Development and validation of the Peer Interaction Macro-Coding System Scales (PIMS): a new tool for observational measurement of social competence in youth with spina bifida

The importance of friendship: influence of peer relationships on physical and mental health in youth with spina bifida

OBJECTIVE

To evaluate associations between peer relationship factors (i.e., quality and quantity) and mental and physical health outcomes in youth with spina bifida (SB).

METHODS

One hundred and forty youth with SB (Mage = 11.43; 53.6% female) were recruited as part of a larger longitudinal study. Families of youth with SB were invited to ask the child's closest friend to participate. The study included questionnaire (youth- and parent-report) and observational peer interaction data.

RESULTS

Observational peer interaction data were associated with mental and physical health in youth with SB. The number of friends was negatively associated with withdrawn/depressed behavior. Self-reported friendship quality and peer emotional support were not associated with physical health outcomes in youth with SB. However, peer emotional support was positively associated with emotional quality of life.

CONCLUSIONS

Friendship quality, particularly observed peer interaction characteristics, was associated with better mental and physical health adjustment. The quantity of friendships was not associated with physical health outcomes but was associated with mental health outcomes. Findings have implications for clinical interventions geared toward improving social functioning in youth with SB.

Adaptation of the German language version of the QUAlity of life assessment of spina bifida for adults (QUALAS-A-G)

INTRODUCTION

Spina bifida (SB) affects almost all activities in daily life and therefore also health-related quality of life (HRQOL). To assess the HRQOL of adults with SB, a self-reported QUAlity of Life Assessment of Spina bifida in Adults (QUALAS-A) was validated in English. The purpose of this study was to develop and validate a German version of QUALAS-A.

METHODS

German-speaking adults > = 18 years were recruited at a tertiary center and through an SB association. Two urologists translated the QUALAS-A into German. Face and content validity were assessed by adults with SB. Back-translation into English was performed. QUALAS-A-G was administered online as part of a larger study of sexuality in SB. Internal consistency was verified using Cronbach's alpha. Factor analysis, convergent validity, and differences between groups based on continence were established.

RESULTS

A total of 45 adults with SB participated (median age of 29 years old). Domain scores demonstrated no floor and minimal ceiling effects. Cronbach's alpha determined good internal consistency (0.58-0.70). The factor analysis converged to a somewhat different three-factor structure compared to the original version, but otherwise had similar properties to the original. Construct validity revealed moderate associations (r = 0.36-0.65) between QUALAS-A-G domains, indicating they measure different aspects of HRQOL. Adults who were continent of both urine and stool reported higher QUALAS-A-G scores than those who were incontinent.

CONCLUSION

We demonstrated QUALAS-A-G to be reliable and valid in German-speaking adults with SB. The QUALAS-A-G could be a useful tool for communication between adults with SB and medical staff.

Social Skills and Medical Responsibility Across Development in Youth With Spina Bifida

OBJECTIVE

To examine the predictive role of social skills in youth with spina bifida (SB) on growth in medical responsibility across development.

METHODS

As part of a larger, longitudinal study, 140 youth with SB were assessed across four time points (ages 8-22 across time points). Mixed-effects models were investigated for change with: (a) no predictors (i.e., change in medical responsibility across age; time was examined using the participant's age, centered at 11.5 years); (b) social variables (i.e., observed social behaviors, parent- and teacher-reported social skills) as predictors; and (c) social variables as predictors with intelligence quotient, lesion level, and sex as covariates.

RESULTS

Significant growth with age was identified for medical responsibility (p < .0001). Observed, parent-reported, and teacher-reported social skills did not significantly predict this growth; however, all three predicted the intercept for medical responsibility at 11.5 years of age (ps ≤ .047). Parent-reported social skills remained a significant predictor of the intercept at 11.5 years of age when including the covariates (p = .008).

CONCLUSIONS

Children with SB who exhibited more positive social skills were more likely to a have higher level of medical responsibility in late childhood, but higher levels of social skills were not associated with a more rapid increase in responsibility over time. Identifying existing social strengths and promoting the practice of prosocial skills may have additional benefits to children with SB, including their acquisition of medical responsibility.

Affective attunement in peer dyads containing children adopted from institutions

Children who have experienced institutional care early in life tend to show deficits in behavioral and adrenocortical regulation that impact their ability to form friendships and have positive social interactions with peers. Understanding how post-institutionalized children interact with unfamiliar peers and the factors that predict the quality of these interactions may shed light on the processes contributing to the persistent, often increasing social deficits seen in post-institutionalized children. In this study, one child (either post-institutionalized or non-adopted; the "target") interacted with another non-adopted child (the "peer"; N = 58 dyads, M age = 9.65 years) through a series of competitive and cooperative games during which interaction quality and affect of each participant were coded. Three saliva samples were also collected from each participant to measure cortisol production across the session. No group differences in behavior, affect, or cortisol were found. However, non-adopted target children's affect was positively associated with their peers' affect and negatively associated with peers' change in cortisol across the session, while post-institutionalized target children's affect was not associated with their peers' affect or cortisol. Thus, future interventions may want to promote social skills in children exposed to early adversity by focusing on dyadic social contingencies rather than individual behavior.

Friendship Quality Over Time in Youth With Spina Bifida Compared to Peers

OBJECTIVE

Examine friendship qualities (i.e., control, prosocial skills, positive affect, support, companionship, conflict, help, security, and closeness) and perceived self-efficacy in friendships of children with spina bifida (SB) and chosen peers over time through observed behaviors and self-report.

METHODS

Families of children with SB (aged 8-15) were asked to invite the child's "best friend" to participate in-home assessment visits; 127 friendship dyads were included in the current study. Mixed-effects models were used to examine children with SB and their peers across age on observed behaviors and self-reported data about their friendships.

RESULTS

For observed behaviors, peers displayed more control (p = .002) and prosocial behaviors (p = .007) with age than youth with SB. Male peers displayed higher control in their interactions as they aged (p = .04); and males with SB maintained their level of prosocial behaviors with age, compared to an increase in prosocial behaviors with age for all other groups (p = .003). For self-reported data, there was no evidence to suggest significant differences in friendship qualities across age (ps ≥ .2), with the exception of increased help (p = .002). Female peers reported increases in companionship across age compared to the other groups (p = .04).

CONCLUSIONS

Differing from previous examinations of social characteristics in SB, most longitudinal trends in friendship qualities did not differ for youth with SB compared to their peers. Promotion of this existing social strength may be a key intervention target for future strategies that promote positive outcomes for youth with SB.

Cultural Considerations for Autonomy and Medical Adherence in a Young Palestinian American Muslim Female With Spina Bifida: A Longitudinal Case Study in a Research Context

This case study examines the unique presentation of a young Palestinian-American Muslim female, who is a part of an ongoing longitudinal study examining family and peer relationships, psychological adjustment, and neuropsychological functioning in youth with spina bifida. Throughout ten years of data collection, Palestinian-Arab culture and Islamic faith have consistently emerged as important factors that can be considered when interpreting this participant's general level of autonomy, medical autonomy, medical adherence, and psychological adjustment. This case study examines important aspects of adaptive and independent functioning for youth with spina bifida and how this family's culture interacts with these different domains of functioning. Moreover, it explores potential conflicts between an Arab collectivist family structure and Western biomedical ethics and suggests how clinicians might navigate these conflicts and bolster culturally-rooted strengths of families and patients from non-Western backgrounds.

Social Skills in Youth With Spina Bifida: A Longitudinal Multimethod Investigation Comparing Biopsychosocial Predictors

Objective

To examine the relative contributions of neuropsychological (attention and executive function), family (cohesion and conflict), and health (body mass index, lesion level, gross motor function) domains on social skills over time in youth with spina bifida (SB).

Methods

In all, 140 youth with SB (T1 mean age = 11.43 years) and their families participated in the study at baseline with an additional visit 2 years later. Study variables were assessed with multiple methods (questionnaire, medical chart review, observation, neuropsychological tests) and reporters (parents, teachers). Multivariate hierarchical linear regressions determined the predictive power of the three domains for T2 social skills.

Results

Neuropsychological variables accounted for significant variance in mother- and father-reported T2 social skills. Neither family nor health variables contributed significantly to later social skills when other domains were included in the model.

Conclusions

Neuropsychological factors are particularly important for social skill development in youth with SB. Findings can inform screening and intervention practices.

Observed differences in social behaviors exhibited in peer interactions between youth with spina bifida and their peers: neuropsychological correlates

OBJECTIVE

To identify differences in social behaviors in observed peer interactions between children with spina bifida (SB) and peers, and to examine neuropsychological correlates of these differences.

METHOD

A total of 100 youth (aged 8-15 years) with SB and peers participated in video-recorded interaction tasks, which were coded for interaction style, affect, and collaboration. Children with SB also completed a neuropsychological test battery.

RESULTS

Children with SB demonstrated less adaptive social behaviors in peer interactions, particularly within the interaction style domain. Observational items found to be different between children with SB and their peers were best predicted by social language and attention abilities.

CONCLUSIONS

Children with SB exhibit a less adaptive interaction style and lower levels of social dominance but are comparable with typically developing peers on other social behaviors. The observed group differences may have a neuropsychological basis.

The influence of condition parameters and internalizing symptoms on social outcomes in youth with spina bifida

OBJECTIVE

To test a model of social competence in youth with spina bifida (SB). Involvement in social activities was expected to mediate associations between SB-related condition parameters (pain, body mass index, and motor function) and social competence. Internalizing symptoms were predicted to amplify the negative impact of condition parameters on social activity involvement.

METHODS

108 youth with SB, their caregivers, peers, and teachers participated in a multimethod study that included cognitive testing, questionnaires, and observational interaction tasks.

RESULTS

Social activity involvement partially mediated the relation between pain and lower social competence. Internalizing symptoms had a significant indirect effect on social competence via decreased involvement in social activities.

CONCLUSIONS

Pain and internalizing symptoms interfere with social activity involvement, which is, in turn, important for social competence development in youth with SB. Assessing and treating these condition parameters and activity factors may be important areas of focus in clinical practice and research with these youth.