This project HE bases in analyse the level of stress that experience a cluster of mothers and parents of family with children that have Needs Educational Specials –NEE- The initiative arises by the limited documentation that exists about of the issue in Panama, since most of the approaches are directed only towards the child who has an SEN or disability, while that he state of health emotional of the father of family No is considered inside of the intervention. This study recurs to the Model Mixed, of guy exploratory. With a sampling no probabilistic that was compound by 25 parents and mothers. The participants they completed two questionnaires called "Questionnaire about stress of Solano-Beauregard” and “Questionnaire for mothers and fathers.” The results reveal that in the sample studied, it is observed that all parents scored a level of General Stress inside of the range Mild (4%), Moderate (twenty%) either Severe (76%) of equal manner HE identifies he level of involvement according to three areas: Muscular: (Mild 52%, Moderate 16% and Severe 32%), Thought-behavior: (Mild 28%, Moderate 28% and Severe 44%) and Organs internal: (Mild 36%, Moderate twenty% and Severe 44%). He finding further relevant of this study has been the high level of Stress Severe who suffer from parents of children with SEN

Keywords: family, stress, education, pressure, psychotherapeutics

The family life cycle is a progression of stages as part of development, ranging leaving an apprenticeship; between stage and stage there are moments of transition that indicate changes that produce physical and emotional alterations in each member. One of these changes undoubtedly arise when a child with a disability is born, automatically this condition it affects to all the members of the family, mostly to the mother and he father due to that is a event that usually be shocking, painful and that probably HE will extend throughout all the life cycle. Based on the above, for parents of children with educational needs special, parenting is a complex process where elements such as care of the child, the training of habits, establishments of rules disciplinary and the despair because your child cannot learn; causes them to experience a level of tension and anxiety due to the uncertain future they are going through, which can lead to levels high stress; “since stress usually appears when faced with certain events in the which HE find situations that imply demands very powerful for the individual, that they can exhaust their resources of coping”.¹

Hans Selye cited by Oblitas et al.,² defines stress as: “the non-specific result of any demand about the body that has a result physical either mental". This Physiological response is a normal part of the body's preparation for training or for the flight; and, to his time, triggers a series of disorders physical in the organism of the person who suffers from it. Additionally, the arrival of a member with SEN with or without disability, can to provoke a stage of crisis, "a period of imbalance, in people who face dangerous circumstances, since they constitute a problem for the subject important, that by the moment No can avoid, neither solve, with the resources accustomed”.³ Facing these crises for families represents, so much the chance of growth, maturity and strengthening, as he danger of deterioration of the state of health of its members.

Having made the previous considerations, the research question arises: What is the level of stress experienced by a group of mothers and fathers with children who present Needs Educational Special? Of the same mode, HE establish goals with in order to analyze the level of stress experienced by this group of parents, second, evaluate the level of stress that they present through the Questionnaire of Solano Beauregard, the main stressors to which they are exposed are then identified exposed and finally seeks to determine the coping strategies used for the management of stress by part of the mothers and parents of family. In the case of this study, the initiative arises from the scarce documentation that exists about about the topic in Panama, since most of the approaches are directed only towards the child who has an SEN or disability, while the state of emotional health of parents is not considered within the intervention. This study proposes give a direct approach to the emotional state of the parents who are the ones who provide the support and accompaniment throughout this process fighting for the children to assume positive attitudes inside and outside the home promoting healthy stress management and mostly exhort to the elaboration of programs that toast aid and accompaniment in the process of adapt to the new situation of have a son with SEN.

This study recurs to the Model Mixed, he guy of investigation to use was exploratory, employing he design pre-experimental. The data quantitative were collected to through of two questionnaires called "Questionnaire about stress of “Solano-Beauregard” and "Questionnaire to mothers and parents of family". The sample was formed by 25 parents and mothers, whose ages oscillated between 25 and 70 years old; with children who have Special Educational Needs. Parent’s family issues were addressed directly at the time of application of the questionnaires. One of the criteria of inclusion was that the parents of family had children that present a SEN with either without disability.

Instrument

The instruments used were two questionnaires, the first one named “Solano-Beauregard Stress Questionnaire”, the questionnaire has 60 items that have been been drafted in shape of prayer either questions and is of self-application, where the answer of Yeah, indicates the presence of the symptom either situation; while that the answer No, indicates that No apply the statement. The results show the level of stress in each area and according to the percentage obtained HE classify in mild, moderate and severe and identifies he level of affectation according to three areas: 1- Muscular Area, composed of 20 items, 2- Thought-behavior, 20 items and 3- Organs internal, 20 items. The second instrument was “Questionnaire for mothers and fathers”, this questionnaire was made to carry out the research and consists of 10 questions, where each one addresses and rescues the knowledge, experience and emotions that a parent or child may feel mother of family front to the breeding of a son that presents SEN Pussy without disability. For achieve cover the population to survey, HE solicitous to the University Latin of Panama campus of David a letter directed to the institution where HE will find he cluster of parents of family required to carry out this research, in addition to the approval by the competent authorities of the university. It is established that participation is voluntary, both the questionnaires are answered anonymously and with complete confidentiality, no repercussions towards the participants.

HE present the results obtained with the purpose of reply to the goals raised in this research. For data analysis at a quantitative level, with the Microsoft Office Excel 2013 package and in the qualitative part coding and category data analysis and triangulation. The sample was applied to 25 parents of children with SEN Pussy without disability. Once the application of the instruments used was completed, the analysis was carried out, interpretation and discussion of the results where it is evident that fathers and mothers participants HE find subjected to constants sources of stress and that this has generated a harmful impact on their state of health. It should be noted when the degree of stress, pressure or change that occurs within the system reaches a level that is either very high or very low in which the members involved begin to express dissatisfaction or developing symptoms, which lead to an emotional disorder, is considered to be facing up a stress severe. In relationship to this last, according to boss aforementioned by Prey: "Enough with that an only family member manifests altered physical or emotional symptoms to understand that the degree of family stress is not optimal for him, therefore the family is in trouble”. The author compares stress to a force that presses, pushes or unbalances the family structure, although it mentions that this impulse can originate, so much inside as out of the system familiar, but is the same power that indicates he level of stress.

The Organization world of the Health postulate that he stress is "he set of physiological reactions that prepare the organism for action” maintains alert in view of the changes of the atmosphere that they can suppose, anticipating the needs and the resources to address them. This physiological response is a normal part of preparation of the body for the training either the flight and, to his time, triggers a series of physical disorders in organism of the person that suffers from it. In that same sense, to respond to the general objective which was aimed at analyze the level of stress experienced by a group of mothers and fathers with children that present Needs Educational specials, HE they got the following results. In Figure 1 Stress General, HE appreciate that of the 25 participants to the that HE them applied he Questionnaire about stress of Solano- Beauregard, he 76% HE located in the range Severe, he twenty% in a level Moderate while that the 4% HE kept inside of the Mild range.

Figure 1 Stress general.
Fountain: Gonzalez, Jimenez & towers Stress level ranges established according to the Solano Stress Questionnaire. Beauregard 0-25: mild, 25-50: moderate and 50 or further: severe.

According to the above, the results indicate that the most relevant characteristic is the elderly punctuation of Stress Severe that are suffering the parents of family with children that present SEN By returning to what was stated by Hans Selye cited by Oblitas et al.,³ who defines stress as “the non-specific result of any demand on the body that has a physical or mental result”, it is possible to observe that the participants of the study are experimenting events that are surpassing their personal resources and there is no relevant management for the care of your health.

In the same order and address, HE found he article that carry by qualification Stress parental with children with Special Needs,⁴ presented a study that evaluated parents that have children that they live with disabilities that included disorder by deficit of attention with hyperactivity, bipolar disorder and Down syndrome. The research analyzed a extent clinic of stress together with the answers of the survey of the parents. "Our findings indicate the magnitude of the stress diary additional that face are families", said the author major, Marsha Mailick seltzer, of the Center Waisman of the University of Wisconsin. The study showed that parents of children with disabilities had a greater amount of stressors and a greater number of days during which they had at least a stressor. They reported having at least one stressor in 50 percent percent of study days, compared to 40 percent of other parents, they also reported experiencing a greater number of physical health problems. The daily cortisol patterns of parents of children with disabilities showed a chronic tension that was much higher than normal on the days when parents spent further time with their children. In conclusion, can to have consequences to long term for the health of the deregulation of the cortisol, by what is important moderate he stress. He questionnaire about stress of Solano- besides of reflect the levels of stress to the which HE come subjected the people to level general It allows appreciate he stress in three dimensions: Muscular, Thought-Behavior and Internal Organs, from which the following were obtained in results (Figure 2).

Figure 2 Area muscular.
Fountain: Gonzalez, Jimenez & towers Stress level ranges established according to the Solano Stress Questionnaire. Beauregard 0-25: mild, 25-50: moderate and 50 or further: severe.

Human beings, when faced with situations that they cannot control, experience discomfort muscular level, respiratory, cardiovascular organs, appearance of depressive symptoms, anxiety or feelings of fear, sleep disturbances and concentration difficulties,⁵ this was verified through the results of the Solano-Beauregard Stress Questionnaire in graph #2, which indicates he level of stress that suffer the parents of family in the Area Muscular. The punctuation further high was 52%, which is in the mild range, followed by 32% in the severe level and finally, 16% suffer of stress moderate. In relation to the latter, the authors Hellriegel, Slocum Wodman cited by Esquivel et al.,⁵ to mention that the agents stressful They are “demands” physical or psychological characteristics of the environment that cause stress”, that is, it is a response of character physiological, that produces changes in the organism in view of some situation either event that HE converts in a agent stressful creating demands in the individual of a physical and psychological nature, where they feel that they do not have the capabilities to can cope with it; in this order the Needs Educational Specials with either without Disability is considered a stressor; since it is an event that causes an impact on the entire family system and the effects vary from person to person and also from family to family taking into account that the way the body reacts goes to depend of the genetics of each organism.

TO difference of the stress mild, the people with stress chronic, they start to suffer further consequences direct with his organism; he same begin to interfere with his ability it which no you it allows carry a style of life normal during a period dragged on, turning further dangerous. The Association American of Psychology, in his place Web, dedicate an article about the issue "As he stress it affects your health"⁶ where The authors, from their personal point of view, state: Stress can make problems worse existing; It can also cause illness, either from changes in your body or from overeating, smoking and other bad habits that people use to cope with stress… How much further hard stress, worse is for the mind and the body (Figure 3).

Figure 3 Area thought – conduct.
Fountain: Gonzalez, Jimenez & towers Stress level ranges established according to the Solano Stress Questionnaire. Beauregard 0-25: mild, 25-50: moderate and 50 or further: severe.

In the result of Graph #3, the percentages obtained in the Thought-Behavior area, registering the high figure of 44% that is located in the range of severe stress, being the highest percentage, while 28% corresponds to range of moderate and mild by equal. In effect, this HE does evident to through of the "Questionnaire to mothers and parents of family"; where they manifested that they think constantly in the SEN that their child suffers and they feel discomfort that invades them body: “I feel fatigued, irritated, with headaches”, “I think it is accumulation of fatigue", "body tired, weak" it that leaves in evidence he discomfort physical and emotional that are going through. According to the above, what was proposed by Femenías & Sánchez et al.⁷ who They affirm that...thoughts undergo a radical transformation when the child is born with some type of alteration, whether physical or psychological, adding to said stage of the life cycle familiar a stress "extra" that the parents face of different ways and with elderly either minor success; added to this the responsibility of the careful diary, generating strain and a effect cumulative; it that It represents a factor of risk for the health physical and mental.

It should be added that parents go through a series of feelings such as fear, guilt, sadness; including the denial phase due to the situation they are experiencing and the hope of standardization of the son/daughter "Are emotions the accompany in the moment knowing the medical diagnosis, but they are reactivated in each of the circumstances associated medical or rehabilitative practices and in the face of the various challenges of parenting”,⁸ which keeps parents in constant submission to the stress already that they must to revive these feelings each time that happen a event that exhaust of her hands and in the which consider that No they drive the control total of the situation. In this sense, the author Ritchie et al.,⁹ in his article titled "Children born with disabilities: how families respond”, mentions the reactions of family members in special of parents when faced with a child with disabilities. It describes that the Parents often suffer from psychological stress, a feeling of loss and low self-esteem. "The Parents may direct their anger toward others, their partner, the doctor, or other families who do not have this stress. Some parents they negotiate with his elderly can. By example, Yeah you fury my child from the disability, I will stop drinking or... They may feel guilty that the child is a punishment for a past sin or that they excessively protect this child that It is a symbol of your failure (Figure 4).

Figure 4 Organs internal.
Fountain: Gonzalez, Jimenez & towers Stress level ranges established according to the Solano Stress Questionnaire. Beauregard 0-25: mild, 25-50: moderate and 50 or further: severe.

In the results of graph #4, the percentages obtained in the Organs Area are observed. Internal, where he 44% of the population evidenced a range of stress severe, while that he 36% mild and finally, 20% a moderate level. In that same sense, of agreement to oblites et al.,³ some of the alterations further Common symptoms caused by chronic stress are: “dyspepsia, gastritis, insomnia, colitis nervous, migraine, depression, aggressiveness, dysfunction familiar, neurosis of distress, disorders sexual, dysfunction labor, hypertension arterial, heart attack to the myocardium, addictions, thrombosis cerebral, behaviors antisocial and psychosis severe”. By other part, convenient mention that in each individual the characteristics of the stress vary, due to that he same No comes of a alone fountain, and besides because exist multiple stressors, which can cause changes in our lifestyle and body affecting health.

It is evident then that the illness of the children affects and deteriorates the health of the children. parents, already be due to the presence of a Need Educational Special either to the coping, non-adaptive response to some stressful event, which reveals the need to promote a driving healthy of the stress through a approach straight to the state emotional of the parents who are the ones who provide support and accompaniment throughout this fighting process for that the children assume positive attitudes inside and out of home. It is valuable to add the response of a participating mother based on question #7 of the “Questionnaire for mothers and fathers” that investigates the situations that make them feel tense: “sometimes when I want to help him and I think I don't know how I can do it” which makes it evident that the lack of knowledge of parents in certain areas of attention of the child generate TRUE degree of frustration in they, feelings of impotence and of blame that leads them to No consider "good parents".

In this order of ideas, De Gracia et al.,¹⁰ can be cited, who states: Parents are further prone to think that their children No will advance and such ideas possess as base feelings and beliefs related to the fact that they consider they lack knowledge basic about the contents that their children they must study, he driving of tools and others inherent elements in education; which leads them to feel fear in the use of pedagogical strategies and the methodology they use to care for or support their child in home. Therefore, the father, by ignoring or partially managing the care, education and attention of a son with SEN with either without disability will present difficulties for understand and provide adequate and optimal support for the development of the activities of growth and development that requires she child, situation that them has an impact to lead a healthier lifestyle for both the child and the father in turn makes it difficult to good stress management.

The research project had three specific objectives: to respond to the first aim, managed to assess he level of stress that experience a cluster of mothers and parents of family with children that present Needs Educational Specials HE applied the questionnaires called: "Questionnaire about stress of Solano-Beauregard et al.,¹¹” and "Questionnaire to mothers and parents of family", where evidently he has identified that Yeah There is a level of stress that is closely related to the situation they are going through. HE You should take into account that the level varies depending on the type of disability being addressed face the parents of family. In this order of ideas HE can mention he article of the page Web titled Comparison of parental stress among mothers and fathers of children with Autism Spectrum Disorder in Iran where the results of this study revealed that the Mothers of children with ASD had higher levels of stress than fathers. The amount of Parental stress was correlated with the severity of the disorder in the child. Therefore, the parents whose children they had disorders further serious reported levels further tall of stress in parenting. These findings show that parents with children with ASD have many needs emotional that they must consider to plan the strategies of treatment effective for these children and its families.

Knowing the nature of stress can help mental health professionals to inclusion and assessment of parents in programs to receive further support and intervention effective in reducing stress levels, therefore it was of utmost importance that the Parents will express their emotions openly and express possible stressors that consider intervene in the quality of life so much of the son like of the themselves. In that same sense, the second objective is proposed, which was aimed at identifying the main stressors to which fathers and mothers are exposed, the data reveal as a marked event stressful he diagnosis of the SEN with either without disability, of one of the family members and the helplessness of not being able to change it or adjust it to the expectations that were had regarding that expected child. Fits indicate the parents' responses in the Questionnaire for mothers and fathers on the question #7: Describe those situations that make you feel tense or that make you think that you have lost he control about it that happens; prevailed the worry by the state of health of the child or progress in the learning process. As expressed by the parents “when the child gets sick I feel like I lose control", "when the child has seizures", "when the child he does not advance, he remains stagnant” or “when there are setbacks in his learning”. Likewise manner they manifested others sources of stress as issues of nature economic, personal situations such as marital separation and complications in organizing the activities relatives daily.

With reference to the above, the article titled Challenges faced by parents of children with learning disabilities in Opuwo, Namibia¹² where to leave of the investigation, remained clear that the parents of children with issues learning faces a series of challenges, such as difficulties in accessing information, services and programs. Most parents, referred by caregivers, They also experienced prejudice since it is thought that the parents distanced themselves from the children avoiding being judged for beliefs in the region; Therefore, they were not responsible for the emotional and financial support of these children. The participants also expressed that experience difficulties financial and No they know the services and programs of that should benefit your children, added to this the separation conjugal.

As has been seen, stress appears when faced with external events in the life of the being human, doing interaction with the answers cognitive, emotional and physical. When some member of the family system is not emotionally strong or ignores the techniques for front facing he stress and the burden you result excessive, with all probability will end tripping either goes succumb to any obstacle that HE you present.¹³ In relation to the above, according to the results obtained through the Questionnaire for mothers and parents, HE evidenced the lack of techniques propitious for achieve adaptive coping with the stressful events to which they are exposed the participating fathers and mothers, in addition, a listening request that they Allow participants to express their emotions and what being father either mother of a child with SEN Having made the previous considerations, responding to the third objective, which was aimed at determining the coping strategies used to manage stress On the part of mothers and fathers, it is observed that they are not as effective for the participating population because ailments, both physical and emotional, prevail that HE manifest in levels elevated of stress, by it that he driving is maladaptive and HE does necessary foment The learning of strategies adaptive.

Regarding the limitations of the study, there is the lack of accessibility to references bibliographical information on studies previously carried out in the country focused on parents of family; also he factor time already that he study HE development in the period between September and December, which is a very short period for its full execution. Furthermore, it coincided with national holidays, school activities for culmination of the school year and of course access to parents was a little difficult due to the working hours that some they had.

The results allowed us to verify the research hypothesis, where 100% of the parents presented a level of stress general broken down of the following manner: he 4% HE located within the mild range, 20% moderate range and 76% within the severe range. Likewise In this way, the scores of the categories were recorded, obtaining in the Muscular area a 52% in stress mild, 16% moderate and 32% severe, next in the area of Thought-Behaviour 28% mild, 28% moderate and 44% severe and, finally, Organs Internal with a 36% in level of stress mild, twenty% moderate and 44% severe. It is appropriate to highlight question #1 from the Questionnaire for mothers and fathers: From it that you know as could define the term Needs Educational Special? Where it was observed that parents do not handle it clearly, since some definitions only contemplate people who have some degree of disability, others are centralize in the aid either attention that HE them has to toast to the children for that achieve to access to the learning, some it compare with limitations that never you will allow be related with other children or people within society and finally, there are parents, who even though They have a child with SEN, they do not master any concept. In relation to the latter, considers it appropriate to create an intervention plan that implements training day’s theoretical training – practices aimed at parents for management and care of the needs educational specials in home.^14–16

Regarding coping techniques used to manage stress, parents They mentioned: see videos, read newspaper, clean the home, go to run, between others; HE observe that the themselves No are so effective for the population competitor because prevail ailments, both physical and emotional, that manifest themselves in high levels of stress, Therefore, management is maladaptive and it is necessary to promote the learning of adaptive strategies. Due to the indices obtained in the questionnaire, it is considered necessary to propose to the institutions where children with SEN with or without disabilities receive the creation of Groups Psychotherapeutics for fathers and mothers that can focus on the management of specific problems, in the acquisition of cognitive-behavioral and enable a space of listen that them allow to the participants express their emotions and feelings so that they take advantage of the benefits that the group experience offers such as method therapeutic.

This investigation it is a first approach to the topic of stress suffered by women. mothers and fathers of families with children who have SEN with or without disabilities, Through it, an opening is created for research centers, universities, institutions either public in general interested in this project can deepen and enlarge research, creating a solid platform that supports both parents of family as to Panama.

None.

The authors declare that there is no conflict of interest.

None.

1. Spout Vindel TO. Techniques cognitive in the control of the stress. 2002.
2. Oblites Guadeloupe L. Psychology of the health and quality of life. Mexico: Cengage Learning editors, SA of CV; 2010.
3. Conti A. Emotional manifestations in the mother upon the arrival of the child with different capacity. Buenos Aires, Argentina; 2011.
4. Nauert R. Parental stress with special-needs children. 2018.
5. Esquivel D, Jimenez M, Jimenez M, et al. Development and implementation of a health education program: a approach of the level of the stress in a cluster of relatives of people drug addicts. Costa Rica; 2008.
6. Krantz D, Thorn B, Kiecolt J. Stress effects on the body. American Psychological Association. 2013.
7. Femenías M, Sanchez J. Century Zero Magazine Spanish about Disability Intellectual. 2003;19–28.
8. David Chiriqui. Durán Estrada M. Family and disability: experiences of mothers and fathers who have a deaf or blind child. Venezuela. 2011.
9. Ritchie M. Children and collecting. Child Research Net. 2013.
10. De Gracia S. Diagnosis of care and management of educational needs specials by parents of children of Yo to III degree of Lion's School; 2018.
11. Soltanifar A, Akbarzadeh F, Moharreri F, et al. Comparison of parental stress among mothers and fathers of children with autistic spectrum disorder in Iran. Iran J Nurs Midwifery Res. 2015;20(1):93–98.             
12. Taderera C, Hall H. Challenges faced by parents of children with learning disabilities in Opuwo, Namibia. Afr J Disabil. 2017;6:283.
13. Borges M, Melgosa J. The power of hope. How to defeat depression anxiety, guilt and stress. Florida. United States: Inter - American Division Publishing Association (IADPA); 2017.
14. Presa M. Stress in the family and family functioning in a psychiatric hospital Of Mexico; 2015.
15. Ritchie M. Children and collecting. Child Research Net. 2013.
16. Rivadeneira C, Minici TO, Daha J. Magazine Therapy Cognitive Behavioral. 2013.