Effectiveness of Orff-Based Music Therapy on Parental Burnout and Parent–Child Interaction in Mothers of Children with Down Syndrome: A Quasi-Experimental Study
Keywords:
Music Therapy, Parental Burnout, Parent–Child Interaction, Down Syndrome, Orff SchulwerkAbstract
This study aimed to investigate the effectiveness of music therapy based on the Orff Schulwerk approach in reducing parental burnout and improving parent–child interaction among mothers of children with Down syndrome. A quasi-experimental design with a pretest–posttest–follow-up structure and a control group was employed. The sample consisted of 30 mother–child dyads recruited from a specialized rehabilitation center in Isfahan, Iran, and randomly assigned to experimental (n = 15) and control (n = 15) groups. The experimental group participated in a 10-session music therapy program (60 minutes per session), while the control group received no intervention. Data were collected using the Parental Burnout Assessment (PBA) and the Child–Parent Relationship Scale (CPRS). Statistical analyses included repeated measures ANOVA and multivariate analysis of covariance (MANCOVA). The findings revealed that music therapy significantly reduced overall parental burnout in the experimental group compared to the control group (p < 0.01), with a large effect size. Specifically, significant improvements were observed in the dimensions of parental exhaustion and feelings of being fed up with the parental role. However, no significant changes were found in emotional distancing or contrast with the previous parental self. Regarding parent–child interaction, no significant improvement was observed in the overall interaction score. Nevertheless, a significant reduction in excessive dependency was identified (p < 0.01), while the dimensions of conflict and closeness remained unchanged. Music therapy based on the Orff Schulwerk approach appears to be an effective intervention for reducing parental burnout among mothers of children with Down syndrome, particularly by alleviating emotional exhaustion and negative feelings toward parenting. However, its effects on broader parent–child relational dynamics are limited and selective. Integrating music therapy with targeted psychological and parenting interventions may enhance its impact on interaction quality.
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1. Kaczorowska N, Kaczorowski K, Laskowska J, Mikulewicz M. Down syndrome as a cause of abnormalities in the craniofacial region: A systematic literature review. Advances in Clinical and Experimental Medicine. 2019;28(11):1587-92. doi: 10.17219/acem/112785.
2. Jain A, Boyd NK, Paulsen KC, Vogel BN, Nguyen L, Santoro JD. Ophthalmologic and neuro-ophthalmologic findings in children with Down syndrome. American Journal of Medical Genetics Part C, Seminars in Medical Genetics. 2023;193(4). doi: 10.1002/ajmg.c.32068.
3. Horne RSC, Shetty M, Davey MJ, Walter LM, Nixon GM. Follow-up of children with Down syndrome and sleep disordered breathing and the effects of treatment on actigraphically recorded sleep, quality of life, behaviour, and daytime functioning. Journal of Sleep Research. 2023;33(1).
4. Alrayes N, Issa NM, Alghubayshi OY, Al-Amaa JY, Alsabban AH, Al Shaer DS, et al. Quality of life in children with Down syndrome and its association with parent and child demographic characteristics: Parent-reported measures. Molecular Genetics & Genomic Medicine. 2023;12(1). doi: 10.1002/mgg3.2337.
5. Rezaei M, Nojomi M, Darvishi A, MohamadiParsa N. Cost-benefit analysis of Down syndrome screening in Iran. 2021.
6. Cheng AWY, Lai CYY. Parental stress in families of children with special educational needs: A systematic review. Frontiers in Psychiatry. 2023;14:1198302. doi: 10.3389/fpsyt.2023.1198302.
7. Desimpelaere EN, De Clercq LE, Soenens B, Prinzie P, De Pauw SS. Parenting a child with Down syndrome: A qualitative study on parents' experiences and behaviors from a self-determination theory perspective. Journal of Pediatric Nursing. 2024;74:e14-e27. doi: 10.1016/j.pedn.2023.10.021.
8. Findling Y, Itzhaki M, Barnoy S. Parental burnout: A model of risk factors and protective resources among mothers of children with/without special needs. European Journal of Investigation in Health, Psychology and Education. 2024;14(11):2883-900. doi: 10.3390/ejihpe14110189.
9. Mikolajczak M, Gross JJ, Stinglhamber F, Norberg AL, Roskam I. Is parental burnout distinct from job burnout and depressive symptoms? Clinical Psychological Science. 2020;8(4):673-89. doi: 10.1177/2167702620917447.
10. Guo X, Li Y, Hao C, Wang W. Parental burnout, negative parenting style, and adolescents' development. Behavioral Sciences. 2024;14(3):161. doi: 10.3390/bs14030161.
11. Wu K, Wang F, Wang W, Li Y. Parents' education anxiety and children's academic burnout: The role of parental burnout and family function. Frontiers in Psychology. 2022;12. doi: 10.3389/fpsyg.2021.764824.
12. Karimi E, Dashtbozorgi Z. Effectiveness of parent-child interaction group training on behavioral problems and mother-child relationship in mentally retarded children. Journal of Psychiatric Nursing. 2019;7(5):36-43.
13. Oteva NI, Malyarchuk NN, Pashchenko LP, Pashchenko EV, editors. Relations in the mother-child dyad in a family raising a child with disabilities. Proceedings of the International Scientific and Practical Conference on Education, Health and Human Wellbeing (ICEDER 2019); 2020.
14. Leung JTY, Fung ALC, Shek DTL, Leung GSM. Perceived overparenting and developmental outcomes among Chinese adolescents: Do family structure and conflicts matter? Journal of Social and Personal Relationships. 2020;38(2):742-64. doi: 10.1177/0265407520971713.
15. Zhang J, Cao T, Guo C. A family dynamics theory perspective on parenting styles and children's aggressive behavior. BMC Psychology. 2024;12(1). doi: 10.1186/s40359-024-02217-3.
16. Hisan K, Muzakkir M, Fitriyani F. Parents' communication patterns towards children with mental disorders. Jurnal Sosiologi Dialektika Sosial. 2024;10(2):135. doi: 10.29103/jsds.v10i2.17256.
17. Tzoka V, Evgenieva E. Music therapy as a holistic approach. Annual of Arts. 2024;117:377-93. doi: 10.60059/GSU.FNOI.Iz.117.377-393.
18. Belousova MV, Utkuzova MA, Futin EV. Music therapy in the integrated neurorehabilitation of children with autism spectrum disorder. Practical Medicine. 2022;20(3):34-9. doi: 10.32000/2072-1757-2022-3-34-39.
19. Zou H, He Y. Analysis of the moderating effect of music therapy on autism in the context of big data. Applied Mathematics and Nonlinear Sciences. 2024;9(1). doi: 10.2478/amns-2024-0153.
20. Koopsen C. The role of shared musical experiences in parent-child relationships. Music and Science. 2020;3(1):1-13.
21. Wang L, Odena O. Improving classroom inclusion through Orff-inspired music education: A study from a secondary school in Fujian, China. Music Education Research. 2025;27(2):191-202. doi: 10.1080/14613808.2025.2465238.
22. Kakaziani TE, Rooij Ad, Bakel HJAv. A Perspective on How Music Performance Training in Childhood and Adolescence Transfers Across Creative Domains Through Self-Regulation and Parental Support. Music & Science. 2025;8. doi: 10.1177/20592043251364627.
23. Zhang X. Music as a language: Assessing the extent to which active music therapy promotes socialization development for children under 12 with Down syndrome. Scholarly Review Journal. 2023;Fall 2023(6). doi: 10.70121/001c.121698.
24. Lin Y, Wang Y, Lin C, Ni Q, Jia R, Chang Y, et al. The mediating role of perceived social support: Alexithymia and parental burnout in parents of children with autism spectrum disorder. Frontiers in Psychology. 2023;14. doi: 10.3389/fpsyg.2023.1139618.
25. Avezum MDMDM, Linhares MBM, Altafim ERP. Spanking and corporal punishment parenting practices and child development: A systematic review. Trauma, Violence, & Abuse. 2022;24(5):3094-111. doi: 10.1177/15248380221124243.
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Copyright (c) 2026 Neda Birjandi (Author); Zohreh Latifi; Behrokh Dayhimnia, Fakhrossadat Khosravani Nazari (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
