Assessing functional impairment in siblings living with children with disability

The impact of individuals with profound intellectual and multiple disabilities on peer relationships of typically developing siblings

INTRODUCTION/BACKGROUND

This study aims to determine the impact of a person with profound intellectual and multiple disabilities on peer relationships of their siblings.

METHODS

Information obtained from typically developing siblings of individuals with profound intellectual and multiple disabilities served as research material for this study. There were a total of 18 participants in the study. The analysis and interpretation were based on the procedures of grounded theory.

RESULTS AND CONCLUSION

The results of the study show that young adults with a brother or sister with profound intellectual and multiple disabilities have some difficulties in establishing relationships with their peers, especially those more intimate such as friendships or romantic endeavors. At the same time, research confirms that siblings of individuals with profound intellectual and multiple disabilities have high levels of empathy and understanding for others as well as sincere attachment to family.

Impact of paediatric cochlear implantation on family life: a conceptual framework informed by parents

PURPOSE

While the impact of paediatric cochlear implantation on parents and siblings are recognised, limited evidence exists regarding the effect of paediatric cochlear implantation on the entire family life (e.g., routine interactions, family activities). This study aimed to describe the impact of paediatric cochlear implantation on family life as perceived by parents, using concept mapping.

MATERIALS AND METHODS

Parents of paediatric cochlear implant (CI) recipients (n = 29) participated in this concept mapping study to generate, group, and rate statements regarding the impact of paediatric cochlear implantation on family life.

RESULTS

In total, 99 unique statements described the impact of paediatric cochlear implantation on family life. The concept map revealed six concepts, namely (i) Financial Outlay and Supports; (ii) Education and Therapy; (iii) Responsibilities and Sacrifices; (iv) Extended Family and Community; (v) Spouses and Siblings and (vi) Achievements and Enrichments.

CONCLUSIONS

This study highlights the multiple areas of family life affected by paediatric cochlear implantation. To improve patient-and-family-centered care, these factors must be considered during pre-operative and successive counselling of paediatric CI recipients and their families.

The "well-sibling" syndrome: hypnosis for the siblings of special needs children

Often overlooked by caregivers because of their ability to adapt to a challenging home life by making few demands themselves, the siblings of special needs children have unacknowledged needs of their own. They often are reluctant to participate in therapy because of their self-concept of having to be the "normal" or "perfect" child. Therapy with these children requires non-pathologizing and attuned rapport building focused on creative self-exploration without requests for change. Two composite case vignettes illustrate the power and versatility of clinical hypnosis to facilitate new learning about becoming visible in the therapeutic relationship and beyond.

The effectiveness of the serious game "Broodles" for siblings of children with intellectual disabilities and/or visual impairment: study protocol for a randomized controlled trial

BACKGROUND

Siblings of children with disabilities also need support. However, there are only a few evidence-based interventions for these siblings. The current study aims to assess the effectiveness of a newly developed serious game for young siblings of children with intellectual disability (ID) and/or visual impairment (VI). This serious game is hypothesized to improve sibling's quality of life, adjustment to their brother's or sister's disability, and multiple aspects of psychosocial well-being.

METHODS

The intervention consists of a serious game called "Broodles" (in Dutch: "Broedels") that helps children to recognize and deal with thoughts, feelings, and difficult situations. The game consists of eight 20-minute levels that all have the same structure with eight game elements. Each level addresses a domain of sibling quality of life and combines animations, mini-documentaries, fun mini-games, and multiple-choice questions. In addition to the game, siblings make a worksheet after playing each level. In order to support the child, the parents or caregivers receive a short brochure with information and tips. The effectiveness of the intervention will be investigated among a sample of 154 children aged 6-9 years and their parents or caregivers, using a two-arm parallel RCT design. The experimental group will play the serious game "Broodles" over a period of 4 weeks, whereas the control group will be placed on a waiting list. Assessments will take place at three time points: pre-test (week 1), post-test (week 5), and follow-up (weeks 12-14). At each timepoint, children and parents will complete several questionnaires on quality of life and different aspects of psychosocial well-being. In addition, children will make drawings to assess the sibling relationship. Next to that, parents and children will answer closed and open-ended questions about the sibling adjustment to their brother or sister's disability. Finally, parents and children will evaluate the serious game through closed and open-ended questions.

DISCUSSION

This study contributes to the knowledge about sibling interventions and serious games. Additionally, if the serious game is proven to be effective, it will be a readily available, easily accessible, and free of charge intervention for siblings.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05376007, registered prospectively on April 21, 2022.

Research on Family Health and Children and Youth With Special Health Care Needs

Families of children and youth with special health care needs (CYSHCN) can face challenges with regard to health and well-being. Health systems are designed to support CYSHCN but do not often consider the health and well-being of their family. Despite a growing body of literature, substantial gaps remain in our understanding of the impact of caregiving on family health and well-being and mechanisms of supporting families. In order to better understand and address these gaps, a national CYSHCN network developed a national research agenda to prioritize key areas of insufficient understanding of health and well-being for families of CYSHCN. Questions identified by the research agenda include: 1) How can family resiliency and adaptability be measured and improved? 2) How can we better assess family mental health needs and implement appropriate interventions? 3) What is the impact of family health on CYSHCN health outcomes? This paper describes a review of what is currently known regarding health for families of CYSHCN, gaps in the literature focused on the research agenda questions, and recommendations for future research. Based on the research agenda and current state of research for family health of CYSHCN, the authors recommend focusing on resiliency and adaptability as outcomes, using implementation science to address mental health concerns of family members and to further assess the impact of family health on health outcomes of CYSHCN. In addition, research should have a special focus on diverse populations of families and consider these questions in the context of different family structures.

Negative emotions in siblings of individuals with developmental disabilities: The roles of early maladaptive schemas and system justification

BACKGROUND

Developmental disabilities (DD) in close family members have profound effects on psychological adjustment of siblings of individuals with DD. One factor that influences the psychological adjustment of siblings is emotions. However, little is known about emotions among siblings of individuals with DD.

AIMS

This study sought to examine negative emotions of adolescent siblings of individuals with DD and focus on the roles of individual- and system-related factors, namely early maladaptive schemas (EMS) and system justification.

METHODS AND PROCEDURES

A cross-sectional study including adolescent 72 siblings of individuals with DD and 109 adolescent siblings of individuals without DD was conducted.

OUTCOMES AND RESULTS

The siblings of individuals with DD had higher scores on the Other-Directedness schema domain and system justification than the siblings of individuals without DD. However, the frequency of negative emotions did not differ between groups. Lower scores on EMS and higher scores on system justification were associated with less frequent negative emotions.

CONCLUSIONS AND IMPLICATIONS

Negative emotions seem to be common in adolescents regardless of having a sibling with DD or not. Nevertheless, EMS and system justification tendencies in siblings of individuals with DD may act as vulnerability factors for negative emotions.

Mental Health Symptoms and Functional Impairment in Children With Atopic Dermatitis

BACKGROUND

The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood.

OBJECTIVE

This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD.

METHODS

The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores.

RESULTS

Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06-1.31), home behavior (OR, 1.18; 95% CI, 1.06-1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06-1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05-1.31) and with siblings (OR, 1.14; 95% CI, 1.02-1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22-1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22-1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety.

CONCLUSIONS

AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.

A Population-Based Study of the Behavioral and Emotional Adjustment of Older Siblings of Children with and without Intellectual Disability

This is the first study on the behavioral and emotional adjustment of siblings of children with intellectual disabilities (ID) to use a population-based sample, from the third wave of the Millennium Cohort Study (MCS); a UK longitudinal birth cohort study. We examined differences between nearest-in-age older siblings (age 5–15) of MCS children (likely mainly with mild to moderate ID) identified with ID (n = 257 siblings) or not (n = 7246 siblings). The Strengths and Difficulties Questionnaire (SDQ) measured all children’s adjustment. For SDQ total problems, 13.9% of siblings of children with ID and 8.9% of siblings of children without had elevated scores (OR 1.65; 95% CI 1.04, 2.62; p = 0.031). Similar group differences were found for SDQ peer and conduct problems. In logistic regression models, variables consistently associated with older sibling adjustment were: adjustment of the MCS cohort child, older sibling being male, family socio-economic position, primary carer psychological distress, and being from a single parent household. The ID grouping variable was no longer associated with adjustment for all SDQ domains, except siblings of children with ID were less likely to be identified as hyperactive (OR 0.30; 95% CI 0.10, 0.87; p = 0.027). Some older siblings of children with ID may be at additional risk for behavioral and emotional problems. Group differences were related mainly to social and family contextual factors. Future longitudinal research should address developmental pathways by which children with ID may affect sibling adjustment.

Interrelations between After-School Settings and the Delinquency and Emotional-Behavioral Problems of Elementary School Children: Findings from Fragile Families and Child Wellbeing Study

Even though there are different types of after-school settings, numerous studies have focused on formal after-school settings (i.e., after-school programs or ASPs) and their association with children’s academic, physical, and social-emotional behaviors. The few findings from informal settings are also outdated. To bridge this gap, our study aimed to locate the interrelations between after-school settings and the behavioral outcomes of children with a particular emphasis on children’s delinquency and emotional-behavioral problems. We used the U.S. national dataset, fifth wave of Fragile Families and Child Wellbeing (nine-year follow-up), with the binary logistic and ordinary least square regression analyses. With a sample size of 3320, we found that children in parental care were reported to commit less delinquency than children in ASPs. Also, children in non-adult care were reported to have more emotional-behavioral problems than children in ASPs. Educators, school social workers, and policymakers should consider the impact of ASPs on children whose parents are not able to spend significant amounts of time with them. In particular, public assistance should be utilized in such a way that helps parents to achieve their children’s positive behavioral outcomes. At the same time, government and community assistance should be provided to enhance the quality of ASPs for the positive results of emotional-behavioral problems of elementary school students.

The quality of the relationship between typically developing children and their siblings with and without intellectual disability: Insights from children's drawings

The current study examined the relationships of typically developing (TD) children with siblings with and without intellectual disabilities (ID), as expressed in TD children's drawings and questionnaires answered by TD children and their mothers. It also examined group differences in the sibling relationships, as well as the associations between having a sibling with or without ID and sibling relationships, and TD children's social-emotional adjustment. Participants were mothers and their TD children (8-13 years). Some had ID siblings ID (N=28); others had TD siblings (N=31). Sibling relationships were examined via mothers' and target children's completion of questionnaires, and objective visual indicators (location, size, distance) and observed content-based indicators (support, investment, presence of parents) of children's drawings were assessed following the art-based phenomenological analytic approach. Mothers reported on children's social-emotional adjustment. Findings indicated differences in sibling relationships, including higher levels of positive relationships for children with ID siblings. Children's drawings also showed positive relationship aspects for these children. Sibling relationship qualities were significantly associated with children's adjustment. Children's drawings may be a useful data gathering tool to deepen our understanding of unique aspects of sibling relationships.

Using administrative data to examine variables affecting the mental health of siblings of children who have a developmental disability

BACKGROUND

There is evidence that siblings of children with a developmental disability (DD) experience poorer mental health outcomes and increased stress compared to siblings of non-disabled children. The variables which contribute to this are unclear.

AIMS

This study was designed to examine population-level and individual variables associated with differences in mental health outcomes among siblings of children who have a variety of developmental disabilities.

METHODS

Population-level administrative health data covering 1985-2014 for the province of British Columbia, Canada were used to develop a cohort of over 45,000 children who have a sibling with a DD. Individual-level, demographic and health care services variables were used in logistic regression to assess their relationship to diagnoses of depression or other mental health problems.

OUTCOMES

Odds of a diagnosis of depression or a mental health problem other than depression were associated with sex of the non-disabled sibling, sex of the child with the developmental disability, type of disability, birth order and income.

CONCLUSIONS

Type of developmental disability, and characteristics of the non-disabled sibling and their family are associated with mental health outcomes of siblings of children with a DD.

A population-level study of the mental health of siblings of children who have a developmental disability

This study used population level administrative data for health service utilization from the Ministry of Health, British Columbia, Canada to assess the mental health of siblings of children who have a developmental disability. At a population level, the study found strong evidence that siblings of children who have a developmental disability experience higher odds of a depression or other mental health diagnosis compared to siblings of children who do not have a developmental disability. In addition, there was evidence that in families with a child with a developmental disability, siblings who are diagnosed with depression or another mental health problem use physician and/or hospital services for these conditions to a greater extent than siblings who are diagnosed with depression or a mental health problem but do not have a family member with a developmental disability. Evidence of increased depression and mental health problems existed across all income levels, indicating that other stressors may have an impact. These findings suggest that siblings of children who have a developmental disability are a vulnerable group in need of programs and services that support their mental health.

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This study used population-level administrative health data to examine some of the variables affecting mental health in 45,578 siblings of children who have a developmental disability (DD) compared to two comparison groups of siblings of children who do not have a developmental disability.

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Siblings of children who have a DD experience increased odds of a depression or other mental health diagnosis compared to either of the two comparison groups.

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In addition there was evidence that siblings of children who have a DD and who have a diagnosis of depression or another mental health problem use the health care system to a greater extent than siblings of children who do not have a DD but have a diagnosis of depression or another mental health problem.

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Evidence of increased depression or another mental health problem existed across all income levels.

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This is the first study to use population-level administrative health data to compare e mental health outcomes of siblings of children with a DD to siblings of children without a DD.

Psychosocial Factors in Children and Youth With Special Health Care Needs and Their Families

Children and youth with special health care needs (CYSHCN) and their families may experience a variety of internal (ie, emotional and behavioral) and external (ie, interpersonal, financial, housing, and educational) psychosocial factors that can influence their health and wellness. Many CYSHCN and their families are resilient and thrive. Medical home teams can partner with CYSHCN and their families to screen for, evaluate, and promote psychosocial health to increase protective factors and ameliorate risk factors. Medical home teams can promote protective psychosocial factors as part of coordinated, comprehensive chronic care for CYSHCN and their families. A team-based care approach may entail collaboration across the care spectrum, including youth, families, behavioral health providers, specialists, child care providers, schools, social services, and other community agencies. The purpose of this clinical report is to raise awareness of the impact of psychosocial factors on the health and wellness of CYSHCN and their families. This clinical report provides guidance for pediatric providers to facilitate and coordinate care that can have a positive influence on the overall health, wellness, and quality of life of CYSHCN and their families.

Measuring Functional Impairment in Children and Adolescents: Psychometric Properties of the Columbia Impairment Scale (CIS)

The role of measuring functional impairment holds an important place in research, clinical practice, and service provision for children and adolescents. Responding to the growing need to measure serious emotional disturbances at the local, state, and national level, the Columbia Impairment Scale (CIS) was developed in the early 1990s and has remained one of the several popular scales for assessing functional impairment. However, despite the growing popularity of the instrument in research and practice, only a few studies to date have specifically examined the psychometric properties of the CIS. In this article, we describe the results of the first item response theory analysis of the CIS utilizing nationally representative data from the Medical Expenditure Panel Survey (N = 69,966). The results of our analysis lend support to the essential unidimensionality of the CIS and demonstrate that the scale is most reliable for those who exhibit high levels of functional impairment. Given the psychometric properties of the scale identified by our analysis, we contend that the CIS is a viable measure in the ongoing efforts to establish a national epidemiologic surveillance system to track the prevalence and impact of serious emotional disturbances in children and adolescents.

Self-reported stress among adolescent siblings of individuals with autism spectrum disorder and Down syndrome

Despite the prevalence of studies showing increased stress among mothers of individuals with autism spectrum disorders, few studies have examined general stress among typically developing siblings. This study used an online survey to compare the levels of self-reported stress between adolescent siblings of individuals with autism spectrum disorder and Down syndrome. Sibling of individuals with autism reported significantly more overall stress than did siblings of individuals with Down syndrome, as well as more stress specifically attributed to the brother/sister with autism. The two groups did not differ on perceived social support from family and friends. In linear regression models, the disability group (autism vs Down syndrome) was significantly related to sibling stress above and beyond target child behavior problems, perceived social support, and demographic factors. These results help shed light on the daily experiences of adolescent siblings of individuals with autism and call for more research into potential interventions to address increased stress levels.

Disabled children's functionality and maternal quality of life and psychological status

BACKGROUND

Physiotherapy is being provided for different disabled groups in pediatric rehabilitation centers. The quality of life (QOL) and psychological status of the mothers of these children is affecting their compliance in the rehabilitation period. The aim of this study was therefore to assess the relationship between disability level of individuals receiving rehabilitation and maternal QOL, psychological status and influencing factors.

METHODS

One hundred and twenty-six disabled children and their mothers were included in this cross-sectional study. Demographic information was noted. Child motor level was assessed using the Gross Motor Function Classification System and the level of independency in activities of daily living (ADL) was assessed with the Katz ADL scale. Maternal QOL was assessed with the 36-item Short Form (SF-36), and psychological status with the Beck Depression Inventory (BDI). SPSS 18.0 was used to analyze data.

RESULTS

Mean maternal age was 36.46 ± 7.2 years. Of the children, 67.5% had physical problems, 16.7% had mental problems, 7.9% had autism, 4.8% had hyperactivity, and 3.2% had hearing and speaking problems. Mild depression was detected in mothers (mean BDI score, 11.27 ± 8.1). There was no correlation between child disability level and maternal QOL and depression (P > 0.05). Maternal BDI score was negatively correlated with all SF-36 subscale scores (P < 0.001 for all parameters).

CONCLUSION

The SF-36 subscale scores of mothers of disabled children were decreased compared with Turkish community norms. Psychological support of mothers of children in the rehabilitation period may positively affect this period.

Psychological Well-Being of Mothers and Siblings in Families of Girls and Women with Rett Syndrome

Few published studies have reported on the psychological well-being of family members of individuals with Rett syndrome (RTT). Eighty-seven mothers of girls and women with RTT completed a questionnaire survey about their daughters' behavioral phenotype, current health, and behavior problems, and their own and a sibling's well-being. Mothers reported increased anxiety but similar levels of depression when compared to a normative sample. Across all problem domains on the Strengths and Difficulties Questionnaire, child and adolescent siblings (n = 39) were reported by mothers to have fewer difficulties than a normative sample. The severity of their daughters' RTT behavioral phenotype predicted increased anxiety and stress for mothers. Increased RTT daughters' current health problems predicted more maternal perceptions of positive gain.

Parenting in the face of childhood life-threatening conditions: The ordinary in the context of the extraordinary

OBJECTIVE

Uncovering what it means to be a parent during the extraordinary time of a child's life-threatening condition (LTC) is important for understanding family goals, decision making, and the work of parenting within this context.

METHOD

Qualitative descriptive methods were employed to describe the everyday experience of parenting both children who have an LTC and their healthy siblings.

RESULTS

Some 31 parents of 28 children with an LTC who have healthy siblings participated in our study. Four themes emerged from the data that describe a parental desire to maintain emotional connection with all of their children, how parents use cues from their children to know them better and develop parenting strategies, how parents change as a result of caring for a child with an LTC, and how they strive to decrease suffering for all of their children.

SIGNIFICANCE OF RESULTS

The findings of our study have implications for clinical practice, family-focused research, and health policy pertaining to families of children with life-threatening conditions.

Family Transitions: The Birth of a Two-Child Family

I remember the morning we discovered we were expecting our second child. I was a second-year pediatric resident starting my rotation in the pediatric intensive care unit. I had just given birth to our first child 14 months earlier and was still overwhelmed, yet amazed, by the process of becoming a parent. Certainly we had always hoped for more than one child but this one was coming 9 months sooner than our grand plan. Being an older, nontraditional medical student, I was already significantly older than my colleagues in residency. I wondered anxiously how I was going to explain to my residency director and my fellow residents, who so graciously covered for me on my first maternity leave, that I was pregnant, yet again. Thankfully, 9 months later our second son was born healthy and vigorous. In those long, yet short 9 months, we discovered that our material needs would drastically change. We contemplated a new car that would accommodate two car seats safely and comfortably, and anticipated finding the room, in an already cramped living space, for both a toddler bed and a crib. Perhaps most important at the time, our nanny, who already did a wonderful job of caring for our eldest child, happily accepted the opportunity to now take care of both our children, at an additional cost.

Financial and psychological stressors associated with caring for children with disability

The magnitude of stress and associated health consequences experienced by caregivers compromises their ability to effectively provide care to children, especially children with disability. We used latent class analysis of data from the 2010 Ohio Family Health Survey and identified 3 distinct classes of caregivers based on patterns of responses to 15 financial and psychological stresses they experienced. Compared with children residing in households in which caregivers experienced very little or no stress, children with disability were twice as likely to reside with caregivers with high levels of financial stress and almost 3.5 times as likely to reside with caregivers with high levels of financial stress and very high levels of psychological stress than typically developing children. Reducing caregiver stress is a critical step to ensuring the best health outcomes possible for children with disability. We identify the heterogeneity that is present in the population of caregivers by virtue of patterns of responses to various financial and psychological stressors. Children with disability are more likely to live in households in which a greater number of stressors affect caregivers. Different confounders are also associated with the latent classes of stress we identify. This is an important implication when determining the right interventions to target to the right subpopulations.