Adolescents with physical disabilities: some psychosocial aspects of health

Characteristics of Existing Online Patient Navigation Interventions: Scoping Review

BACKGROUND

Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear.

OBJECTIVE

This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature.

METHODS

A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention.

CONCLUSIONS

To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs.

Cross-cultural adaptation of the Rotterdam Transition Profile to Brazilian Portuguese: measuring autonomy in participation of Brazilian youth with cerebral palsy

BACKGROUND

Autonomy in participation of young adults with cerebral palsy (CP) is not well understood due to the lack of appropriate instruments, especially for the Brazilian population. The Rotterdam Transition Profile (RTP) categorizes autonomy in Participation (education, employment, finances, housing, leisure, intimate relationships, sexuality, transportation) and Health Services (care demands, services and aids, and rehabilitation services) domains.

OBJECTIVES

To cross-culturally adapt the RTP for use in Brazil, and to describe the levels of autonomy in participation and associated factors of Brazilian youth with CP.

METHODS

RTP was translated and content validity was investigated through an expert panel (n = 4 researchers and n = 4 clinicians); 30 adolescents and young adults with CP provided data for construct validity and internal consistency analysis. To analyze influencing factors, 56 youth with CP, mean age 25 years (SD = 6.9 years), with good cognitive level remotely responded to the RTP, sociodemographic information, and functional classifications (gross motor, manual ability).

RESULTS

Following translation, content and construct validity were established, with changes made to improve the clarity of items. Cronbach's alpha (0.82) was considered good and test-reliability was fair to good for most items. High levels of autonomy were found in the areas of Leisure and Rehabilitation, with the lowest proportion of participants with autonomy in Housing, Intimate Relationships, and Finances. Autonomy in participation was associated with age, gross motor and manual ability classifications, and with context-related factors.

CONCLUSION

The Brazilian Portuguese version of the RTP was considered valid and reliable. Findings will support transition planning for young people with CP.

Factors Influencing Participation in Physical Activity, Sports, and Exercise in Children and Adolescents with Spinal Pain or Spinal Conditions: A Systematic Review and Meta-Ethnography

BACKGROUND

Physical activity is an effective treatment for paediatric spinal pain. However, participation rates remain low and review evidence is needed to establish why. This review identifies factors influencing participation in sports, exercise, and physical activity in those aged 18 or under with spinal pain or spinal conditions. Trends or differences between discrete sub-populations are identified.

METHODS

A meta-ethnographic review was undertaken. Qualitative papers were identified and appraised using the JBI checklist. Thematic trends were mapped onto the biopsychosocial model and subthemes identified. Uniqueness was calculated and the confidence in the evidence was evaluated using the GRADE-CERQual tool.

RESULTS

Data were gathered from nine qualitative papers (384 participants). Three themes were identified: (1) biological: physical challenges and bladder and bowel care; (2) psychological: perceptions of differences to peers, struggle, anger, sadness, adjustment, and acceptance; and (3) sociological: influence of friends, social acceptance, negative attitudes from others, and the influence of their disability on family routine.

CONCLUSIONS

Sociological factors were most influential on exercise participation alongside related psychological and biological factors. Adolescents over 14 years offered greater critical insight compared to the younger children. Results are best applied to neuromuscular conditions with further robust evidence required in paediatric musculoskeletal spinal pain.

The mediating role of anxiety between negative feelings and depression among students with congenital physical disabilities

Congenital physical disability is associated with various psychological challenges, including negative feelings, anxiety, and stress. These challenges will, in turn, predict significant negative emotional well-being among students with congenital physical disabilities, but the mechanisms of these effects are not well known. This study examined whether Negative Emotional Wellbeing Anxiety (NEWA) would mediate the effect of Negative Feelings (NF) and Negative Emotional Wellbeing Depression (NEWD) among students with congenital physical disabilities. Forty-six students with congenital physical disabilities (mean age: 20 years, SD = 2.05; 45.65% females) completed self-rating measures that included sociodemographic variables (age and sex), emotional state for Children to assess negative feelings, and an emotional distress protocol to assess NEWA and NEWD. Results show that NF was positively correlated with NEWA (r = .69, p < .001) and NEWD (r = .69, p < .001), and NEWA was positively correlated with NEWD (r = .86, p < .001). Findings further reported that NEWA significantly mediated the positive relationship between NF and NEWD (a*b = .37, Bootstrap CI95 = .23 and .52) [Sobel test statistic of 4.82 (p < .001)] among students with congenital physical disabilities. The results highlight the importance of screening students with congenital physical disabilities for common psychological challenges and providing suitable interventions.

School Functioning and Educational Aspirations in Adolescents With Social Anxiety-The Young-HUNT3 Study, Norway

Social anxiety disorder (SAD) typically emerges during childhood or early adolescence and often has long-term effects on several areas of an individual's life, including school and education. The purpose of this study is to examine whether social anxiety is associated with (1) school functioning in terms of behavioral difficulties (hyperactivity and/or attention problems), school dissatisfaction, social exclusion, truancy, and learning difficulties, and (2) educational aspirations (educational level). We use data from the population-based Young-HUNT3 study (2006-2008), where 8,199 Norwegian adolescents participated. Social anxiety is measured both as self-report [the Social Phobia and Anxiety Inventory for Children (SPAI-C)], and as screening information from diagnostic interviews [Anxiety Disorder Interview Schedule for DSM IV: child version (ADIS-C)]. ADIS-C screening positives (n = 388) reported higher rates of behavioral difficulties (RR = 1.06), school dissatisfaction (RR = 1.15), social exclusion (RR = 1.24), truancy (RR = 1.05), and learning difficulties (RR = 1.10) compared to screened negatives. Self-reported social anxiety symptoms showed similar patterns. Further, higher mean scores of self-reported social anxiety symptoms and being ADIS-C screening positive were negatively associated with aspirations of higher education (OR = 0.92 and OR = 0.74, respectively). However, as regards to having aspirations for the future (aspirations of higher education and/or aspirations of vocational training), no associations were found. The results indicate that social anxiety in adolescence is related to unfavorable/poorer school functioning and lower tendency of aspirations of higher education, which may have consequences for future educational pathways and later work life.

Examining the Relationship Between Community Integration and Mental Health Characteristics of Individuals With Childhood Acquired Neurological Disability

Background: Many individuals with cerebral palsy (CP) or acquired brain injury (ABI) are at higher risk of lowered psychosocial functioning, poor mental health outcomes and decreased opportunities for community integration (CI) as they transition to adulthood. It is imperative to understand the characteristics of those at highest risk of dysfunction so that targeted interventions can be developed to reduce the impact. Methods: This quantitative, cross-sectional study examines current patients of the Living Independently Fully Engaged [(LIFEspan) Service], a tertiary outpatient hospital-based clinic. The Patient Health Questionnaire-4 (PHQ-4) and the Community Integration Questionnaire (CIQ) were administered to participants. Personal health information was also collected from participants' health charts, and participant interviews. Associations of sex and condition with the outcomes of screening for further assessment of depression, screening for further assessment of anxiety, and CI were calculated using t-tests and Chi-square tests. Results: 285 participants completed standardized screening tools for depression and anxiety (PHQ-4) and 283 completed the Community Integration Questionnaire (CIQ). Mean age was 23.4 (4.2) years; 59% were diagnosed with CP, 41% diagnosed with ABI, and 56% were male. A moderate proportion of the sample screened positive for further assessment of anxiety (28%) and depression (16%), and the overall mean score on the CIQ for the sample was 15.8 (SD 5.1). Participants that screened positive for further assessment of depression and anxiety on the PHQ-4 had lower scores on the Social Integration subscale of the CIQ (p = 0.04 and p = 0.036, respectively). Females were found to have significantly higher community integration than males (p = 0.0011) and those diagnosed with ABI were found to have significantly higher community integration than those with CP (p = 0.009), respectively. A weak negative association was found between age for the total sample and overall PHQ-4 score (p = 0.0417). Presence of an intellectual or learning disability/challenge was associated with a lower CIQ score (p = 0.0026). Conclusions: This current study, highlights the need for further research to explore the unique needs and barriers faced by this population. This study may inform assessments and interventions to support the mental health and community integration of this population.

Effect of a mentoring program for adolescents with physical disabilities attending a therapeutic camp

PURPOSE

Youth with physical disabilities are at an elevated risk for poor psychosocial health. Pediatric medical camps are one common intervention utilized to provide short-term psychosocial support. However, there is a growing criticism that the effects of such programs diminish as participants return to home and school settings post residential camp experience. A post camp support intervention, the first known in the literature, was tested for perceptions of mattering and self-esteem. Specifically, this study examined the psychosocial effect of a year-round mentoring and online support program as an adjunct to residential camp (intervention) as compared to peers that attended only the summer residential experience (comparison group).

METHODS

A quasi-experimental design using an intervention and comparison group was implemented. Data were analyzed using a repeated measures analysis of variance to test for within group and between group effect.

RESULTS

A small effect (partial η2= 0.096) between groups (p< 0.17) and a moderate effect (partial η2= 0.133) within groups (p< 0.10) was detected for the mattering construct. A positive effect for self-esteem was not detected between or within groups.

CONCLUSIONS

The online and mentoring support program appeared to improve perceptions of mattering three months into implementation. Future implications center on the refinement of the support program and suggestions for further longitudinal research.

Transitional Care Interventions for Youth With Disabilities: A Systematic Review

CONTEXT

Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations.

OBJECTIVE

In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders.

DATA SOURCES

Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched.

STUDY SELECTION

In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years.

DATA EXTRACTION

Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment.

RESULTS

Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components.

LIMITATIONS

Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes.

CONCLUSIONS

Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.

Let's Talk About Sex: Special Considerations in Reproductive Care and Sexual Education in Young Women With Spina Bifida

Medical advances in the last several decades have allowed an increasing number of children with spina bifida to reach adolescence and adulthood. As they reach puberty, girls with spina bifida face unique social and health challenges to their sexuality, such as orthopedic restrictions, continence, and pelvic floor disorders. Recent research efforts have focused on better understanding female sexual desires, dysfunctions, and activity and the role of the physician in educating this vulnerable population. This article aims to summarize current literature on sexual function, knowledge gaps, and the importance of tailored sexual education from providers in women with spina bifida.

Health and educational aspirations in adolescence: a longitudinal study in Finland

Background

The health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement.

Methods

Using classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12–13 years,) up to the 9th grade (15–16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students’ educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools.

Results

All studied health factors were associated with adolescents’ educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9.

Conclusions

Our findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.

Promoting Independence for Teens and Young Adults with Physical Disabilities

The transition to adult roles and responsibilities poses unique challenges for young people with physical disabilities. The Independence Programme (TIP) assists youths to meet these challenges. TIP is client-centred and addresses each participant's occupational performance problems. Participants live in a student residence located near shops, restaurants and other businesses for 20 consecutive days during TIP.

This paper describes TIP and results from the evaluation of one summer's programme. Ten youths with physical disabilities, such as cerebral palsy, participated. The programme was evaluated using interviews with each participant at the beginning and end of the programme, and at a four month follow-up with the Canadian Occupational Performance Measure (COPM) (Law et al., 1994a). Participants made clinically important changes in performance and satisfaction of their identified occupations. They rated this programme as the best experience of the summer. Participants valued the opportunities to learn about and access environmental supports, to assume greater independence, and to develop connectedness with peers.

Intimate Relationships of People With Disabilities

Despite the difficulties people with disabilities may have garnering intimate relationships, intimate relationships may be particularly beneficial for people with disabilities as they result in greater self-acceptance, less internalized stigma, and more camaraderie. The aim of this study was to explore the intimate relationships of adults with disabilities (n = 1,443) in its many forms (from intimate friendships to romantic relationships). We particularly explored what factors increased the odds of adults with disabilities having intimate relationships, what supports resulted in increased likeliness to have intimate relationships, and what factors resulted in the presence of favorable intimate relationship outcomes. Our analysis revealed service organizations are key to enhancing the social and intimate relationships of adults with disabilities.

The impact of people with disabilities choosing their services on quality of life outcomes

BACKGROUND

In recognition of the importance of services and supports that are defined and chosen by the recipient with disabilities, there has been a shift toward person-centered services. Quality person-centered services not only aim to ensure people have control over their own lives, but also to improve individually defined outcomes.

OBJECTIVE

The aim of this study was to explore the relationships between people with disabilities (PWD) choosing their services and their quality of life (QOL).

METHODS

We had two main research questions: 1) what factors predict PWD choosing their services - who was most/least likely to choose their services?; and, 2) how does choosing their services impact the QOL of PWD? To examine these questions, we analyzed Personal Outcome Measures^® interviews from approximately 1100 PWD.

RESULTS

Our findings have revealed that when PWD are able to choose their services, the impact can be widespread.

CONCLUSIONS

By ensuring PWD are able to choose their services, organizations are not only facilitating self-determination, but, ultimately, improving PWD's QOL.

Efeito da intervenção com videogame ativo sobre o autoconceito, equilíbrio, desempenho motor e sucesso adaptativo de crianças com paralisia cerebral: estudo preliminar

RESUMO Crianças com paralisia cerebral (PC) comumente são identificadas como diferentes de seus pares típicos devido à sua condição neuromotora, o que afeta a motivação e consequentemente o desempenho em atividades. A realidade virtual (RV) pode ser uma ferramenta potencial para melhora de aspectos motivacionais e desempenho motor durante a reabilitação. O objetivo deste estudo foi verificar o efeito de um programa de intervenção fundamentado em RV utilizando um videogame ativo no autoconceito, equilíbrio, desempenho motor e sucesso adaptativo de crianças PC. Participaram do estudo oito crianças entre 5 e 14 anos (10,37±3,29), com diagnóstico de PC, níveis I e II no GMFCS. O autoconceito foi avaliado com a Escala Infantil de Autoconceito Piers-Harris, o equilíbrio por meio do domínio quociente motor 3 da Escala de Desenvolvimento Motor. Para avaliação do desempenho motor foi utilizado o quociente motor geral, e as pontuações dos jogos avaliaram o sucesso adaptativo no ambiente virtual. A intervenção aconteceu durante oito semanas, sendo duas sessões semanais de 45 minutos cada. Foram utilizados quatro jogos ativos com demandas de equilíbrio, coordenação motora, saltos, agachamentos e deslocamento lateral do corpo. O teste de Wilcoxon foi usado para verificar as diferenças pré e pós-intervenção. Constatou-se diferença após a intervenção nos domínios: ansiedade, intelectual, popularidade, aparência física, satisfação, felicidade, equilíbrio, desempenho motor, e pontuação dos jogos. Conclui-se que a RV pode influenciar na forma com que essas crianças se enxergam quanto ao autoconceito, equilíbrio, desempenho motor geral e sucesso adaptativo, ajudando os profissionais a desenvolver formas de terapia que possam melhorar tais aspectos.

The use of the Rotterdam Transition Profile: 10 years in review

The aim of this literature review was to describe the use and utility of the Rotterdam Transition Profile (RTP), as we near the tenth year since its publication in 2008. It is a tool to summarize a youth’s transition process to adulthood by classifying various domains of participation and health care into developmental stages. This review provided a comprehensive synthesis of available knowledge on the RTP by summarizing published and grey literature. Using search terms related to transition, social participation, and questionnaire, a systematic search was conducted for literature up to November 2017 in MEDLINE and Embase databases, and was supplemented with a hand-search using Google Scholar and a general internet search using Google Search. Inclusion criteria were specified to determine the papers selected for review, yielding fifty-five materials for detailed review. Combined analysis of published and grey literature identified nine papers that used some form of the RTP as a measure, 18 materials that cited the RTP or its domains but did not employ it as a measure, and twenty-eight materials that cited the original RTP development and validation paper for information not directly related to the RTP. The literature demonstrated that the RTP seems to be a useful tool to describe and monitor the transition process of adolescents and young adults, in both research and clinical settings. While it has been used with youth of 14–31 years of age across genders and health conditions, more evidence is needed to demonstrate its psychometric properties beyond construct validity in young adults with cerebral palsy.

"I've Had Bad Experiences With Team Sport": Sport Participation, Peer Need-Thwarting, and Need-Supporting Behaviors Among Youth Identifying With Physical Disability

This study was guided by self-determination theory to explore the sport experiences of youth with a physical disability and the role of peers within this context. Interviews were conducted with eight youths using a relational mapping technique and analyzed using a deductive thematic approach. Sport peers were broadly defined by the youth as individuals from a large age range and of all abilities. Youth perceived their sport peers to have dynamic roles throughout their participation in sport. The perceived roles of these sport peers included supporting and thwarting basic psychological needs, and influencing the youths' processing of sport internalization. Findings focus on the complexity of peer need-thwarting and need-supporting interactions in sport for youth with physical disabilities. Overall, peers have a multifaceted role in the sport experiences of youth identifying with a physical disability and may, in some cases, thwart youths' basic psychological needs.

Adolescents’ Perspectives on Living and Growing up with Treacher Collins Syndrome: A Qualitative Study

Objective

This study explored the experiences and essences of growing up and living with Treacher Collins syndrome (TCS) from an adolescent perspective.

Design

A qualitative approach using the long interview method was used to explore the adolescents’ experiences. Semistructured interviews and peer debriefing techniques were used to gather and verify data with each participant.

Participants

A purposive sampling technique was used to recruit a sample of six adolescents with TCS, ranging in age from 12 to 18 years, who received care from a craniofacial center in a large pediatric hospital.

Results

The themes central to the adolescents’ experiences were balancing sameness and difference and the journey toward social and self-acceptance. Five subthemes further described this experience: reconstructing perceptions of others; making meaning of the difference; forming friendships and fitting in; handling staring and teasing; and excelling.

Conclusions

The study group described good psychosocial adjustment, experienced an increasing acceptance of self, TCS, and social acceptance over time and demonstrated resilient adaptive strategies (optimism, motivation, and positive meaning making). They were, however, also challenged by the social stigma associated with difference and by the challenges of finding a good fit in their school environments in meeting unique needs, particularly in their early grades. This study highlights the value of using a qualitative research approach in furthering our understanding of the experiences of children and youth with facial differences.

Evaluation of spina bifida transitional care practices in the United States

PURPOSE

Recent studies have revealed that the lack of continuity in preparing patients with spina bifida to transition into adult-centered care may have detrimental health consequences. We sought to describe current practices of transitional care services offered at spina bifida clinics in the US.

METHODS

Survey design followed the validated transitional care survey by the National Cystic Fibrosis center. Survey was amended for spina bifida. Face validity was completed. Survey was distributed to registered clinics via the Spina Bifida Association. Results were analyzed via descriptive means.

RESULTS

Total of 34 clinics responded. Over 90 characteristics were analyzed per clinic. The concept of transition is discussed with most patients. Most clinics discuss mobility, bowel and bladder management, weight, and education plans consistently. Most do not routinely evaluate their process or discuss insurance coverage changes with patients. Only 30% communicate with the adult providers. Sexuality, pregnancy and reproductive issues are not readily discussed in most clinics. Overall clinics self-rate themselves as a 5/10 in their ability to provide services for their patients during transition.

CONCLUSIONS

Characteristics of current transitional care services and formal transitional care programs at US clinics show wide variances in what is offered to patients and families.

Sexuality and Disability in Adolescents

Healthy sexual development is important for adolescents with and without disabilities, yet the topic of sexuality is often ignored in the disabled population. Adolescents with mild or moderate degrees of disability have rates of sexual activity and reproductive health needs comparable to their typically developing peers. Their need for support, risk reduction, and education in sexual health may exceed that of their peers. The medical provider may support healthy sexual development through education, anticipatory guidance, menstrual and contraceptive management, and by expanding the notion of sexuality to include a broader conceptualization of sexual behavior and expression.

Friends United: An Evaluation of an Innovative Residential Self-Management Programme in Adolescent Rheumatology

Independence in activities of daily living, self-advocacy and peer support are important aspects of adolescent development. These skills are potentially affected by chronic rheumatic diseases and are worthy of attention by occupational therapists and other members of the multidisciplinary team.

An innovative 4-day residential programme for young people diagnosed with chronic rheumatic disease, known as the ‘Independence Break’, was evaluated in order to determine its perceived benefits. The participants were invited to complete a brief evaluation form immediately after the trip to determine the benefits of participation in the programme. The levels of continuing social contact within the group were established 4 months later during a subsequent telephone call.

Thirty young people (median age 14 years) attended the 4-day programme and reported friendship and improved performance in activities of daily living as the major benefits. The majority stayed in touch with at least one other person, with more girls staying in touch than boys. The preferred method of communication was text messaging.

Overall, the programme was perceived to be a valuable experience and offered the young people an opportunity to develop informal peer support networks. The potential of text messaging within adolescent rheumatology is also highlighted.

Social and sexual relationships of adolescents and young adults with cerebral palsy: a review

Objective: To investigate possible barriers to successful social and sexual relationships in adolescents and young adults of normal intelligence with cerebral palsy.

Design: A literature review based on a PubMed and PsycINFO search for the period 1990–2003. Included were studies focusing on one or more of the outcome parameters (i.e. social, intimate and sexual relationships) or on associated factors that described relationships with the outcome parameters.

Results: Fourteen papers were selected. Two studies investigated exclusively people with cerebral palsy whereas 12 concerned people with a congenital disability and/or physical disabilities, including people with cerebral palsy. All studies addressed adolescents or adults of normal intelligence. A. Social and sexual relationships: In social relationships adolescents and young adults with cerebral palsy were less active than their age mates, and dating was often delayed and less frequent. Adolescents with congenital disabilities indicated that sexuality is an important aspect of their lives, but they experienced difficulties developing a sexual relationship. B. Associated factors: Psychological maladjustment, insufficient self-efficacy and low sexual self-esteem may impair the development of social and sexual relationships. Overprotection in raising children with cerebral palsy and the negative attitudes of other people may have a negative influence on the self-efficacy of people with cerebral palsy.

Conclusion: The reviewed studies suggest many factors that may influence the development of social and sexual relationships in adolescents and young adults with cerebral palsy. However, evidence was found only for the personal factors self-efficacy and sexual self-esteem and their interrelationships with the parents' way of raising their children and successful experiences in social situations.

Participation in School: School Assistants Creating Opportunities and Obstacles for Pupils with Disabilities

This study addresses how help is provided for pupils with physical disabilities and how school assistants influence their participation in school. Data were collected through field observations and interviews with seven pupils between 7 and 15 years old and with each pupil's teacher and assistant. The analysis resulted in a description of features that influenced how help was provided and the consequences in school for the pupil with disabilities. A major finding was that the assistants could both facilitate and hinder participation. We concluded that an awareness of the priority the pupils place on social participation with their peers is needed to ensure effective and flexible support is made available to pupils with disabilities.

Women Aging with Childhood Onset Disability

Women with childhood onset disabilities (CODs) are living longer and it is time for holistic nurses to focus on understanding such women from a life course perspective. As women with CODs live into later adulthood, nurses must be prepared to anticipate and assist as needed. Without studies designed to understand the life course of these women, nursing can neither gain a clear understanding of the problems they face with aging nor help prevent the high number of social inequities, secondary conditions, and comorbidities experienced. To begin nursing's exploration of the problems faced by women with CODs, the relevant historical changes and literature associated with aging with a COD are reviewed. Next, the life course paradigm is critically analyzed in relation to the lives of these women. In conclusion, it is posited that the life course paradigm provides the most useful guide for a holistic understanding of women with CODs.

The goal of making friends for youth with disabilities: creating a goal menu

BACKGROUND

Clinicians working with youth with disabilities have acknowledged making friends as a commonly identified client goal. Clinicians find this goal difficult to address, as there are no measures that provide a breakdown of making friends into functional steps. In addition, research on friendship has traditionally focused on characteristics and quality of friendships rather than the friend-making process as a whole. A goal menu, comprised of a variety of steps that address the goal of making friends, would provide guidance to clinicians challenged with this goal in practice.

PURPOSE

To develop an understanding of the friend-making process as a first step towards the development of a goal menu for the goal of making friends.

METHODS

A literature review, youth focus group and expert clinician semi-structured interviews and consultation were used to generate a comprehensive data set. Established qualitative methods were used to sort and group the data into categories. A thematic analysis of the categories was performed.

RESULTS

Analysis revealed four themes integral to the friend-making process: person factors influencing friend-making, making friend-making a priority, opportunity for friend-making and motivation to make friends. An additional theme identified as occasionally involved in the process was a little bit of luck in making friends.

CONCLUSIONS

The themes generated by this research indicate that actionable target areas exist for the somewhat abstract notion of friend-making and the authors recommend that clinicians explore beyond person factors when addressing the goal of making friends. As a next step, the identified themes will provide the foundation for a goal menu, ultimately enabling clinicians to address the goal of making friends in a more efficient and effective manner.

The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC)

INTRODUCTION

Adolescents and young adults aged 15-39 years who have been diagnosed with cancer (AYAC) have unique medical and psychosocial needs. Following their cancer treatments, AYAC must learn to manage the sometimes irreversible general side effects of cancer treatments including side effects that impact their sexuality. These side effects include but are not limited to: infertility, altered body/physical appearance, and sexual dysfunction. Such effects may hinder AYAC efforts to date and experiment sexually, limiting sexual maturation and confidence, as well as the formation or maintenance of meaningful couple and sexual relationships. It is clear that we need to tailor our clinical approaches to ensure that we assess the unique needs and concerns faced by AYAC.

AIMS

Based on consistent study findings substantiating the distinctive needs of AYAC, the main objective of this article is to present the core clinical components involved in assessing sexuality among AYAC.

METHODS

The clinical recommendations are based on the authors and experts' clinical experiences coupled with a thorough examination of the literature related to AYAC sexuality.

MAIN OUTCOME MEASURES

This article first describes the three components (clinical interview, review of chart notes, and self-report questionnaires) of a sexuality assessment and the seven core domains that highlight target areas of focus.

RESULTS

A detailed outline of each of the core domains of assessment (socio-demographics; medical history; fertility and sexually transmitted infection; sexual functioning; sexual coping style; body and self-image; and sexual history and dating/couple experience) is presented. A "toolbox" table containing useful resources for clinicians (e.g., questionnaires and red flags) and direct resources for AYAC patients are included.

CONCLUSION

Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care.

Disability and Discussions of Health-Related Behaviors Between Youth and Health Care Providers

PURPOSE

The purpose of this study was to examine the likelihood of discussing health-related behaviors with health care providers (HCPs), comparing youth with and without mobility limitations (MLs).

METHODS

Analyses were conducted using baseline data from the MyPath study. Adolescents and young adults between the ages of 16 and 24 years completed a survey about their health care and health-related experiences. Analyses assessed the relationship between mobility status and discussing health-related behaviors with an HCP. Secondary analyses examined the extent to which adolescents and young adults' engagement in these behaviors was associated with these discussions.

RESULTS

Overall, we found low rates of discussions about the following topics: substance use, sexual and reproductive health, healthy eating, weight, and physical activity. Adolescents and young adults with MLs were less likely to report discussing substance use and sexual and reproductive health, but were more likely to discuss healthy eating, weight, and physical activity than peers without MLs. Those adolescents and young adults who reported substance use had higher odds of discussing this topic and those who reported having sexual intercourse had higher odds of discussing sexual and reproductive health.

CONCLUSIONS

Results suggest mobility status and a young person's engagement in health risk and promoting behaviors are associated with the likelihood of discussing these behaviors with an HCP. It is important that HCPs view adolescents and young adults with MLs as needing the same counseling and guidance about health-related behaviors as any young person presenting him/herself for treatment.

A retrospective study of past graduates of a residential life skills program for youth with physical disabilities

BACKGROUND

Young people with physical disabilities experience issues regarding employment, schooling, independent living and establishing meaningful personal relationships. A lack of life skills has been recognized as an important factor contributing to this lag. The Independence Program (TIP) is a short-term residential life skills program that aims to equip youth with the foundational life skills required to assume adult roles. This study retrospectively examined the achievements, skills acquired and program attributions of youth and young adults who took part in this three-week immersive teen independence program over a 20-year period.

METHODS

A total of 162 past graduates were invited to take part, with 78 doing so (a 48% response rate). These past graduates completed an online survey assessing objective outcomes such as employment and independent living; subjective outcomes such as feeling in control and living meaningful lives; and reflections on skills acquired, opportunities experienced and attributions to TIP.

RESULTS

The majority of respondents were female (71%), had a diagnosis of cerebral palsy (55%) and ranged from 20 to 35 years of age (92%). Despite a range of outcomes related to the achievement of adult roles, high levels of life satisfaction and overall quality of life were reported. Nearly every respondent reported using the skills they learned at the program in their lives afterwards and a high percentage attributed the acquisition and consolidation of core life skills to participating in this intensive immersive program.

CONCLUSIONS

Although causality cannot be assumed, respondents reflected very positively on the opportunities provided by TIP to develop their independent living and life skills, extend their social networks and understand their strengths and weaknesses. Such findings validate the importance of targeted skill development to assist young people with physical disabilities in attaining their life goals and encourage focused investigations of key features in program design.

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.

An exploration of the value of social interaction in a boys' group for adolescents with muscular dystrophy

BACKGROUND/AIM

  Engagement in peer-based social activities is a normal and important aspect of adolescence. Adolescent boys with muscular dystrophy typically lack opportunities for participation in peer-based recreation and socialization activities. 'MD Mafia' is a group which aims to reduce social isolation and offer social and recreational opportunities for adolescent boys with muscular dystrophy. This research is a qualitative exploration of the value of 'MD Mafia' and seeks to answer the question: "what does the experience of participating in 'MD Mafia', a group for adolescent boys with muscular dystrophy, mean to the boys and their parents?".

METHODS

  This research sought the views of the boys who participate in MD Mafia and their parents. The sample included seven boys and four mothers. Data collection methods included creative group activities, specifically chosen to match the participants' age, interests and skills, and online data collection. The theoretical perspective of symbolic interactionism guided the theoretical analysis of the data.

RESULTS

  Analysis of the data provided a description of the meaning and value of 'MD Mafia' from the participants' perspective. MD Mafia has a strong collective identity, which reflects ideals of masculinity and common interests. The group provides much valued opportunity for socialization in a safe and familiar environment, but parents also felt that MD Mafia could offer greater opportunities for skill development by increasing the challenge level of the activities and social environment. The theoretical analysis provides insight into the value of social interactions between participants in a group which has had positive implications for the boys as individuals and for MD Mafia as a group.

CONCLUSIONS

  The research supports a group model of service delivery for boys with muscular dystrophy and has implications for the development of the group into the future.

Self-reported adolescent health status of extremely low birth weight children born 1992-1995

OBJECTIVES

To compare the self-reported health of extremely low birth weight (ELBW, <1 kg) adolescents with that of normal birth weight (NBW) controls and the children's assessments of their general health at ages 8 versus 14 years.

METHODS

One hundred sixty-eight ELBW children and 115 NBW controls of similar gender and sociodemographic status completed the Child Health and Illness Profile-Adolescent Edition at age 14 years. It includes 6 domains: Satisfaction, Comfort, Resilience, Risk Avoidance, Achievement, and Disorders. At age 8 years, the children had completed the Child Health and Illness Profile-Child Edition. Results were compared between ELBW and NBW subjects adjusting for gender and sociodemographic status.

RESULTS

ELBW adolescents rated their health similar to that of NBW adolescents in the domains of Satisfaction, Comfort, Resilience, Achievement and Disorders but reported more Risk Avoidance (effect size [ES] 0.6, P < .001). In the subdomain of Resilience, they also noted less physical activity (ES -0.58, P < .001), and in the subdomain of Disorders, more long-term surgical (ES -0.49) and psychosocial disorders (ES -0.49; both P < .01). Both ELBW and NBW children reported a decrease in general health between ages 8 and 14 years, which did not differ significantly between groups.

CONCLUSIONS

ELBW adolescents report similar health and well-being compared with NBW controls but greater risk avoidance. Both ELBW and NBW children rate their general health to be poorer at age 14 than at age 8 years, possibly due to age-related developmental changes.

Longitudinal Evaluation of Transition Services ("LETS Study"): protocol for outcome evaluation

BACKGROUND

Because of advances in medical treatment, most children with physical disabilities can expect to achieve near normal life spans. Typically, coordinated teams of health care providers in specialized pediatric settings care for these children. As these children reach adulthood, however, the availability of services and expertise changes because the adult health care system has different processes designed to meet their specialized needs. Gaps in continuity of care during the transition from pediatric to adult services, and associated poor health outcomes are well documented. In response, new models of care are being introduced to address the complex process of health care transition. This paper describes a study protocol of a client-centred, prospective, longitudinal, mixed-method evaluation of linked model of health care across the lifespan (the LIFEspan Model), offered by a pediatric rehabilitation centre and an adult rehabilitation centre.

METHOD

This project will include a process and an outcome evaluation of the LIFEspan Model. The process evaluation will detail the specific service delivery that occurs with respect to preparation for transition and transfer of care through chart audits of pediatric medical records and qualitative interviews with LIFEspan staff. The outcome evaluation will measure the effect of the model on: 1) maintaining continuity within the health care system from pediatric to adult care; and 2) secondary outcomes related to health, well-being, social participation, transition readiness, and health care utilization of youth with cerebral palsy and acquired brain injury. Standardized instruments will include Health Utilities Inventory, Assessment of Life Habits, Arc's Self-Determination, Assessment of Health-Related Quality of Life, Partners in Health Questionnaire, Social Support Questionnaire, and Self-Efficacy for Managing Chronic Disease.

DISCUSSION

The LETS study will be original in its undertaking of a prospective examination of outcomes 1-year post-transition, use of multiple comparison groups, and absence of disability-related exclusion criteria ensuring that the transition experiences of varied populations of young people and their families will be represented.

TRIAL REGISTRATION

http://www.clinicaltrials.gov, ID NCT00975338.

Ethics in health care services for young persons with neurodevelopmental disabilities: a focus on cerebral palsy

In this article we review and discuss some of the key ethical and social challenges that young persons with cerebral palsy face in health care delivery. We identify and explain these challenges, some of which are rarely discussed in contemporary medicine and biomedical ethics, partly because they are not considered genuine "ethical" challenges per se. Most of these challenges are heavily shaped by broader social context and institutional practices, which highlights the importance of nonbiological aspects of the care of young persons with cerebral palsy from an ethics standpoint.

The first sexual experience among adolescent girls with and without disabilities

First sexual intercourse is an important experience in the young adult life course. While previous research has examined racial, gender, and socioeconomic differences in the characteristics of first sexual intercourse, less is known about differences by disability status. Using a racially diverse (27% Black, 20% Hispanic, and 53% non-Hispanic white) sample of 2,729 adolescent girls aged 12-24 at first sexual intercourse from the National Longitudinal Survey of Youth 1997, this article examines the association between disability and type of first sexual relationship, degree of discussion about birth control, and pregnancy wantedness. Regression analyses indicate that girls with mild or learning or emotional disabilities experience first sexual intercourse in different types of relationships than girls without disabilities. Adolescents with learning or emotional conditions have greater levels of discussion about birth control with their first sexual partners than those without disabilities. In addition, among those who do not use birth control at first sexual intercourse, girls with multiple or seriously limiting conditions are more likely to want a pregnancy-versus not want a pregnancy-at first sexual intercourse. Findings indicate that disability status is important to consider when examining adolescent sexuality; however, not all youth with disabilities have equal experiences.

Examining changes in self-perceived quality of life in children and adolescents with physical disability using a longitudinal design

PURPOSE

 The study aimed to investigate the changes in self-perceived quality of life (QOL) of children and adolescents with physical disability (PD).

METHOD

 Two hundred students aged 10-18 with PD were recruited from primary and high schools in Taiwan to participate in this longitudinal study. The Student Version of the Comprehensive Quality of Life Scale (COMQOL-S) was used to measure self-perceived QOL, which was recorded at baseline, and 6, 12 and 18 months post-baseline. Statistically, linear mixed models were used to compare the QOL scores among the four time points.

RESULTS

 At the second, third and fourth visit, 192, 151 and 128 participants completed COMQOL-S, respectively. Significant changes over time were found in overall objective and subjective OQL scores (slope = 0.8, p = 0.002 and slope = -1.3, p < 0.001, respectively). Specifically, significant reductions of the subjective QOL scores over the period of the four visits were observed in five domains, namely, Productivity (slope  =  -1.7, p = 0.005), Intimacy (slope  =  -1.6, p = 0.004), Safety (slope = -1.6, p = 0.008), Place in community (slope  =  -1.4, p = 0.019) and Emotional wellbeing (slope  =  -2.5, p < 0.001). Age was negatively correlated with the change of overall subjective score. Positive correlation was found between the change in mean objective scores and mean subjective scores in the Intimacy and Productivity domains.

CONCLUSIONS

Even though the conditions of material wellbeing and health can be kept steady, the overall QOL of children and adolescents with PD could still decline over time. This might be attributable to the fact that social life becomes more sophisticated when children become older.

Prevalence of obesity-related chronic health conditions in overweight adolescents with disabilities

The prevalence of 15 common obesity-related chronic health conditions was examined in a convenience sample of adolescents, ages 12-18 years old, with mobility and non-mobility limitations (n = 208 and 435, respectively). In both groups, overweight adolescents (BMI ≥ 85th %ile) had a significantly higher number of obesity-related chronic health conditions than their counterparts with healthy weight status (2.74 versus 1.74 for the mobility limitation group, and 1.79 versus 1.45 for the non-mobility limitation group). Prevalence of high blood cholesterol was significantly higher among overweight adolescents than healthy weight adolescents across the two groups. While prevalence of asthma and early maturation appeared to increase as a function of body weight for both groups, a significant difference was found only in the group with non-mobility limitations. Across the two groups, there was a clear tendency toward a higher prevalence of chronic health conditions in overweight adolescents compared to their healthy weight counterparts. Greater efforts must be made to address the higher rates of obesity-related health conditions in youth with disabilities during childhood and adolescence to avoid significant health consequences and health care costs in adulthood.

'Just like you': a disability awareness programme for children that enhanced knowledge, attitudes and acceptance: pilot study findings

PURPOSE

Participation of people with disabilities is influenced by environmental and contextual factors. Disability awareness programmes aim to increase knowledge and acceptance of disability. This study evaluated a disability awareness programme for students aged 9-11 in Australia.

METHOD

Pre-post questionnaires and focus groups evaluated the programme. The intervention took a cognitive-behavioural approach including a person with a disability co-presenting. Students (n = 147) participated in two sessions of discussions, written activities, demonstrations and disability simulation activities.

RESULTS

Significant improvements (p < 0.001) in knowledge, attitudes and acceptance of disability were evident immediately following the intervention. Focus group analyses further demonstrated these findings.

CONCLUSIONS

A brief disability awareness programme for children improved knowledge, attitudes and acceptance of disability in the short-term. Further research is required to identify the potential impact of such programmes on inclusion and social participation of people with disabilities both inside and outside of the school setting.

The perception of friendship in adults with Down syndrome

BACKGROUND

Measuring the perception of friendship in adults with Down syndrome (DS) has long been a research challenge. While there have been studies investigating the number of friends children with DS have in, the study of how adults with DS view the concept of friendship has been relatively unexplored. The aim of this study was to evaluate the perception of friendship in adults with DS using a visually based scale.

METHODS

Sixty-six individuals participated in this study: 22 adults with DS, 22 typical mental age (MA) matched children and 22 typical adults matched for chronological age (CA). We administered a visually based Friendship scale made up of photographs depicting social interactions between individuals or groups. The scale was composed of two parts. In Part 1 participants were shown two photographs and asked to select the photograph that best depicted friends. In Part 2 participants were asked to view one photograph and asked, 'Is it okay for friends to do this?'

RESULTS

Adults with DS scored lower on the Friendship scale in comparison with the CA and MA matched groups. Adults with DS made more errors in identifying 'friends' from 'non-friends' but were equally able to distinguish friendly behaviours and actions from non-friendly behaviours as their CA and MA matched peers. Individuals with DS were more likely to incorrectly identify photographs depicting a teacher, or a mother with a child as friends. Actions or behaviours that depicted subtle negative emotions were also incorrectly identified.

CONCLUSIONS

These results are an important first step in understanding the perception of friendship and social behaviours related to friendship in adults with DS.

Do the self-concept and quality of life decrease in CP patients? Focussing on the predictors of self-concept and quality of life

PURPOSE

To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.

METHODS

A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers-Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.

RESULTS

Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.

CONCLUSION

Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.

How do Computer Assistive Technologies Enhance Participation in Childhood Occupations for Children with Multiple and Complex Disabilities? A Review of the Current Literature

Functional impairments can limit the participation of children with disabilities in childhood occupations, which can be detrimental to their overall development and social and emotional wellbeing. The primary goal of occupational therapy for children with disabilities is to facilitate and enable active participation in meaningful occupations. Computer-based assistive technologies can be used as an enabler, allowing children with severe disabilities access to a variety of activities. The aim of this study was to establish how computer assistive technologies can have an impact on the participation of children with complex and multiple disabilities in childhood occupations and in the development of their occupational roles.

A comprehensive and systematic search and review of contemporary literature pertaining to computer use by children with severe and complex disabilities and its impact on a child's participation was undertaken. Articles included were critically appraised and analysed using a conceptual model of occupational therapy, with findings relating to the occupational performance areas of productivity, self-maintenance and leisure (a summary table is included). The findings supported the use of computer technologies for participation to a varying degree in all occupational performance areas, but were particularly positive in the areas of education, communication and play activities for children with disabilities.

The National Spina Bifida Program transition initiative: the people, the plan, and the process

This article outlines and summarizes the rationale and the working process that was undertaken by the National Spina Bifida Program to address the issues of transitioning throughout the life course for persons growing up with spina bifida. Their challenges include achieving independent living, vocational independence, community mobility, and participation in social activities, and health management. The creation, the underlying concepts, and the dissemination of the Life Course Model are described.