Psychological Defense Mechanisms and the relationship to Mental Health among mothers of children with Autism

Dr.Medya Abdulkhalic Othman Dzayee

Medya.othman@su.edu.krd

00964750 4659662

 

Abstract

This research aimed to identify some of the psychological defence mechanisms and their correlation to mental health amongst mothers of children with ASD in Autism centres in the Kurdistan region-Iraq. The researcher used the scale (Al-Kharousi, 2018) (psychological defence methods) to deduct results from the original scale; the researcher adopted (30) items presented in (15) defensive psychological mechanisms, alongside consultation with several psychological experts in choosing the appropriate mechanisms for the study. The agreement came on these mechanisms, respectively: (Withdrawal, idealization, Reaction formation, displacement or transfer, Help-Rejecting-Complaining, isolation, denial, rationalization, repression, projection, devaluation of others, projective identification, self-depreciation). As for the variable measurement (mental health), the researcher chose to adopt the (Suleiman, 2019) scale. What rose was the validity of the translation of the two scales from Arabic into English was extracted, as well as checking the psychometric characteristics, including apparent validity and extracting reliability, through the Cronbach alpha equation with a value of (0.755) for the measure of psychological defence mechanism and (0.854) for the measure of mental health. The scale was applied in its final form to a research sample consisting of (112) mothers of children with Autism among five autism centres in Erbil. The results of the study came the fact that the most common mechanisms used by the mother of the autistic child with a significant difference by comparing the arithmetic mean and percentages for each mechanism as follows {withdrawal, idealism, 78.19%, 75.05%} were of a high level according to the standards of the scale, either (displacement, rejection to help Complaint, sublimation, isolation, denial, rationalization, oppression, about standards) (68.13, 67.08, 66.77, 65.93, 60.27, 57.86, 55.34, 54.51, 52.83%) came in the middle level about the scale criteria, While (projection, other devaluation, projective identification, self- devaluation) (%47.48, %41.29, %40.67,% 34.59) were in the low level according to the criteria. The results of the mental health variable showed that there were significant differences between the arithmetic averages of the sample as a whole with a value of (68.67) compared to the default average with a value of (93.0). This is an indication of the low mental health of mothers of children with autism, in addition to the significant differences in the t-value calculated with a value of (t=4.668) compared to the Sig. (2-tailed= (t=2.00) at the level of significance (0.05). As for the relationship between defence mechanisms and mental health, the results of the research showed the existence of a strong relationship and in an inverse direction between some of the defensive mechanisms used and mental health, especially the following mechanisms (withdrawal, displacement, idealization, repression, projective identification, denial) (-.199, -.168, -.163, -.162, -.156, -.111 ) that is, the more the mother

exaggerates in using these previous mechanisms, the lower mental health recorded. In light of the results of the study, the researcher presented several recommendations and suggestions

Keywords: psychological defence mechanisms, mental health,oppression, displacement, denial

آليات الدفاع النفسية وعلاقتها بالصحة النفسية لدى أمهات أطفال التوحد

الدكتورة ميديا عبد الخالق عثمان دزايي

جامعة صلاح الدين – كلية التربية – قسم التربية الخاصة – اربيل  العراق

الخلاصة               

هدف البحث الى التعرف على بعض من آليات الدفاع النفسية وعلاقتها بالصحة النفسية لدى امهات الأطفال المصابين بالتوحد في مراكز التوحد في إقليم كردستان- العراق. واستخدمت الباحثة مقياس (الخروصي، 2018) (اساليب الدفاع النفسية) ومن المقياس الأصلي تبنت الباحثة  (30) فقرة متمثلة في(15)آلية نفسية دفاعية، وبأستشارة عدد من الخبراء النفسين في اختيار الاليات المناسبة للدراسة، وجاء الاتفاق على هذه الآليات على التوالي: (الانسحاب، المثالية، تكوين رد الفعل العكسي، الإزاحة او النقل، رفض المساعدة و الشكوى،, العزلة، الإنكار، العقلنة، الكبت، الإسقاط،  التقليل من قيمةالاخرين ، التماهي الاسقاطي ، تخفيض قيمة الذات). أما للقياس متغير (الصحة النفسية) فقد تبنت الباحثة مقياس(سليمان,2019) ،  وتمت استخراجصدق الترجمة للمقياسين من اللغة العربية الى الكوردية لتعسر قراة الفقرات بالعربية في هذه المنطقة،  وكذلك تم التحقق من الخصائص السيكومترية ومنها الصدق الظاهري واستخراج الثبات، ومن خلال معادلة كرونباخ الفا تماستخراج الثبات بقيمة (0.755) لمقياس أساليب الدفاع النفسية و(0.854) لمقياس الصحة النفسية. تم تطبيق المقياس بصورته النهائية الكترونيا على عينة البحث المكونة من (112) من امهات اطفال التوحد موزعات على خمسة مراكز للتوحد في أربيل. وجاءت نتائج الدراسة إلى أن الآليات الأكثر شيوعا التي تستخدمها أم الطفل التوحدي وذات فرق معنوي بمقارنة المتوسطات الحسابية والنسب المئوية لكل آلية كالاتي {الانسحاب، المثالية، ٪78.19، ٪75.05،} جأتابمستوى عالي حسب معايير المقياس،  اما (الإزاحة، رفض المساعدة و الشكوى، التسامي، العزلة، الإنكار، العقلنة، الكبت، (٪68.13, 67.08, 66.77, 65.93, 60.27,  57.86 ، 55.34 ، 54.51 ، 52.83٪ )كانوا في المستوى المتوسط بالنسب للمعايير المقياس ,بينما( الإسقاط ، تخفيض قيمة أخرى ، التحديد الإسقاطي ،تخفيض قيمة الذات)(47.48٪ ، 41.29% ، 40.67، 34.59) كانوافي المستوى المنخفضحسب معايير المقياس.واظهرت نتائجمتغير الصحة النفسية إلى وجود فروق معنوية بين  متوسط  الحسابيللعينة ككل بقيمة (68.67) مقارنة بالمتوسط الافتراضي بقيمة (93.0) وهذا مؤشر على تدني الصحة النفسية لدى امهات اطفال التوحد اضافة الى الفروق المعنوية في القيمة التائية المحسوبة بقيمة (4.668)مقارنة بالجدولية (2.00) عند مستوى الدلالة(0.05).، وبالنسبة للعلاقة بين الاليات والصحة النفسية , فقدأظهرت نتائج البحث بوجود علاقة قوية وباتجاه عكسي بين بعض من

الآليات الدفاعية المستخدمة والصحة النفسية وخاصةالاليات

الاتية(الانسحاب,الازاحة,المثالية,الكبت,التماهي الاسقاطي,الانكار)بمعاملات الارتباط كالاتي(-.199, -.168, -.163, -.162, -.156, -.111 ),اي كلما بالغت ام الطفل التوحدي في استخدام هذه الاليات كلما تدنت صحتها النفسية . وفي ضوء نتائج الدراسةقدمت  الباحثة عددامن التوصيات والمقترحات

الكلمات المفتاحية : اليات الدفاع النفسية, الصحة النفسية,الكبت,الانكار, الازاحة

 

 

1. Introduction

The birth of a child with physical, mental and psychological health is a blessing for the parents and expresses the fulfilment of their expectations, and these expectations will be put to the test during a confrontation with the reality of the child’s birth, as the child may have a disability or disorder that hinders his development in various aspects, whether mental or physical or psychological. And the mother in particular believes that the expected child will be full of all virtues and all talents, and the painful idea comes when he is disabled. This discovery raises feelings in which fear, grief, and disappointment mixed with feelings of guilt and confusion with embarrassment, and here lies the problem in confronting the idea of ​​a child with a disability, especially for the mother, and the responsibility he bears on her, as parents consider that the project that connects them with their child has been shaken forever, and therefore it may be buried. All their desires for independence, professional and emotional life, and the child may have some developmental disorders such as autism, which is considered one of the most serious disorders because it is not limited to one aspect of the child’s personality, but extends to several aspects, including cognitive, social, linguistic and emotional.

1.1 Problem of research

Autism is a developmental disorder that appears during the first years of a child’s life, and negatively affects the child’s social and communication life, where autistic children face a defect in social interactions, a deficiency in communication and language, a deficiency in interests and activities, in addition to stereotypical behaviours. Characterizing an autistic child. Thus, autism disorder has adverse results on the happiness and well-being of the parents, as the presence of a disabled child in the family causes additional problems and more complex family relationships, and may have a significant impact on bringing about a change in the family’s adaptation, and creating a defect in the psychological and social organization of its members, in addition to the needs and demands of health care. of the autistic childWe also find concern about the future and the reactions that they experience when they learn of their child’s injury, which is represented by shock, denial and a sense of guilt, especially the mother who faces many problems and difficulties in light of the contemporary economic, social and cultural changes as a result of her multiple roles as a wife, mother, housewife and in many cases a working woman, and also She is considered the closest person to the autistic child compared to the rest of the family, as she is the one who takes care of him and takes care of him, which exposes him to a lot of psychological stress.,In order to face this trauma, the mother uses psychological defense tricks, and these defensive tricks or mechanisms are subconscious behavioral methods used by the individual when he fails to achieve his goals, due to factors of frustration and conflict, to escape from the painful situations of factors that he is unable to confront through direct methods, as it protects from pain and helps him to bear the burdens Life and its shocks give him some comfort and calm, albeit in an illusory temporary manner, and the defense mechanisms share one element, which is to hide the conflict or escape from it instead of confronting it. The problem lies in the following question: What are the psychological defence mechanisms that the mother uses in her attempt to control her life after having an autistic child?

indexes of negative psychological effects on caregivers of children with ASD ( Al Tourah, Al Ansari, Jahrami, 2020,p125-128) (Riahi,&Izadi, 2012,p91-95).

 Yet, scholars that focused on the correlation of such an impact with the perceived social support by mothers of children with ASD are lacking. In China, 72.5% of mothers caring for children with ASD developed depressive symptoms, 80.2% developed anxiety, and 67.1% suffered from both symptoms of the disorder (Baker, Seltzer, Greenberg, 2011;p601–609)( Zhou, Liu, Xiong,& Xu.2019,p95).

Based on the results of the previous research, parents of regular children and parents of children with ASD and attention deficit hyperactivity disorder ADHD experience higher levels of mental stress associated with parenting, which may be triggered by the special needs of these children and the distinctive psychological and mental differences between them and their peers (Elham, Mohammad, Zarbakhsh,2019,p93).

There is much therapeutic and psychiatric comorbidity to enhance the difficulty of management of Autism disabled. The parents turn out shuttling between (psychiatrists, physicians, occupational therapists, and special educators). They turn out to spend most of their time and potency on the child’s needs, leaving them with slight time for themselves(Maulik&Harbour,2010). Both parents may experience great stress as they adapt and learn to care for their special child. The self-defence mechanism is independent of the severity of ASD and worsens through denial, expressive action, and avoidance.

Further, the role of specific coping mechanisms and their relation to psychopathology has not yet been explored. This area is imperative to study as it will impact the overall management of these cases(Suyog, Alka Anand,1 Henal,1 and Ravindra,2018, p312,317).

Psychological defensive methods occupy an important place in the theory of psychoanalysis as part of the defensive methods that the ego possesses in its dealings with external reality, and its constant attempt to reconcile the requirements of external reality with the impulses of the id and the prohibitions of the superego(Paulhus, D. L., Fridhandler, B., & Hayes, S. 1997,p543-475). Conflict arises, and when the ego fails to resolve the conflict, the conflicting psychological energy of the conflict turns into vague unconscious anxiety, which poses a threat to the ego or personality. In order to repel this unclear anxiety and overcome it, the ego mobilizes the means of psychological defence that alleviates the anxiety, and when the ego collapses under the pressure of the external reality and the impulses of the id and the prohibitions of the higher ego that forms the watchdog, a disease or psychological disorder occurs, as the defence becomes immature, neurotic, or The psychotic is the dominant form, and understanding the psychological defence and its form and dealing with it is an important part in the process of psychoanalysis, and in understanding the therapeutic relationship that prevails between the therapist and the therapist, and when the patient understands the unconscious motives behind his behaviour and then the form and function of the defence used, he becomes more able to deal with reality, And reduce the impact of improper defence and replace more mature forms of defensive methods(Saul Mcleod,2023)

The behaviourist school perspective attributed the defence mechanisms to the laws and principles of learning and indicated that the mechanisms are acquired and learned responses within the individual’s experience in the early stages of his development in particular which in turn affect the context of his present and future and its main goal is to reduce anxiety(Dai & Sternberg, 2004).

Although the behaviourist school rejects some of the concepts of the school of behaviour Psychoanalysis, However, this does not hide the position of the behaviourist school on defensive mechanisms, as the proponents of this theory do not refer to the unconscious, they completely reject this concept, and they may explain the behaviour that the individual takes when using a defensive ploy in the form of the behaviour that the individual has acquired according to the rules that they have extracted of their studies in the learning process(Walinga,2014,p48)

The cognitive perspective sees the human being as a processor of information and a solver of problems and his actions are governed by thinking and planning. The cognitive perspective leads to the question, how do mental processes affect the motives, emotions and behaviour of individuals? As the owners of the cognitive perspective believe that defensive mechanisms result from mental, cognitive, and emotional processes to confront situations(Jordan,2022,), Han presented in 1961 an alternative model to the classic defensive mechanisms (analytics) and called it (mechanisms dealing with events). He drew a comparison between the psychoanalytic point of view of Psychological and the point of view of cognitive psychology, as he believes that if we look at behaviour through defence mechanisms, it differs from behaviour if we look at it through coping mechanisms. To be defence means, as they are means of dealing with the subject (the problematic or stressful situation) by cognitive means(Cramer,2015).

Whether they are unconscious defence mechanisms as described by the analytical theory, or methods of dealing with events, in both cases they are factors affecting human behaviour. Their mental health, and the psychological and social pressures on the mother of the autistic child are unfamiliar, especially for the autism spectrum disorder, which may seem unknown to the societies of developing countries and the intimidation that accompanied the causes and methods of dealing with the disorder that baffled the parents and the mother in particular, and that led to the deterioration and worsening of her mental health.

2.2Research Method

This research was a descriptive and correlational study. The statistical population included mothers of children with autism disorder in the Kurdistan region in Erbil- Iraq 2022-2023. The sample size of the research consisted of (112) mothers who were selected by convenience sampling. Defense Style Questionnaire (Al-Kharousi, 2018) adopted and Sense of mental health (Al-Salamin, 2019)were used to measure the variables. The data were analyzed by comparing means and one sample T-test and person correlation

2.3Rresearch sample

From (381) mothers who have children with ASD in the centres of Autism spectrum disorder just (112) mothers voluntarily answered, which was approximately 29.39% of the total number of mothers. The question nairesconverted into a screen electronic.

Table (1). The Institutions of ASD in Erbil

 

2.4Research instruments

For the purpose of measuring the current research variables, which are (psychological defines mechanisms) among mothers of children with autism, the researcher used the (Al-Kharousi, 2018) scale. In the current study, it decided to take the following procedures to determine the validity and reliability of follows

The researcher used a scale (Al-Kharousi, 2018) (mechanisms of psychological defence). Thirty items of the questionnaire were adopted with the selection of 15 psychological defence mechanisms because the questionnaire was designed, with every two paragraphs representing one mechanism, and thus the number of the questionnaire items in the current study reached (30) items for ( 15) mechanisms, The mechanisms were chosen with the experts and include (projection, justification, reverse formation, denial, emptying, withdrawal, rationalization, displacement or transfer, suppression, ideal appreciation, complaint of refusal of help, isolation of emotion, self-devaluation, projective identification, belittling others). The paragraphs that represent each of the two mechanical paragraphs were as follows (projection 1 + 2), (justification 3 + 4), (reverse formation 5 + 6), (denial 7 + 8), (discharge 9 + 10), (withdrawal 11 + 12), (rationalization 13 + 14), (displacement or transfer 15 + 16), (repression 17 + 18), (perfect estimation 19 + 20), (complaint of refusal of help 21 + 22), (isolation of emotion 23 + 24), (Depreciation of self-25 + 26), (projective identification 27 + 28), (underestimation of others 29 + 30)There are criteria by which the level of use of psychological defence mechanisms is determined, as shown in the following table(2)

Table (2) criteria of the level of the mechanism in the questionnaire study

The researcher also adopted the (Al-Salamin, 2019) measure of (mental health), and the scale consists of (31) items completely disagree 1-2-3-4-5 completely agree).) answered by

2.5Validity of translations

After verifying the apparent or face validity of the items of the Psychological Defense Mechanisms and mental health Scales in Arabic, the instructions and items of the Arabic version of the Psychological Defense Mechanisms and mental health Scales were translated into Kurdish by an expert in the Kurdish language, then the Kurdish version was translated again into Arabic by an expert in the Arabic language. A third expert in the Arabic language was asked to compare the two Arabic versions original with translated, and they were very close with slight modifications in the concept, which indicates the veracity of the translation of the tool and that it is considered valid and reliable, Appendix (1,2) clarifies the names of the translation experts.

2.6 Reliability

The researcher used Alpha Cronbach for the reliability of the paragraphs of the two scales self-defence mechanism and mental health. A sample of mothers was taken to extract the reliability and their number reached (50) mothers were randomly selected, and were not within the research sample in the final application of the research and the data was processed statistically as it was found that the two scales have a good degree of stability as shown in Table(3).

Table (3) Reliability of Scales

2.7Data Collection

The data was distributed to the sample of mothers from (11-2-2023 to 25-3-2023, )and the manual questionnaire was designed and converted to electronic by using the Google Drive application, building a new folder, choosing the forms in the More option, and then entering all paragraphs as it is in the original questionnaire, and the quality of the answer to the questions was determined, which is (linear scale). Done Sending the electronic questionnaire by e-mail to the mothers with Autism children, and the questionnaire is answered by drawing a circle around the number or choosing the number if it is electronic from the existing numbers to answer (1-2-3-4-5-6-7-8-9), meanwhile, for mental health were answer (1,2,3,4,5,) has been unloaded data to the scale and then processed statistically to obtain the results and using appropriate statistical means

3.1 Data AnalysesFirst aim:

The first aim of the research was to identify the psychological defence mechanisms used by the mother of children with autism in the Kurdistan region-Iraq.

Table (4) the level of the Self –defence mechanism

Table No. (4) showed that there was a significant difference in using psychological defence mechanisms among  mothers of children with autism and these improved by mean and percentage of each mechanism   {withdrawal, Idealization, %78.19, %75.05,} High level

Reaction formation, Displacement, Help-Rejecting Complaining, Acting out, Isolation Rationalization, Denial, Intellectualization, Suppression, (%68.13, 67.08%, 66.77%, 65.93%, 60.27%, 57.86%, 55.34%, 54.51%, %52.83) in and medium level.Projection, Devaluation other, Projective Identification, Devaluation-self with percentage (%47.48, 41.29%, 40.67%, %34.59)in low level.

The results showed that the methods that reach high rise are (withdrawal and idealization) if we look at the factors that explain the quality of these mechanisms and classifications that the researcher relied on, we find that withdrawal is considered one of the neurotic mechanisms, where the person withdraws himself from the situation completely for fear of being reminded of an idea or a painful sensation, and we also find that the ideal appreciation is one of the mechanisms that reduce the pressure and tension caused by some people who threaten their existence in the uncomfortable reality.

Studies explain that immature psychological defence methods and neurotic methods are exaggerated in the present reality for the purpose of protecting psychological and self-security from any danger and this is what mothers emphasize from their use of the withdrawal mechanism to search for psychological security (Zahran, 1997). Other studies believe that defence methods are attempts to maintain psychological balance, and their goal is self-protection and defence, self-confidence, self-esteem, and achieving ps

The results of the mental health variable showed in the table No(5) that there were significant differences between the arithmetic averages of the sample as a whole with mean value of (84.32) compared to the default average with a value of (93.0). This is an indication of the low mental health of mothers of children with autism, in addition to the significant differences in the t-value calculated with a value of (t=4.668) compared to the Sig-two-tailed (t=2.00) at the level of significance (0.05).

Third aim:

The last aims were to find the relationship between the extent of using these psychological defense mechanisms and their psychological or mental health the Table No.(6) showed these relations.

          Table (6) the relationship of self-defense Mechanism and Mental health

Table No (6) above showed the relationship between self-defence mechanisms and mental health, and the power of some relations was strong but inverse direction between the self-defensive mechanisms used and mental health, especially the following mechanisms (withdrawal, displacement, idealization, repression, projective identification, denial) (-.199, -.168, -.163, -.162, -.156, -.111 ) that is, the more the mother exaggerates in using these previous mechanisms, the lower mental health recorded. Table (6) showed the person correlation between self-defence and mental health.

Conclusion

Based on the results of the current research, mothers of children with autism experience a high level of using some self-defence mechanism in a negative way to copying with reality. Lower levels of mental health were recorded, which may be caused by parting children with Autism. And having a lot of conflict anxiety and stress made by the wrong self-defence mechanism. The relationship between some of the mechanisms and mental health was strong and reversed, that is, the more defensive mechanisms were used excessively, the lower mental health among mothers recorded.

Recommendation

1. Providing the necessary material support and social support for mothers of children with autism and their families in order to take good care of this group.
2. Organizing seminars and lectures on autism spectrum disorder for members of the general community and correcting some misconceptions about autism that prevail among the Kurdish community or different societies.
3. Conducting intervention programs according to the results of the current research for mothers of children with Autism.

Suggestion

1. Conducting a comparative study between mothers of healthy children with mothers of children with autism ASD or ADHD in terms of mental health and social adaptation.
2. Design interventions copying strategies programs for mothers of children with Autism In spite of using less negative mechanisms for solving their conflict.
3. Conducting studies aimed at revealing the nature of the relationships between psychological defence mechanisms and other demographic variables such as the level, education, age of the mother, and occupation of the mother.

References

1. Abdulrahman J. AlTourah* Ahmed Malalla Al Ansari, FRCPc, Haitham Ali Jahrami,(2020); Depression, Anxiety and Stress among Mothers of Children with Autism Spectrum Disorder, Bahrain Medical Bulletin, Vol. 42, No. 2, June

https://www.bahrainmedicalbulletin.com/JUNE_2020/JUNE2020_ABSTRACT/JUNE2020_ABSTRACT_DEPRESSION.pdf

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Publishing; 2013.

3. Baker, J. K., Seltzer, M. M., & Greenberg, J. S. (2011). Longitudinal effects of adaptability on behaviour problems and maternal depression in families of adolescents with autism. Journal of Family Psychology, 25(4), 601–609. https://doi.org/10.1037/a0024409

4. Cramer, Phebe, (2015)Defense Mechanisms: 40 Years of Empirical Research. Available from.: [109.111.138.208]On 26 August 2015, At 22:31Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office:5Howick Place, London, SW1P 1Whttps://www.researchgate.net/publication/

5.Candina Jordan ,(2022)What Is Cognitive Psychology? , mental health, May 31, https://www.webmd.com/mental-health/what-is-cognitive-psychology#1-4

6.Dai, D. Y., & Sternberg, R. J. (Eds.). (2004). Motivation, emotion, and cognition: Integrative perspectives on intellectual functioning and development. Lawrence Erlbaum Associates Publishers.https://doi.org/10.4324/9781410610515

7. Elham Taati1, Mohammad Reza ZarbakhshBahri *2,(2019); Comparison of the Coherence and Defense Mechanisms between Parents of Normal Children and Parents of Children with Autism and Attention Deficit Hyperactivity Disorder, J Child Ment Health 2019,6(3): 15-27. https://childmentalhealth.ir/browse.php?a_id=391&sid=1&slc_lang=en
8. ForoughRiahi, MD1 and SakinehIzadi–mazidi, MSc•(,2012); Comparison Between the Mental Health of Mothers of Children With Autism and Control Group, Iran J Psychiatry Behav Sci. Autumn-Winter; 6(2): 91–95.

https://scholar.google.com/scholar_url?url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940011/&hl=en&sa=X&ei=_p95ZLLeJriBy9YP0MKi-AY&scisig=AGlGAw-FV928GB5q1_ahrr640uUN&oi=scholarr

9..Jaiswal, Suyog Vijay; Subramanyam, Alka Anand1; Shah, Henal Rakesh1; Kamath, Ravindra M.1

Author Information Indian Journal of Psychiatry 60(3):p 312-317, Jul–Sep 2018. | DOI: 10.4103/psychiatry.IndianJPsychiatry_259_17

10. Al-Kharusi, Khalid bin Abdullah, (2018). Investigation of the defense methods used by tenth and eleventh-grade students in South Batinah Governorate in light of some variables, (Master’s Thesis), JumaNizwa, College of Arts and Sciences, Department of Education and Human Studies, Amman, Jordan, retrieved from link]https://www.unizwa.edu.om/content_files/01029-7503.pdf[

11.Maulik PK, Harbour CK. Epidemiology of intellectual disability. In: Stone JH, Blouin M, editors. International Encyclopedia of Rehabilitation. 1st ed. Buffalo: Centre for International Rehabilitation Research Information and Exchange; 2010. [Google Scholar]

Psychopathology and coping mechanisms in Parents of children with intellectual disability

12Meral BF, Cavkaytar A: A study on social support perception of parents who have children with autism.

IJONTE.2012, 3:124-35.

13.Paulhus, D. L., Fridhandler, B., & Hayes, S. (1997). Psychological defence: Contemporary theory and research. In R. Hogan, J. A. Johnson, & S. R. Briggs (Eds.), Handbook of personality psychology (pp. 543-579). http://dx.doi.org/10.1016/B978-012134645-4/50023-8

14. Pallab K. Maulik a b, Maya N. Mascarenhas c 1, Colin D. Mathers c 2, TarunDua d 3, Shekhar Saxena e 4,(2011); Prevalence of intellectual disability: A meta-analysis of population-based studies, Research in Developmental Disabilities, Supports open access, Volume 32, Issue 2, March–April 2011, Pages 419-436

https://www.sciencedirect.com/science/article/abs/pii/S0891422210003082

15. Saul Mcleod,2023, Defense Mechanisms In Psychology Explained (+ Examples), May 12, 2023

Defense Mechanisms in Psychology Explained (+ Examples)

16. Stephanie A Hayes 1, Shelley L Watson,2013, The impact of parenting stress:

Appendix No. (1) Names of translation Experts Names

Appendix( 2)self -defence Mechanism to Kurdish Language