Constructing a Prospective Model of Psychosocial Adaptation in Young Adolescents with Spina Bifida: An Application of Optimal Data Analysis

2023 updates to the spina bifida transition to adult care guidelines

PURPOSE

This article provides an update to the 2018 Spina Bifida Association's Transition to Adult Care Guidelines.

METHODS

A workgroup of topic experts was convened including authors from the initial guideline workgroup. The workgroup reviewed and updated the primary, secondary, and tertiary outcome goals, clinical questions, and guideline recommendations based on a literature review.

RESULTS

Twenty-two additional articles were identified from the literature search. Updated references included observational studies describing transition to adult care outcomes, transition care model initiatives, and a validated self-management assessment tool.

CONCLUSION

Structured transition initiatives increase the likelihood of establishing with adult care, decrease acute care use for young adults with spina bifida, and have the potential to improve quality of life and optimize chronic condition management. However, there is still a need to implement structure transition practices more broadly for this population using these recommended guidelines.

Psychopathic Traits, Pubertal Timing, & Mental Health Functioning in Justice-Involved Adolescents

Although psychopathic traits and pubertal timing have garnered a great deal of attention as potent risk factors for antisocial trajectories, very little research has examined how these processes may be related. We investigated whether psychopathic traits were related to deviations in pubertal onset in a clinically-relevant sample of youth detained in juvenile detention facilities. One-hundred and thirty-seven adolescents (ages 12-17) completed surveys of pubertal timing, psychopathic traits, and mental health functioning. As predicted, psychopathic traits were found to be associated with pubertal timing, and the psychopathy facets evidenced differential associations with the onset of puberty. Trait disinhibition was associated with relatively earlier pubertal timing, whereas trait boldness appeared to confer protection against early pubertal onset in this sample. Symptoms of alcohol/ substance use and anger/ irritability were positively related to psychopathic traits, but only among youth who reported average-/late-pubertal development. These findings implicate psychopathic personality traits as individual difference variables that may influence the onset of pubertal timing and interact with pubertal timing to place justice-involved youth at risk for poor mental health.

Longitudinal study of neuropsychological functioning and internalizing symptoms in youth with spina bifida: social competence as a mediator

OBJECTIVE

To examine the longitudinal relationship between neuropsychological functioning and internalizing symptoms, as mediated by social competence in youth with spina bifida (SB).

METHODS

A total of 111 youth (aged 8-15 years, M = 11.37) with SB, their parents, and teachers completed questionnaires regarding attention, social competence, and internalizing symptoms. Youth also completed a battery of neuropsychological tests.

RESULTS

An indirect-only mediation model revealed that social competence mediated the relation between neuropsychological functioning and subsequent levels of teacher-reported internalizing symptoms, but not parent or youth report of internalizing symptoms. Specifically, better neuropsychological functioning was associated with better social competence, which, in turn, predicted fewer internalizing symptoms 2 years later.

CONCLUSIONS

Youth with SB with lower levels of neuropsychological functioning may be at risk for poorer social competence and, as a result, greater internalizing symptoms. Interventions that promote social competence, while being sensitive to cognitive capacities, could potentially alleviate or prevent internalizing symptoms in these youth.

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

Many children with chronic health conditions encounter enduring difficulties in their peer interactions and friendships. This study aimed to create and validate scales derived from an observational coding system (i.e., Peer Interaction Macro-Coding System, or PIMS) in a sample of children with spina bifida and their peers. Participants were 106 target child-peer dyads who completed a battery of questionnaires and interviews and were videotaped performing 4 interaction tasks, which were then coded across multiple domains of social functioning. Five scales (i.e., Control, Prosocial Skills, Positive Affect, Conflict, and Dyadic Cohesion) were rationally derived based on a review of the literature and a panel of experts. Internal consistency and interrater reliability at the scale level were good to excellent for all 5 scales. Interscale correlations were in the low-to-moderate range for 4 of the scales, although the Dyadic Cohesion Scale was highly correlated with two other scales and was subsequently dropped. Convergent validity and discriminant validity were established by examining the 4 remaining scales in association with comparable questionnaire and interview data. The 4 PIMS scales appear to be reliable and valid measures of social competence and may enhance future multimethod research efforts aimed at learning more about peer interactions and overall social competence.

Risking it for love: romantic relationships and early pubertal development confer risk for later disruptive behavior disorders in African-American girls receiving psychiatric care

Disruptive behavior problems (DBP) represent a growing concern for young women (e.g., Snyder and Sickmund, 2006), but gender-specific investigations have been traditionally underrepresented in this area. The purpose of this study is to examine the associations among gender-relevant risk factors for DBP among 217 African American girls in psychiatric care. African American girls, 12-16 years old (M = 14.6; SD = 1.2), and their primary female caregivers (N = 254) were recruited from outpatient mental health clinics and reported on girls' DBP, heterosexual dating experiences (romantic and sexual), peer relationships, pubertal development, and self-silencing at baseline, 6-, and 12 months. Structural Equation Modeling examined evidence for full versus mediated (via self-silencing) models and the structural relationships (direct and indirect) among key study variables. Results suggest that the full model was a significantly better fit than the mediated model as indicated by a Chi-squared difference test (p < 0.01). In the full model, direct effects of greater romantic dating experiences and lower quality peer relationships at baseline predicted DBP at 12 months. Sexual dating experiences were more strongly linked with DBP at 12 months for early maturing compared to average or later maturing girls. Indirect effects analyses suggested that girls' suppression of relational needs, assessed through a measure of self-silencing, explained the association between peer relationships and DBP. Findings highlight the importance of the relational context for girls' DBP, with treatment implications supporting relationship-based models of care, early intervention, and skill building around negotiating needs with peers and partners.

Theoretical perspective: resilience in medically fragile adolescents

Medically fragile adolescents require medical technology and skilled care from parents and nurses in daily life. These adolescents may be ventilator dependent, require intravenous nutrition or medications, depend on nutritional or respiratory support, and depend on nursing care or other medical devices for daily living. Much of the extant research on medically fragile children and adolescents has lacked an overarching theoretical perspective. Findings suggest that peer relationships, family support, technology dependence, school attendance, and self-esteem are concepts of relevance for these adolescents. Thus, a theoretical framework derived from the risk and resilience literature was developed to identify the nature of their interrelationships using theory derivation techniques. The resilience in medically fragile adolescents framework was derived using concepts described by these adolescents. Further study is needed to test this model in medically fragile adolescents with hopes to foster positive outcomes for these adolescents.

Process of normalization in families with children affected by hemophilia

To understand the normalization process in families with hemophiliac children, and to explore the impact of two different therapeutic regimes on it (on-demand therapy and prophylaxis), we conducted a two-phase study using semistructured interviews. In the course of the first phase, we interviewed 13 parents belonging to 10 families with hemophiliac children in on-demand therapy. In the second phase, 5 years later, we repeated the interviews with three families who began prophylaxis at different times. We analyzed the interviews using text analysis software. The results show very different representations of hemophilia and daily life. Normalization processes involve the overcoming of a divided conception of life, and encourage the integration of care practices within daily life. Moreover, in our article we suggest that although prophylaxis facilitates the recovery of a regular family routine, it alone cannot produce normalization.

Profiles of self-concept, goal orientation, and self-regulation in students with physical, intellectual, and multiple disabilities: Implications for instructional support

The present study explored physical self-concept, goal orientation in sport, and self-regulation in regard to a motor task, in 75 secondary students with physical, intellectual, and multiple disabilities, who were educated in the same special education units. It was found that students with intellectual disabilities generally presented a positive profile in all three psychosocial constructs, whereas students with physical disabilities presented low scores in most measures. Students with multiple disabilities did not differ essentially from students with intellectual disability in regard to physical self-concept and goal orientation; however, they compared unfavorably to them regarding self-regulation. The delineation of a distinct and defendable profile of self-concept, goal orientation, and self-regulation for each disability group allows the formulation of proposals for the implementation of appropriate instructional programs for students belonging to the above mentioned categories.

A family perspective: how this product can inform and empower families of youth with spina bifida

This article focuses on how the Life Course Model Web site can help family members build on the strengths of individuals with spina bifida and address areas of difficulty. A developmental perspective is adopted, which maintains that the Life Course Model Web site is useful at all stages of development, with the information provided for families at one stage of development building on the information provided for those at earlier stages of development. A brief overview is provided of relevant theories that supported the development of the Life Course Model. There is a review of the literature on the adjustment of families of individuals with spina bifida and the psychosocial adjustment of affected youth. How families may benefit from engagement with the 3 content areas covered by the Web site is discussed, namely child health and the transfer of medical management from parent to child (health/self-management), the development of social relationships (social relationships), and the achievement of milestones during emerging adulthood, including achievements in the areas of education and employment (education, employment, and income support).

Factors which determine the referral of potentially malignant disorders by primary care dentists

OBJECTIVES

The detection of potentially malignant disorders (PMD) is of paramount importance, yet few studies have examined what factors or cues primary care dentists (PCDs) take into account when diagnosing and referring PMD. The objective of this study was to determine what cues PCDs use when making a decision to refer PMD to secondary care.

METHODS

Ten clinical vignettes were presented to PCDs using a website in the public domain. Five vignettes represented PMD and five represented benign conditions. Participants were asked to provide a differential diagnosis, a referral decision and score 12 supplied cues based on their importance in this decision. Optimal data analysis was then used to determine which of the 12 cues were significant at predicting the participants' referral decision.

RESULTS

147 participants responded and the number of accurate diagnoses for the PMD group ranged from 46.3 to 79.5%, whilst the number of correct referral decisions ranged from 77.6 to 86.9%. The number of accurate diagnoses and referral decisions in the benign group ranged from 63.0 to 89.0% and 40.1 to 71.9% respectively. Risk factors were statistically significant in their ability to predict a referral decision in both groups, but overall there appeared to be a lack of discrimination in the referral decision.

CONCLUSION

The results show that PCDs use a range of cues in the decision making process and suggest that if they are at all in doubt or are faced with worrying cues, their default position is to refer. Whilst this is reassuring, greater education of PCDs and standardised criteria are essential to avoid over-referral.

Psychosocial and family functioning in spina bifida

A developmentally oriented bio-neuropsychosocial model is introduced to explain the variation in family functioning and psychosocial adjustment in youth and young adults with spina bifida (SB). Research on the family functioning and psychosocial adjustment of individuals with SB is reviewed. The findings of past research on families of youth with SB support a resilience-disruption view of family functioning. That is, the presence of a child with SB disrupts normative family functioning but many families adapt to such disruption and exhibit considerable resilience in the face of adversity. Parents of youth with SB, and particularly those from lower socio-economic status (SES) homes, are at-risk for psychosocial difficulties. Individuals with SB are at-risk for developing internalizing symptoms, attention problems, educational difficulties, social maladjustment, and delays in the development of independent functioning. Emerging adults are often delayed in achieving milestones related to this stage of development (e.g., vocational and educational achievements). Methodologically sound, longitudinal, and theory-driven studies of family and psychosocial functioning are needed, as are randomized family-based intervention trials, to promote adaptive functioning and better psychosocial outcomes in families of individuals with SB.

Views on psychosocial functioning: responses from children with imperforate anus and their parents

INTRODUCTION

High and intermediate imperforate anus (IA) is a congenital malformation that may entail psychosocial consequences. The objective was to examine disagreement on psychosocial functioning in reports between children with high and intermediate IA and their mothers.

METHOD

Twenty-five children with IA and their mothers participated, including two groups for comparison. The responses on 15 psychosocial variables were compared on pair-level, between the mothers and their child, within each group.

RESULTS

Statistically significant differences were found on the psychological variables in all groups, for example, feelings of sadness. For responses related to the social variables, few statistical discrepancies were found, except for the items "bullied" and "teased." Two specific discrepancies emerged in responses from children with IA and their mothers, the child's self-confidence and the mothers' thinking about their child's disability.

DISCUSSION

It is vital to gather information from both the child and the parents in order to obtain a complete assessment of the child. The course of disagreement can give valuable information for future care, including where to exert extra effort.