18]. Similarly, the challenges faced by Nigerian parents, as reported by Daniel et al. (2021), underline the importance of contextual factors, including the availability of healthcare services and community support, in shaping the parental adaptation process. Moreover, the phase of life in which the child is diagnosed plays a critical role in shaping the family’s experience [19]. Nelson Goff et al. (2016) compare the experiences of parents of children with Down syndrome across different life span stages, suggesting that parental needs and stressors evolve as the child grows [20]. This evolution necessitates a dynamic approach to support that adapts to the changing needs of the family over time. The economic and social consequences of raising a child with a disability cannot be overlooked. Michelsen et al. (2015) highlight the significant social and economic burdens faced by Danish families, emphasizing the need for comprehensive support systems that address both the direct and indirect costs associated with disabilities [21].
Therefore, the psychological adaptations of parents to childhood disabilities encompass a wide array of experiences, challenges, and coping mechanisms. Accordingly, this study further elucidates these adaptations by focusing on parents residing in Richmond Hill, Ontario, Canada, exploring their unique experiences and strategies for navigating the complexities of parenting a child with a disability. Through a qualitative lens, this research seeks to contribute to the body of knowledge on parental adaptations, offering insights that could inform the development of targeted support interventions and policies.

Materials and Methods
Study design and participants
This study utilized a qualitative research approach to explore the psychological adaptations of parents to childhood disabilities. The qualitative framework allowed for an in-depth exploration of personal experiences, perceptions, and adaptive strategies employed by parents in navigating their child’s disability. This approach facilitated a rich, detailed understanding of the complex emotional, social, and psychological landscapes that parents navigate.
The participants were recruited from Richmond Hill, Ontario, Canada, to participate in this study. The inclusion criteria were parents or primary caregivers of children with diagnosed disabilities. The study aimed for a diverse representation of disabilities to capture a wide range of experiences and adaptations. The participants were selected using a purposive sampling method to ensure a diverse representation of disabilities and experiences. Theoretical saturation was achieved with a total of 26 participants, ensuring a comprehensive exploration of themes and experiences without new information emerging from subsequent interviews.

Data collection tools
The data were collected exclusively through semi-structured interviews, allowing for both directed questions and the flexibility for participants to share their experiences in their words. Interviews were conducted in person and via video calls, based on the preference of the participant, and lasted between 45 to 90 min. Each session was audio-recorded with participant consent and transcribed verbatim for analysis. The semi-structured interview guide included prompts on the child’s diagnosis, changes in family dynamics, support systems, coping strategies, and perceptions of societal attitudes toward disability.
The semi-structured interview guide included questions on the child’s diagnosis, changes in family dynamics, support systems, coping strategies, perceptions of societal attitudes toward disability, and the impact on the parents’ marital and job status. The interviews were conducted solely by the first author, who ensured consistency in the data collection process. Field notes were made during and after each interview to capture additional insights and contextual information.
The third author, who has extensive experience in qualitative research, conducted all the interviews. The interviewer established a relationship with the participants before the commencement of the study through initial contact and pre-interview meetings to build rapport and trust.

Data analysis
Data analysis followed a thematic analysis approach, using NVivo software, where transcripts were meticulously reviewed and coded to identify common themes, patterns, and divergences in the experiences of parents. Initial coding was conducted by two researchers independently to enhance reliability, followed by collaborative discussions to reach consensus on emerging themes. The analysis was iterative, with ongoing comparison of data to refine and define themes. Through this process, the study aimed to capture the breadth and depth of psychological adaptations among parents, grounding the findings in direct quotes and narratives from the participants. Transcripts were returned to participants for their comments and corrections to ensure the accuracy and reliability of the data. While repeat interviews were not conducted, follow-up questions were asked during the initial interviews to clarify and gather additional information as needed.

Results
The study comprised a diverse group of 26 participants, all of whom were parents or primary caregivers of children with various disabilities, residing in Richmond Hill, Ontario, Canada. The age range of participants ranged from 28 to 52 years, with an average of 39 years. The cohort included 17 mothers and 9 fathers. The study included parents living with their spouses; none were single parents. Participants’ educational levels varied: 10 had advanced degrees, 8 had some college education, and 8 had high school education. Job status and the presence of other children, including non-disabled siblings, were also considered. Specifically, 15 participants were employed full-time, 7 were part-time, and 4 were unemployed. Regarding other children, 18 families had only one disabled child, while 8 families had additional non-disabled children. Regarding the nature of the children’s disabilities, 12 families were navigating developmental disorders (e.g. autism spectrum disorders, attention deficient hyperactivity disorder), 7 were managing physical disabilities (e.g. cerebral palsy, muscular dystrophy), and the remaining 7 were dealing with complex health conditions that included genetic disorders and chronic illnesses. The children’s ages spanned from 9 to 15 years, allowing for a broad exploration of parental adaptation across different developmental stages. Approximately 65% of the participants reported having accessed specialized support services for their children, indicating a high engagement with healthcare and educational systems to meet their children’s needs. The participant group also showcased a range of socioeconomic backgrounds, with 50% identifying as middle-income, 30% as low-income, and 20% as high-income families.
The qualitative analysis of the semi-structured interviews revealed four primary themes associated with the psychological adaptations of parents to childhood disabilities: Emotional journey, coping strategies, family dynamics, and social and community support. Each theme encompassed several subthemes, through which various concepts emerged, capturing the specific experiences of the participants (Table 1).



Emotional journey
The participants described a wide range of emotions following their child’s diagnosis, categorized into subthemes, including initial reactions, adaptation over time, grief and acceptance, stress and anxiety, positive reappraisals, and isolation and loneliness. Initial reactions often involved shock, denial, and disbelief, with one parent maintaining, “It was like being hit by a truck. I just could not accept it at first.” As time progressed, many moved towards “adaptation, growth, and resilience,” with another participant noting, “You find a new normal, one step at a time. It is not easy, but you grow in ways you never expected.” The subtheme of positive reappraisals highlighted how some parents found deeper meaning and “enhanced empathy” through their experiences.

Coping strategies
The coping strategies theme captured how parents navigated their challenging circumstances. Subthemes included seeking information, building a support network, professional support, personal coping mechanisms, and advocacy and empowerment. Parents emphasized the importance of research and education as foundational steps in understanding their child’s condition. Building a support network was critical, with one parent explaining, “Connecting with other parents in similar situations through social media groups and local communities was a lifeline for us.”

Family dynamics
Changes in family roles, sibling relationships, marital/partner relationships, and interactions with extended family and in-laws were central to how families adapted. The adjustment to new parenting roles and caregiving responsibilities was often mentioned, with one respondent stating, “It is a delicate balance, but we’ve found our way through open communication and mutual support from my partner.” Sibling relationships were also affected, with efforts to foster understanding amidst Jealousy.

Social and community support
Community involvement, access to resources, public perception and stigma, and inclusion and accessibility were identified as external factors impacting parents’ psychological adaptations. The fight against stereotypes and discrimination was highlighted by many, with one parent stating, “Awareness and community understanding can change the narrative around disability.” Access to financial aid and educational support were also critical for easing the journey.

Discussion
The findings of this qualitative study present psychological adaptations of parents to childhood disabilities, revealing profound consequences in their emotional journeys, coping strategies, family dynamics, and the significance of social and community support. These results resonate with existing literature, highlighting the complex interplay between stress, adaptation, and resilience within the context of parenting children with disabilities.
The emotional journey of parents, characterized by initial reactions of shock and denial, followed by a process of adaptation, grief, acceptance, and positive reappraisal, aligns with the findings of Arzeen et al. (2020), who maintained significant levels of stress, depression, and anxiety among parents of intellectually disabled children. This study extends the understanding of such emotional trajectories, emphasizing not only the challenges but also the growth and resilience emerging from these experiences [4]. Auriemma et al. (2021) similarly identified parenting stress in the context of learning disabilities, underscoring the pivotal role of cognitive appraisals and coping styles in moderating stress outcomes. The observed shifts toward positive reappraisal and the development of resilience in the present study echo these findings, showcasing the dynamic nature of parental adaptation [11].
In terms of coping strategies, the reliance on information seeking, building support networks, professional support, and advocacy observed among participants mirrors the strategies documented by Beresford [22]. This study’s emphasis on the importance of coping mechanisms in mitigating stress and facilitating adaptation further corroborates the work of Wang et al. (2010), who highlighted the critical role of coping strategies among Chinese families with children with autism [18]. The diverse coping strategies identified in the current study reflect a proactive engagement with the challenges of parenting, resonating with the concept of parental learning and adaptation discussed by Reio and Fornes [17], who emphasized the importance of education and knowledge acquisition in adapting to a child’s diagnosis [17].
The impact of childhood disabilities on family dynamics, particularly changes in family roles, sibling relationships, and marital/partner relationships, is consistent with the findings of Nelson Goff et al. (2016). These researchers noted the evolving challenges and adaptations required at different lifespan stages of children with Down syndrome [20]. The present study extends these insights, highlighting the ongoing negotiation of roles within the family and the complex interplay between caregiving responsibilities and familial relationships. This aligns with Lobato, Kao, and Plante’s (2005) observations on Latino sibling knowledge and adjustment to chronic disability, emphasizing the family as a dynamic system of support and adaptation [23].
The critical role of social and community support in the parental adaptation process identified in this study echoes the findings of Michelsen et al. (2015), who outlined the social and economic burdens faced by families of children with cerebral palsy in Denmark [21]. The present study underscores the importance of inclusive and accessible community resources, which align with the recommendations of Werner et al. (2022) for supporting parents during the COVID-19 pandemic [9]. Moreover, the emphasis on combating public perception and stigma complements the observations of Jacob et al. (2019) regarding the stigma faced by young adult children of parents with disabilities, highlighting the societal dimensions of the parental adaptation process [24].
To further explain the findings, it can be said that the obtained results from the study on psychological adaptations of parents to childhood disabilities align closely with established theoretical frameworks in the field [25]. The emotional journey theme, encompassing initial shock, adaptation, grief, acceptance, and positive reappraisals, resonates with Kubler-Ross’s stages of grief model [26]. This model suggests that individuals confronted with significant loss or life-changing diagnoses go through stages of denial, anger, bargaining, depression, and acceptance [25-27]. Similarly, parents in the study reported experiencing initial reactions of shock and disbelief, gradually transitioning to acceptance and finding new meaning in their experiences. This trajectory underscores the applicability of grief models in understanding parental adaptation to childhood disabilities, highlighting the importance of providing emotional support tailored to these stages.
Furthermore, the coping strategies identified in the study, including seeking information, building support networks, and advocacy, are supported by Lazarus and Folkman’s transactional model of stress and coping [28-34]. According to this model, coping is a dynamic process involving cognitive appraisal and the employment of problem-focused and emotion-focused strategies [35-39]. The parents’ proactive engagement in research, professional support, and advocacy aligns with problem-focused coping, aimed at altering the source of stress. Concurrently, personal coping mechanisms like mindfulness and exercise represent emotion-focused strategies [1], aimed at managing emotional distress. This dual approach facilitates resilience and adaptation, highlighting the need for comprehensive support systems that provide both informational resources and emotional relief to parents navigating the challenges of raising children with disabilities.

Conclusion
This study explored the psychological adaptations of parents to childhood disabilities, revealing the complex emotional landscape, coping strategies, familial dynamics, and the pivotal role of social and community support. Key findings indicate that parents undergo a significant emotional journey, marked by initial shock and evolving towards acceptance and positive reappraisal. Coping strategies such as information seeking, building support networks, and advocacy were essential in managing stress and fostering resilience. The dynamics within families also adapted, with shifts in roles and relationships highlighting the impact of the child’s disability on the entire family unit. Moreover, the importance of social and community support was underscored, with parents indicating that external resources and inclusive environments significantly mitigate challenges.
The emotional journey theme encapsulated the initial and evolving emotional responses of parents to their child’s disability. Categories within this theme included Initial Reactions, such as shock, denial, and disbelief; adaptation over time, featuring adaptation, growth, resilience, and the establishment of a new normal; grief and acceptance, highlighting the grieving process, acceptance, and emotional healing; stress and anxiety, with chronic stress, anxiety, and emotional exhaustion; Positive Reappraisals, including finding meaning, spiritual growth, and enhanced empathy; and isolation and loneliness, characterized by social withdrawal, feeling misunderstood, and loneliness. These categories reflect the complex emotional landscape navigated by parents.
The coping strategies theme detailed the methods parents employ to manage the stress and challenges of raising a child with a disability. This theme was divided into categories, such as seeking information, involving research, education, and online forums; building a support network, with social media groups, local communities, and family; professional support, featuring therapists, counselors, and support groups; personal coping mechanisms, including mindfulness, exercise, and hobbies; and advocacy and empowerment, characterized by policy change, awareness campaigns, and educational rights. These strategies illustrate the proactive and varied approaches parents take to cope with their circumstances.
Under the family dynamics theme, the focus was on the impact of the child’s disability on familial relationships and roles. Categories identified included changes in family roles, involving parenting roles, caregiving responsibilities, and work-life balance; sibling relationships, featuring siblings’ support, jealousy, and understanding; marital/partner relationships, with communication, stress on relationships, and support from partner; and extended family and in-laws, characterized by support, misunderstandings, and judgment. This theme underscores the significant adjustments and challenges within the family unit.
The social and community support theme highlighted the external factors that influence parental adaptation, emphasizing the importance of an inclusive and supportive community environment. Categories within this theme were community involvement, including volunteering, social events, and school activities; access to resources, featuring financial aid, therapeutic resources, and educational supports; public perception and stigma, with stereotypes, discrimination, and awareness; and inclusion and accessibility, characterized by barrier-free access, inclusive programs, and community awareness. These categories point to the critical role of societal support and resources in facilitating parents’ adaptation to their child’s disability.
In conclusion, this study contributes valuable insights into the adaptive processes of parents navigating the complexities of childhood disabilities. It highlights the resilience and dynamic coping mechanisms employed by parents in the face of considerable challenges. By illuminating the various dimensions of psychological adaptation, this research underscores the critical need for comprehensive support systems that address both the emotional and practical needs of families. It calls attention to the strength and perseverance of parents, offering a foundation for further exploration and development of supportive interventions.

Study limitations
This study, while insightful, is not without limitations. The qualitative nature and small sample size, drawn from a specific geographic area, may limit the generalizability of the findings. Additionally, the reliance on self-reported data may introduce bias, and the cross-sectional design prevents the examination of changes over time. These limitations suggest caution in extending these findings to broader populations without further research.
Future research should aim to address these limitations by incorporating larger, more diverse samples and longitudinal designs to capture the dynamic nature of parental adaptation over time. Investigating the specific needs and experiences of underrepresented populations can enrich the understanding of these processes [40-42]. Furthermore, quantitative studies could complement the qualitative insights, providing a more comprehensive view of the psychological impacts and coping mechanisms.
The findings of this study have important implications for practice. Healthcare providers, educators, and policymakers should consider the multifaceted needs of families with disabled children, emphasizing the development of comprehensive support services [43-47]. Interventions should be tailored to address both the emotional and practical aspects of caregiving, including mental health support, respite care, and accessible community resources. Encouraging community inclusion and reducing stigma are crucial for fostering environments that support both children with disabilities and their families. By focusing on these areas, stakeholders can contribute to more resilient families and inclusive communities [44].

Ethical Considerations
Compliance with ethical guidelines
The study received ethical approval from the KMAN Research Institute, Richmond Hill, Canada (Code: KEC.2023.5A2). Before participation, all participants were informed about the study’s purpose, their rights as participants, and measures taken to ensure confidentiality and anonymity. Written informed consent was obtained from all participants. Additionally, participants were assured of their right to withdraw from the study at any point without any consequences.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization: Nadereh Saadati, Saeed Abdullah Al-Dossary, Olga Coelho, Mehdi Rostami, Sefa Bulut, Zohreh Zadhasan, and Parichehr Mehdi Abadi; Methodology: Nadereh Saadati, Saeed Abdullah Al-Dossary, Mehdi Rostami, Kamdin Parsakia, and Seyed Hadi Seyed Ali Tabar; Analysis: Mehdi Rostami, Sefa Bulut, and Kamdin Parsakia; Sources and drafting: Nadereh Saadati, Olga Coelho, Kamdin Parsakia, Zohreh Zadhasan, and Seyed Hadi Seyed Ali Tabar; Editing and review: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to express their gratitude to all individuals who helped them to do the project.


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