Review of group interventions for pediatric chronic conditions

OBJECTIVE

To identify treatment studies on group interventions for pediatric conditions and to review their efficacy using standardized criteria.

METHODS

Through a systematic literature review, we identified 125 studies describing group treatments for pediatric populations. Group interventions were classified into one of four types of groups distinguished by their primary goals and intended outcomes: emotional support, psychoeducation, adaptation/skill development, or symptom reduction. A fifth category, summer camps, contained elements of the other categories, but due to their unique setting, we considered them separately. Treatments were evaluated and designated as "promising," "probably efficacious," or "well-established," based on the Chambless/Society for Pediatric Psychology criteria.

RESULTS

Group interventions for children and adolescents have been developed to increase knowledge of illness, to increase psychological adaptation, and to decrease physical symptoms and side effects. This literature falls on a broad continuum, ranging from descriptive articles with no empirical assessment of outcome to treatment outcome studies employing randomized control conditions and standardized outcome measures.

CONCLUSIONS

Although well-established group interventions do exist, much work is required to establish the efficacy of most group treatments for children and adolescents with chronic illness. Recommendations for improving the status of research are offered.

Neurodevelopmental and medical status of low-birthweight survivors of bronchopulmonary dysplasia at 10 to 12 years of age

Thirty low-birthweight (less than 1500g) infants (15 with bronchopulmonary dysplasia (BPD), and 15 controls less than or equal to 5 days O2) and 15 fullterm controls were evaluated at 10 to 12 years of age. BPD children weighted less than fullterm children and had smaller head circumferences than either preterm or fullterm controls. They also had significantly more neurological abnormality than both control groups. BPD children and preterm controls had lower WISC-R arithmetic scores and lower Beery VMI scores, as well as greater need of resources and special education compared with fullterm controls. BPD survivors at 10 to 12 years of age continue to manifest sequelae related to their early pulmonary disease.

What mentally retarded and nonretarded children expect of one another

Twenty mentally retarded students and nonretarded students matched for chronological age (n = 20) or mental age (n = 16) made judgments about children described as having or not having learning problems. Results showed that students had both positive and negative stereotyped expectations about these children and that there were few differences between the expectations of retarded and nonretarded students. Students' responses to stereotype questions 11 to 18 months later revealed few changes in their stereotypes and no significant differences between stability of retarded and nonretarded students' stereotypes. Results suggest that understanding social relations between retarded and nonretarded children requires consideration of the expectations of both groups.

Psychosocial characteristics of preschool siblings of handicapped and nonhandicapped children

This project examined psychosocial characteristics of 24 preschool-aged siblings of handicapped children in relation to a control group of 22 siblings of nonhandicapped children. Subjects were matched on family size and income, sibling age, birth order, sex, age spacing, and marital status of their parents. Results indicated no statistically significant differences between groups of children on measures of perceived self-competence and acceptance, understanding of developmental disabilities, empathy, and child care responsibility. Significant group differences were found where brothers of handicapped children were rated by their mothers as being more depressed and aggressive than brothers of nonhandicapped control children. Sisters of handicapped children were rated by mothers as being more aggressive than sisters of nonhandicapped children. Sisters of handicapped children and brothers of nonhandicapped children had significantly fewer privileges and more restrictions on their home activities than other groups. Results are discussed in relation to previous research on older siblings of handicapped children and the general literature on family stress and childhood disability and disease. The importance of examining sibling functioning via multiple measures of child behavior is stressed.

Modified satiation reducing ruminative vomiting without excessive weight gain

Satiation procedures involving increased food intake recently have been used to reduce rates of ruminative vomiting in mentally retarded children. Use of these nonaversive intervention procedures has been limited almost exclusively to clients who are seriously underweight since excessive weight gain is a common side effect. The purpose of the present study was to determine whether modified satiation, provided by unlimited quantities of low calorie foods, could decelerate ruminative vomiting to clinically acceptable rates without producing undesirable weight gain. The two subjects were a severely mentally retarded man and a profoundly mentally retarded woman whose histories of ruminative vomiting were extensive but whose body weights were within their ideal ranges. A multiple-baseline-across-subjects combined with a withdrawal design demonstrated significant reductions in both subjects' rates of ruminative vomiting while their body weights remained within the middle of their ideal weight ranges. The results are discussed in terms of their clinical utility and the need for future analyses of the critical components of food satiation techniques.

Siblings of handicapped children: a review

Research is critically reviewed and evaluated, first, in order to determine if the presence of a handicapped child in a family uniquely affects the nonhandicapped siblings, and, second, to identify factors mediating the nature and power of those effects. In addition, projects involving sibling therapy, education, and training are described. Currently there are few well-controlled empirical investigations supporting the popular belief that, as a group, siblings are adversely affected by their handicapped brothers or sisters. Rather, only certain siblings appear to be vulnerable to negative reactions, depending on such factors as sibling sex and birth order, family socioeconomic status, and parental responses to the handicapped child. Recommendations are offered for improved research strategies and questions and for the careful evaluation of future educational and support services for siblings.

Sensorimotor functioning and prelinguistic communication of severely and profoundly retarded individuals

The prelinguistic, nonverbal communicative behavior of 40 institutionalized severely and profoundly retarded children and adolescents functioning at various stages of Piaget's sensorimotor period was examined. Five scales of the Uzgiris and Hunt (1975) sensorimotor assessment were used to determine general level of sensorimotor functioning. A standard set of communication elicitation tasks was employed to examine the gestures used to communicate in both imperative and declarative contexts. More competent sensorimotor performance was associated with higher frequency of more sophisticated and symbolic forms of gestural communication, and subjects generally used more complex gestures to communicate in the imperative than in the declarative tasks. Applicability of the results to the design of future language-intervention programs and their implications for general theory concerning the relations between language and cognition and between normal and atypical development were discussed.