12th ANNUAL CONFERENCE OF THE EUROPEAN ASSOCIATION OF ISRAEL STUDIES ISRAEL AND ISRAEL STUDIES: THE EUROPEAN AND INTERNATIONAL PERSPECTIVE

Quality of Life and Mental Well-Being of
Families of Children with Severe
Developmental Disabilities
During Wartime
Dana Roth - BIS, Sagit lev - BI
Yael Karni-Visel , Nomi Werbeloff, Bar-Ilan University
Israel
40th ANNUAL CONFERENCE OF THE ASSOCIATION FOR ISRAEL STUDIES
12th ANNUAL CONFERENCE OF THE EUROPEAN ASSOCIATION OF ISRAEL STUDIES
ISRAEL AND ISRAEL STUDIES: THE EUROPEAN AND INTERNATIONAL PERSPECTIVE
Charles University, Faculty of Arts, July 1-3, 2024

Terror attack which led to the massacre of 1400
babies, children and people from southern
Israel and the Nova Nature party.
Background
On October 7th, the State of
Israel was forced to confront
a brutal reality
About 200,000 Israeli residents were evacuated
and displaced from their homes.
Hundreds of thousands men and women were
drafted to the army.
Israel has been hit by rocket and missiles
attacks, drones, anti-tank missiles, and
hundreds of sirens in most parts of the country

Research Objectives
• To examine the quality of family life
and the mental wellbeing/mental
health of parents of children with
disabilities during wartime.
• To learn about the needs, challenges
and coping of children with
disabilities and their family during
wartime.

What does the literature say? (Not much)…
Article 11 of the UN Convention on the Rights of Persons with Disabilities specifically addresses the
vulnerability of persons with disabilities in times of war and humanitarian emergencies. The article requires
States Parties to the Convention to take specific measures to protect persons with disabilities in these times.
For people with disabilities, regression in legislation and in policy achievements, exacerbated
discrimination and exclusion, increased negative attitudes and overreliance on institutional care, reduced
activity and autonomy.
Children with disabilities and their parents are more vulnerable, have limited preparedness for disasters,
with increased challenges in accessing essential services. They have limited and inadequate resources
allocated for their evacuation, protection, and rehabilitation after the disaster. As a result, there is an
exacerbation of health, developmental, and psychological problems in the long term.
War is a disaster that threatens human life, disrupts daily routines, breaks down social order, and causes
loss of resources and support systems. It leads to fear, uncertainty, lack of control, depression, anxiety,
widespread psychological distress and potential long-term consequences.

Research Procedure
The research questionnaire included both quantitative and qualitative components
(Mixed Methods).
The questionnaire was distributed to service providing organizations, on social
networks, acquaintances, professionals, parent groups, mailing lists, “WhatsApp”
groups, and via the "snowball" method by forwarding the questionnaire link.
Parents who participated responded to an online questionnaire using an anonymous
link (the questionnaires were distributed in Hebrew and Arabic).
Emphasis was placed on distributing to diverse populations in different geographical
areas and among different cultural/religious groups.

Research Instruments
Quantitative Section
Mental health Inventory (Short Form) - MHI-5 (Steward et al., 1988).
The questionnaire assesses the sense of well-being or distress experienced by the individual.
– It consists of 10 questions (5 identical - before the war; and after the outbreak of the war).
Family Quality of Life Survey (Short Form) (Brown et al, 2006).
The survey examines 9 domains: Health, Economic well-being, Family relationships, Social support,
Support from disability-related services, Values - worldview as a source of support, Education, work
preparation, and work, Leisure, Community interaction.
– Of the 6 dimensions for each domain 2 were applied: importance and attainment.
– The survey consists of 54 questions (27 identical - before the war; and after the outbreak of the war).
Socio-demographic variables
Participants answered questions about their age, gender, education level, and socio-economic status, place of
residence, and the existence of a routine in the child's educational frameworks. They were asked about their
exposure to emergency conditions, for example: a mobilized family member, evacuation from their place of
residence, and more.

Characteristics of the Research Participants N=408
Children's
characteristics
Parent and
family
characteristics
292 boys
(71.6%)
116 girls (28.4%)
Average age: 9.2 years
S.D: 5.0
Range: 1 – 21 years
58% of the children are diagnosed with ASD
10% intellectual developmental disability
11% physical disability
21% combined disability
356 mothers (
87.2%
) ;
52 fathers (
12.8%
)
Jewish (n=365, 89.5%); Arab (n=43,10.5%)
Secular (n=245, 60%)
Married (n=324, 79.8%)
With academic education (n=286, 70%)
61.3% have an
average income
or above
Half of the participants (50%, n=203) live in the Center District, Tel Aviv-Yafo
District, and Gush Dan. The remaining participants are spread across the other
districts, with 13% from the Sharon region, 10% from the North of Israel and
the Golan Heights, 8% from the Haifa District, 8% from Jerusalem and Judea
and Samaria, and 11% from Ashkelon and the South.
Parents who receive National Insurance benefits for their child (100% or higher of disability).
Childs’ age is six months to 21 years.

Parent Mental well being
Decrease in
Mental Well-Being
of 28.4%
1-6 scale

4.50
4.00
3.50
3.00
No Sig. Differences in Decline of Mental Well-Being
Across Age Groups, Disability Type, or Child’s need of support

Family Quality of Life
“For the most part, families consider their lives to be happy and
fulfilling if all members are healthy, have a safe place to live,
have a stable income, enjoy their lives together, have
opportunities to learn and improve, benefit from their community
supports and resources, and experience fulfilling social
relationship with others.”
(Zuna, Brown & Brown, 2014, p. 162)

Importance
Attainment
Satisfaction
Opportunities
initiative
Stability
Health
Financial
well-being
Family
Relationships
Support/others
Support/services
Values
Careers
Leisure
Community
Domains
Dimensions Family quality of life survey (2006)

Family Quality of Life Domains Before and During War
N=408
***
***
***
***
***
***
***
***
***

***
***
***
***
*** ***
***
***
Personal disparity Index

Major Quantitative Findings
A significant decrease in the mental well-being of the parents after the
outbreak of the war (28.4%).
A significant decrease in the quality of family life in all areas examined. The
highest gaps between the period before the war and during it were found in the
domains of leisure, studies/work/career and support from services
A significant increase in "personal disparity" has been observed, which refers
to the gap between the importance of life domains and their actual attainment.
The "personal disparity" index indicates a significant sense of deprivation in all
aspects of quality of life except for values.
●
●
●

The Qualitative Study
Aim: to examine the needs, challenges, strengths, as well as
personal, family, and community resources of parents of
children with disabilities during wartime.
The study involved preliminary qualitative research through
telephone and face-to-face interviews with seven mothers of
children with various developmental disabilities to construct and
refine the research questions.

The Qualitative Research Questions
1. What is your impression of your child's coping since the war
began (emotions, behavior, etc.)?
2. Could you please describe the different roles that your family
members took on in caring for the child with disability following
the war? How do they cope with these roles, in your opinion?
3. Is there anything else important that you would like us to
know about your child's, your family's, and your own
experiences dealing with the war situation?

Qualitative Analysis
345 participants answered the qualitative questions in the
Hebrew and Arabic languages.
The study employed a qualitative research design, utilizing
content analysis informed by the principles of inductive
analysis.
The analysis was conducted by two researchers. First, they
established interrater reliability by independently coding 20%
of the answers and then discussed discrepancies until
agreements were reached.

Findings
1. Wartime environmental challenges for parents of
children with disabilities
2. Wartime reactions of children with disabilities
2.1. Emotional reactions
2.2. Behavioral reactions
3. Wartime coping resources for families of children
with disabilities
4. Ramifications of wartime coping on parents
of children with disabilities

Exposure to
stressors
25%
Changes in the
environment
75%
Changes, Absence,
or Reduction in:
1. Educational
Frameworks
2. Routines
3.Treatments
4. Activities
1. Exposure to
traumatic events
and information
2. Sirens and
booms
3. Absence of a
parent
1. Wartime Environmental Challenges
for Parents of Children with Disabilities
(n=118)

50%
17%
14%
11%
5%
3%
Anxiety
Distress
Boredom Longing
Agitation
Restlessness
2.1. Wartime Emotional Reactions of Children with
Disabilities (n=186)

0
5
10
15
20
25
30
35
40
45
50
48
22 20 19
11 10 10 7 7 6 5 5 4 4 3 2
2.2. Wartime Behavioral Reactions of
Children with Disabilities (n=183)

Child
coping
55%
Parental
support
27%
External
support
18%
"
" "
"We don't convey stress or hysteria ,
which helps him accept the situation .
Even when we enter the safe area ,
everything remains calm".
"The child tries to
avoid the news
because he is too
sensitive. However,
reality still seeps in
through sirens and
stories he hears, and
it manifests in other
ways, such as black
humor."
"In the beginning, it
was difficult for her to
break out of the
routine, which made
daily activities
challenging. However,
now that the school has
reopened, she seems to
be gradually returning
to her routine."
3. Wartime Coping Resources for families of
Children with Disabilities (n=80)

Damage to work
and family
relationships
17%
Resilience
29%
Burden, stress
and fatigue 54%
4. Ramifications of wartime coping on parents of
children with disabilities (n=75)
"One of us closely accompanies our
daughter during her Zoom learning
sessions because she needs assistance.
The other works during the day, and then
we switch roles. It's challenging because
work often spills into the night. We feel
guilty about relying on screens and
sometimes get frustrated and lash out,
only to feel guilty again afterwards. In the
evenings, our older children want us to
spend time together watching or playing,
but we're torn between wanting to be with
them, fulfilling work obligations, and
simply feeling exhausted from the day."
" "The first two weeks were the toughest, filled with
fear. Gradually, we found our rhythm again. My
wife manages most daily care, I handle logistics,
and the sisters assist with playtime. Due to our
child's rare syndrome requiring constant
supervision, we've become accustomed to it."
"

Major Qualitative Findings
War poses a significant challenge to family members of
children with disabilities.
This situation intensifies emotional difficulties of parents and
may harm family relationships.
The reduction In service availability, combined with the
stressful situation, may lead to a worsening of the mental and
functional condition of children with disabilities.
Despite these challenges, participants emphasized the
importance of family resilience and the use of family and
personal resources to cope with the stressful situation.

Conclusions and Recommendations
There is a need for readily available
emergency plans and the development of
dedicated intervention and support
programs for families of children with
disabilities during wartime, in cooperation
with various professional bodies.
The feasibility of using the "Personal
disparity Index" as an effective tool for
identifying and responding to families in
need should be examined.
Raising awareness of the unique needs of
families of children with disabilities among
decision-makers and professional teams
during wartime and allocating dedicated
resources to support these families.
There is a need for further research to
better understand the long-term effects of
war on children with disabilities and their
families.

Benjamin Franklin,
Letter to Quincy, 11 September 1783
There never was
a good war
or a bad peace
`
danar@beitissie.org.il
Thank
you

12th ANNUAL CONFERENCE OF THE EUROPEAN ASSOCIATION OF ISRAEL STUDIES ISRAEL AND ISRAEL STUDIES: THE EUROPEAN AND INTERNATIONAL PERSPECTIVE

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12th ANNUAL CONFERENCE OF THE EUROPEAN ASSOCIATION OF ISRAEL STUDIES ISRAEL AND ISRAEL STUDIES: THE EUROPEAN AND INTERNATIONAL PERSPECTIVE