Pathways by which Maternal Factors are Associated With Youth Spina Bifida-Related Responsibility

Bidirectional, longitudinal associations between chronic pain and family functioning in youth with spina bifida

INTRODUCTION

Chronic pain does not reside within an individual. Pain is affected by and affects larger systems (e.g., families). We examined longitudinal, bidirectional associations between chronic pain and family functioning in spina bifida (SB). We hypothesized a bidirectional association between pain and family functioning (cohesion and conflict); youth chronic pain status would be associated with maladaptive family functioning and maladaptive family functioning would be associated with youth chronic pain status.

METHOD

Participants were from an ongoing longitudinal study of adolescents with SB (N = 140, 53.6% female, ages 8-15 at Time 1). Data were collected every 2 years, with this study using data from Times 1 and 2 (T1, T2; T1: 2006-2009, T2: 2008-2011). Parents reported on youth demographics and family functioning. Youth reported on family functioning and pain; pain was dichotomized into a categorical variable (chronic pain vs. no chronic pain). Family functioning (cohesion and conflict) was also assessed using observational data.

RESULTS

Youth chronic pain status was associated with decreased family conflict (child report) and increased cohesion (parent report) over time. Increased family conflict (parent report) was associated with a greater likelihood of reporting chronic pain 2 years later. Findings were nonsignificant between observed family conflict or cohesion and chronic pain in either direction.

DISCUSSION

With the presence of an additional stressor (chronic pain) families increase cohesion and reduce conflict. Increased conflict may increase a child's vulnerability of developing chronic pain. It is critical that interventions for both pain and family functioning in SB are guided by a strengths-based model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Self-Management in Youth With Spina Bifida: Associations With Parent Factors in the Context of a Summer Camp Intervention

OBJECTIVE

To investigate cross-sectional and longitudinal associations between parent factors and self-management for youth with spina bifida (SB).

METHODS

Participants were 89 camper-parent dyads recruited for a summer camp program for youth with SB (Myouthage = 12.2 years); 48 of these families participated across 2 years. Campers and parents completed assessments at Time 1 (pre-camp) and Time 3 (post-camp) for one or two summers. Parents reported on demographics, their own adjustment, perceptions, attitudes, and behaviors, and youth condition-related responsibility and task mastery. Youth also reported on condition-related responsibility. Hierarchical multiple regression analyses and multilevel modeling were used to examine relationships between parent factors and youth self-management.

RESULTS

Parents' expectations for future goal attainment were positively associated with camper responsibility and task mastery, and these associations were moderated by camper age (only significant for older campers). When examining changes over one summer, parental expectations for the future were significantly associated with changes in campers' condition-related task mastery. When examining trajectories across summers, parental perception of child vulnerability was negatively associated with the slope of condition-related responsibility and parents' expectations for future goal attainment were positively associated with the slope of task mastery.

CONCLUSIONS

Parent perceptions and behaviors may be important targets for assessment and intervention when promoting condition-related independence for youth with SB.

Parents' school-related concerns and perceived strengths in youth with spina bifida

BACKGROUND

Although the academic difficulties of children with spina bifida (SB) are well-documented, there is limited literature on parents' views of their children's school experiences and school-related supportive services. Thus, the current study examined parents' school-related concerns, as well as perceived areas of strength, among children with SB.

METHODS

Using a mixed-methods approach, 30 families (29 mothers and 19 fathers) of children with SB (ages 8-15 years) completed questionnaires and interviews. Content analysis was used to generate themes from interview data about parents' school-related concerns and perceptions of their child's strengths.

RESULTS

Overall, six themes emerged when assessing both parents' concerns and perceived strengths. Some parents did not endorse school concerns or strengths for their child. However, other parents described concerns related to academic performance, cognitive abilities, lack of school support, missed school and/or class time and disengagement, as well as strengths such as academic skills, cognitive abilities, persistence, self-advocacy and agreeableness. Despite parents' concerns about their children's academic performance, quantitative data revealed that less than 50% of children had received a neuropsychological evaluation and/or academic accommodations; additional quantitative data supported the qualitative findings.

CONCLUSIONS

The mixed-methods approach used in this study provides a richer understanding of parents' experiences in the school setting when they have a child with SB. Results can inform clinical practice, identifying a need to improve academic support for children with SB and help parents manage education-related stressors.

Controle Materno e Autocuidado de Crianças com Diabetes Tipo 1

Introdução: O autocuidado em crianças portadoras de doenças crônicas pode ser promovido ou prejudicado pelo comportamento parental. O objetivo deste estudo foi analisar as relações entre as práticas maternas de controle (suporte apropriado vs. controle psicológico) e o autocuidado em crianças com diabetes mellitus tipo 1 (DM1). Método: Participaram 23 mães de crianças portadoras de DM1, que responderam a uma entrevista semiestruturada sobre práticas de controle materno e ao Questionário da Rotina Pediátrica do Diabetes, que avaliou o autocuidado das crianças. Resultados: o suporte apropriado da mãe, especialmente quando expresso em explicações, encorajamento e afeto positivo, foi um preditor efetivo do autocuidado infantil. Discussão: o suporte apropriado favorece a conquista de autonomia por parte da criança, que se torna progressivamente mais capaz de cuidar da própria saúde. Conclusões: programas de intervenção para crianças portadoras de DM1 e suas famílias devem promover práticas de suporte apropriado nos pais.

Longitudinal Trajectories of Clean Intermittent Catheterization Responsibility in Youths with Spina Bifida

PURPOSE

Clean intermittent catheterization (CIC) responsibility among youths with spina bifida is not well studied. We sought to determine longitudinal trajectories of CIC responsibility to examine the transition of CIC responsibility from caregiver-CIC to self-CIC.

MATERIALS AND METHODS

We performed a secondary analysis of a prospective cohort study of youths with spina bifida. Participants aged 8-15 years originally recruited from 4 hospitals and a statewide spina bifida association were followed every 2 years. Participants who required CIC were included. Group-based trajectory modeling was used to isolate distinct trajectories of CIC responsibility, which was the primary outcome and was graded from caregiver-CIC to shared-CIC to self-CIC. Predictors of trajectory group membership were entered into multivariate logistic regression models and included various demographic, clinical and psychosocial characteristics such as CIC adherence and CIC mastery.

RESULTS

Of 140 youths in the original cohort study, 89 met eligibility criteria for this study. Mean age was 11 years at enrollment and 93% of patients had myelomeningocele. Two distinct trajectory groups emerged: 17% of patients had a low-flat trajectory and 83% had a high-increasing trajectory of CIC responsibility, with shared-CIC by age 8-9 years and increasing self-CIC responsibility thereafter. Significant predictors of group membership in the high-increasing trajectory group included less severe spinal lesion levels, higher CIC mastery and lower CIC adherence.

CONCLUSIONS

Nearly 1 in 5 youths with spina bifida in our cohort persistently required caregiver-CIC over time, while the remainder achieved shared-CIC responsibility by age 8-9 years, with increasing self-CIC responsibility thereafter.

Medical responsibility growth in youth with spina bifida: Neuropsychological and parenting predictors

OBJECTIVE

For youth with spina bifida (SB) there is a growing need to understand how responsibilities for health care are transferred from family- to self-management over time. The current study examined trajectories of responsibility for medical tasks in youth with SB across adolescence, as well as executive functioning/attention and parenting behaviors as predictors of growth.

METHOD

As part of a larger, longitudinal study, 140 youth with SB (ages 8-15 at time 1; Mage = 11.43) reported on their responsibility for relevant medical tasks across five time points. Attention and executive functioning were assessed via performance-based and parent/teacher-report methods. Parenting behaviors consisted of acceptance, behavioral control, and psychological control and were assessed via observational and parent-report.

RESULTS

Growth curve analyses revealed significant increases in youth medical responsibility across all SB tasks over time. Attention, executive functioning, maternal behavioral control, and paternal psychological control emerged as predictors of growth parameters in responsibility for communicating about SB and managing health care appointments.

CONCLUSION

Results indicated that youth with SB obtain increasing responsibility for their health care over time. The transfer of responsibility for SB management may differ based on individual (i.e., the child's neuropsychological abilities) and family level (i.e., parenting behaviors) factors. Further research is needed to understand how growth in medical responsibility relates to changes in other aspects of SB self-management across development, such as medical adherence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cross-Lag Model of Medical Responsibility and Skills in Youth With Spina Bifida

OBJECTIVE

This study examined bidirectional associations between mother- and father-reported medical responsibility and medical skill mastery in youth with spina bifida (SB).

METHODS

Participants were 140 youth with SB and their parents who participated in three waves of a longitudinal study across four years (ages 8-15 years at Time 1). Mother- and father-report of both medical responsibility and medical skill mastery were used, and age and estimated intelligence quotient were included as covariates, in cross-lagged models.

RESULTS

The cross-lagged model provided evidence for significant bidirectional associations between mother-reported medical responsibility and skill mastery across time (root mean square error of approximation=0.09, comparative fix index=0.97). These paths showed that higher levels of child responsibility predicted an increase in skill mastery and that higher levels of mastery predicted an increase in child responsibility across time. Moreover, based on mother-report, sharing of responsibility had stronger effects on increases in skill mastery (Time 1 to Time 2 β=.25, Time 2 to Time 3 β=.27) than skill mastery had on increases in child responsibility (Time 1 to Time 2 β=.08, Time 2 to Time 3 β=.07). The only significant cross-lagged path for father-report was from Time 1 skill mastery to Time 2 responsibility (β=.34).

CONCLUSIONS

Mothers perceive a bidirectional relationship between responsibility and skill mastery across time, whereas fathers appear to mainly consider how skills might affect a subsequent increase in responsibility sharing. Thus, it is important to consider both parents' perspectives when working to increase medical autonomy in youth with SB.

Factor Structure of Medical Autonomy Scales in Young People with Spina Bifida

OBJECTIVE

The primary goal of this study was to examine the factor structure of a spina bifida (SB) medical responsibilities measure and a medical regimen skills scale across time in families of youth with SB.

METHOD

One-hundred and forty youth with SB and their parents were assessed in both childhood/adolescence and adolescence/young adulthood. The Sharing of SB Medical Responsibilities Scale (SOSBMR) includes 34 items for which participants indicate who is responsible for each task. The SB Independence Survey (SBIS) is composed of 50 SB-specific medical skills items in yes-no format. Confirmatory factor analyses (CFA) were conducted to examine the factor structure of the SOSBMR and SBIS in childhood and adolescence (ages 8-15) and in adolescence/young adulthood (AYA; ages 16-25).

RESULTS

One- and seven-factor CFAs were compared for both measures. For the SBIS, both mother- and father-report were used in childhood; self-report was employed for AYA. For the SOSBMR, only self-report was used for both age groups. Across each rater and time point, the seven-factor models of the SBIS and SOSBMR had adequate to excellent fit and reliability, indicating the ability to use each subscale. In addition, each of the corresponding subscales on the SOSBMR and SBIS were associated with each other across raters and time, showing good concurrent and predictive validity.

CONCLUSIONS

From childhood to young adulthood, the subscales of the SOSBMR can be used to examine responsibility across multiple medical tasks and the SBIS can be used to assess medical regimen skills and mastery in young people with SB.

Predictors of Distinct Trajectories of Medical Responsibility in Youth with Spina Bifida

OBJECTIVE

To determine if there are distinct developmental trajectories of medical responsibility in youth with spina bifida (SB) across ages 8-17 years and to identify condition-related, parental, and family systems predictors of membership in these trajectory groups.

METHODS

Participants were 140 youth with SB and their parents who participated in four waves of a longitudinal study across 6 years (ages 8-15 years at Time 1). Multi-method (questionnaires and observed family interactions) and multi-respondent assessments were conducted during home visits.

RESULTS

Findings revealed that there were two distinct developmental trajectories that characterized this sample, with one being labeled "high increasing" (two thirds of the sample) and one labeled "low increasing" (one third of the sample). Most predictor variables were significantly associated with trajectory group membership, with the exception of ethnicity, SES, and measures of conflict. When all significant univariate predictors were included in the same model, only intelligence quotient (IQ), family stress, and gender were retained as significant.

CONCLUSIONS

Most youth exhibited relatively rapid increases in responsibility over the course of late childhood and adolescence, but there was a smaller portion of the sample that did not exhibit this type of developmental trajectory. The magnitude of the IQ effect on group differentiation appeared to attenuate the effects of most other predictors. It will be important for clinicians working with youth with SB to recognize that the transfer of medical responsibility from parent to child cannot be expected to unfold in the same manner for all families of youth with SB.