Family functioning in children and adolescents with spina bifida: an evidence-based review of research and interventions

Parents of Children Diagnosed with Congenital Anomalies or Cerebral Palsy: Identifying Needs in Interaction with Healthcare Services

The changes deriving from the birth of a child with a congenital anomaly (CA) or cerebral palsy (CP) imply, in many cases, an increased interaction with health services. A cross-sectional descriptive study was conducted with a convenience sample of parents of children diagnosed with four groups of CA (severe heart anomalies, spina bifida, orofacial clefts, and Down syndrome) and/or CP. A semistructured online questionnaire to be answered by parents was sent by web link to focal points of five parent associations and professional institutions. Data were analyzed through thematic content analysis (open-ended questions) and descriptive analysis (closed-ended questions). The results indicate consistency of responses of parents of children diagnosed with different conditions, namely with respect to the perception of health services and professionals. Closed and open-ended responses indicated three main topics in the interaction between health services and parenthood: information, coordinated and integrated responses, and support. The less positive outcomes suggest unmet information needs, while positive aspects include confidence in the care provided and the "training" received from health professionals.

Child, Parent, and Family Adjustment for Patients Followed in a Multidisciplinary Spina Bifida Clinic

Objectives

To characterize child, parent, and family adjustment for patients followed in a multidisciplinary spina bifida (SB) clinic.

Methods

Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Participants included 209 youth under 19 years old who were diagnosed with SB and their parents. Self-reported internalizing symptoms were measured in youth in grade 3 through 12 using the 25-item Revised Children's Anxiety and Depression Scale-25 (RCADS-25). Self- and parent-reported quality of life and family functioning were obtained using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and Family Impact Modules.

Results

A total of 45.7% of children and adolescents reported at-risk psychosocial functioning on the PedsQL. In contrast, only 5% of patients reported clinically elevated internalizing symptoms on the RCADS. Parents' quality of life and family functioning in the study were higher than in most studies of parents of children with other chronic health conditions, children with attention deficit-hyperactivity disorder, and healthy control samples.

Conclusion

Our findings indicate that children and adolescents with SB are at risk for poor health-related quality of life (HRQOL); however, poorer HRQOL may not necessarily be associated with more severe psychiatric symptoms in this population. Examining resilience factors that may help to buffer against challenges to HRQOL will be important in informing future interventions.

Association of ethnicity and adaptive functioning with health-related quality of life in pediatric myelomeningocele

PURPOSE

The purpose of this study was to evaluate associations of ethnicity and adaptive function with health-related quality of life (HRQOL) in youths with spina bifida myelomeningocele (SBM).

METHODS

Participants included Hispanic (n = 75) and non-Hispanic White (n = 86) children and adolescents with SBM. Participants completed ratings of adaptive function and SBM-specific HRQOL. A series of linear multiple regression models was computed to investigate whether ethnicity moderates the relation between adaptive function and HRQOL.

RESULTS

Results showed that greater adaptive function was associated with higher HRQOL. While no relations were found between ethnicity and HRQOL, a significant interaction was observed between adaptive function and ethnicity over and above other terms. Although groups did not differ on HRQOL at lower levels of adaptive function, Hispanic participants rated higher HRQOL relative to non-Hispanic White participants at higher levels of adaptive function. Further analysis showed this was true of both nonmotor and motor aspects of adaptive function.

CONCLUSION

Results suggested complex relations between ethnicity and adaptive function with HRQOL, highlighting the importance of optimizing adaptive functioning in youth with SBM.

Family functioning guidelines for the care of people with spina bifida

Research supports a resilience-disruption model of family functioning in families with a child with spina bifida. Guidelines are warranted to both minimize disruption to the family system and maximize family resilience and adaptation to multiple spina bifida-related and normative stressors. This article discusses the spina bifida family functioning guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida, and reviews evidence-based directions with the intention of helping individuals with spina bifida achieve optimal mental health throughout their lifespan. Guidelines address clinical questions pertaining to the impact of having a child with spina bifida on family functioning, resilience and vulnerability factors, parenting behaviors that may facilitate adaptive child outcomes, and appropriate interventions or approaches to promote family functioning. Gaps in the research and future directions are discussed.

Development of the Parent Forum: An in-person approach to supporting caregivers of youth with spinal cord injury

Context/Objective: Describe development, implementation, review, and redesign of a hospital-based, in-person psychoeducational intervention for caregivers of youth with spinal cord injury (SCI) ages 7-17. Design: Process evaluation/case study to describe intervention development, as well as preliminary evaluation data. Setting: Pediatric specialty hospital. Participants: 41 caregivers of youth with SCI. Interventions: Caregivers attended an in-person intervention ("Parent Forum"), after which they were randomized into two groups: one received monthly phone calls from a mental health professional and the other services as usual. Caregivers were invited to attend a second Parent Forum one year later. The current paper focuses solely on the Parent Forum components. Outcome Measures: Caregiver problem solving, study-specific satisfaction questions, and qualitative focus groups. Results: After consulting with multiple stakeholders (including caregivers, clinicians, and researchers), the first Parent Forum was designed to focus on caregiver health/well-being. While caregivers from Parent Forum I reported greater positive problem solving and relatively high satisfaction scores, they also reported wanting more time together and more discussion of their children's health. We redesigned Parent Forum II to incorporate this feedback which yielded positive results, particularly during focus groups. Conclusion: The purpose of this manuscript was to share our development process to inform other teams engaged in intervention design for this or similar populations. Our experience emphasized the need to not only involve multiple stakeholders, but to pilot test intervention components, and be open to modifying them after receiving participant feedback. The final intervention model yielded positive reactions, but also emphasized the need for ongoing caregiver support.

Assessment of the family environment in pediatric neurodisability: a state-of-the-art review

The importance of the family environment for the development of children with neurodisabilities is undisputed. The objective of this study is to describe how family environment has been measured in research on families of children with neurodisabilities, in order to support researchers and clinicians to select appropriate methods for use. A three-step approach was used and 13 measures of family environment were identified within 77 studies. Five measures were used most commonly across a majority of studies (n=50). The measures varied considerably in terms of theoretical background, content, subscales, and populations for which they were developed and validated. These measures were used with considerable variability between studies and with a limited range of research respondents, most typically the child's mother. Challenges, opportunities, and suggestions on how to improve the application of family environment measures in research are discussed.

The Nature of Family Engagement in Interventions for Children With Chronic Conditions

Recognizing the bi-directional relationship between family functioning and child well-being in the context of childhood chronic conditions, researchers have tested family-focused interventions aimed at promoting both child and family well-being through improving the family's condition management capacity. Based on a sample of 70 interventions for families in which there was a child with a chronic physical condition, this analysis examined the nature of family engagement in the interventions. Data were extracted from the intervention reports using a standardized template; conventional content analysis was used to describe family engagement. Interventions varied in focus, structure, and level of family engagement. Investigators most often sought to improve condition control or management, with parent engagement focused on improving capacity to manage the treatment regimen. Few investigators addressed capacity building in the context of family functioning. Recommendations are made for reporting standards for family-focused interventions and for enhancing the family systems grounding of interventions.

Mental health problems in children with neuromotor disabilities

Mental health in children with neuromotor disorders is part of a dynamic system, including medical and developmental domains, family, school and community. Presentations are often complex and multifactorial, requiring a broad, individualized approach. A narrative overview of mental health symptoms in children with neuromotor disabilities is provided, along with recommendations for their assessment and management using the WHO's International Classification of Functioning framework.

Spina bifida

Spina bifida is a birth defect in which the vertebral column is open, often with spinal cord involvement. The most clinically significant subtype is myelomeningocele (open spina bifida), which is a condition characterized by failure of the lumbosacral spinal neural tube to close during embryonic development. The exposed neural tissue degenerates in utero, resulting in neurological deficit that varies with the level of the lesion. Occurring in approximately 1 per 1,000 births worldwide, myelomeningocele is one of the most common congenital malformations, but its cause is largely unknown. The genetic component is estimated at 60-70%, but few causative genes have been identified to date, despite much information from mouse models. Non-genetic maternal risk factors include reduced folate intake, anticonvulsant therapy, diabetes mellitus and obesity. Primary prevention by periconceptional supplementation with folic acid has been demonstrated in clinical trials, leading to food fortification programmes in many countries. Prenatal diagnosis is achieved by ultrasonography, enabling women to seek termination of pregnancy. Individuals who survive to birth have their lesions closed surgically, with subsequent management of associated defects, including the Chiari II brain malformation, hydrocephalus, and urological and orthopaedic sequelae. Fetal surgical repair of myelomeningocele has been associated with improved early neurological outcome compared with postnatal operation. Myelomeningocele affects quality of life during childhood, adolescence and adulthood, posing a challenge for individuals, families and society as a whole. For an illustrated summary of this Primer, visit: http://go.nature.com/fK9XNa.

Resilience and Disruption in Observed Family Interactions in Youth With and Without Spina Bifida: An Eight-Year, Five-Wave Longitudinal Study

OBJECTIVE

To examine differences between families of youth with spina bifida (SB) and families of typically developing (TD) youth on family-, parent-, and youth-level variables across preadolescence and adolescence.

METHODS

Participants were 68 families of youth with SB and 68 families of TD youth. Ratings of observed family interactions were collected every 2 years at 5 time points (Time 1: ages 8-9 years; Time 5: ages 16-17 years).

RESULTS

For families of youth with SB: families displayed less cohesion and more maternal psychological control during preadolescence (ages 8-9 years); parents presented as more united and displayed less dyadic conflict, and youth displayed less conflict behavior during the transition to adolescence (ages 10-13 years); mothers displayed more behavioral control during middle (ages 14-15 years) and late (ages 16-17 years) adolescence; youth displayed less engagement and more dependent behavior at every time point.

CONCLUSIONS

Findings highlight areas of resilience and disruption in families of youth with SB across adolescence.

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.

Delimiting family in syntheses of research on childhood chronic conditions and family life

Synthesis of family research presents unique challenges to investigators who must delimit what will be included as a family study in the proposed review. In this paper, the authors discuss the conceptual and pragmatic challenges of conducting systematic reviews of the literature on the intersection between family life and childhood chronic conditions. A proposed framework for delimiting the family domain of interest is presented. The framework addresses both topical salience and level of relevance and provides direction to future researchers, with the goal of supporting the overall quality of family research synthesis efforts. For users of synthesis studies, knowledge of how investigators conceptualize the boundaries of family research is important contextual information for understanding the limits and applicability of the results.

Stress among parents of infants with neural tube defect and its associated factors

The purpose of this study was to assess the stress among parents (either the mother or the father) of infants with neural tube defects (NTDs) and its associated factors. Using Parenting Stress Index-Short Form (PSI-SF), 100 parents of infants with NTDs were compared with 100 parents as a normative group. The total mean score for parents of infants with NTDs was 104.0 (standard deviation (SD) = 22.9) compared with 84.3 (SD = 18.9) for parents of infants without NTDs. Fifty-three (53.5%) parents of infants with NTDs and 15% of the control group had clinically significant high total stress score. Parents of infants with NTDs had a significantly higher score of distress in all scales of PSI-SF compared with those of infants without NTDs. Multivariate analysis found that mothers of infants with NTDs had a significantly higher average score for parental distress, parent-child dysfunctional interaction and total stress than fathers. Parents' lower education, unemployed parents and lower family income per month were significantly associated with increased parent-child dysfunctional interaction and parental distress. Parents with lower education and lower family income are in need for psychological and emotional support from health-care professionals.

Patterns of family management of childhood chronic conditions and their relationship to child and family functioning

Understanding patterns of family response to childhood chronic conditions provides a more comprehensive understanding of their influence on family and child functioning. In this paper, we report the results of a cluster analysis based on the six scales comprising the Family Management Measure (FaMM) and the resulting typology of family management. The sample of 575 parents (414 families) of children with diverse chronic conditions fell into four patterns of response (Family Focused, Somewhat Family Focused, Somewhat Condition Focused, Condition Focused) that differed in the extent family life was focused on usual family routines or the demands of condition management. Most (57%) families were in either the Family Focused or Somewhat Family Focused pattern. Patterns of family management were related significantly to family and child functioning, with families in the Family Focused and Somewhat Family Focused patterns demonstrating significantly better family and child functioning than families in the other two patterns.

Functional disability of children with spina bifida: its impact on parents' psychological status and family functioning

OBJECTIVE

To evaluate the impact of functional disability of Turkish children with spina bifida (SB) on parents' psychological status and family functioning.

METHODS

Fifty-four children with SB and parents were included. The Functional Measure for Children (WeeFIM), Beck Depression Inventory (BDI), and Family Assessment Device (FAD) were used.

RESULTS

Mothers' BDI scores were significantly higher than fathers' (p < 0.001). No significant effects of the knowledge of having children with SB before birth and the number of children in families on BDI scores and FAD sub-scores were found (p > 0.05). According to multiple regression analysis; significant correlations with fathers' BDI were problem-solving (p = 0.012) and general functioning (p = 0.037) and with mothers' BDI was roles (p = 0.018). Only childrens age was found to be an influential variable on WeeFIM scores (p < 0.001).

CONCLUSION

Spina bifida healthcare should include psychological support to parents of these children and this support should be independent from disability level of children.

Psychosocial outcomes of children and adolescents with early-onset spinal cord injury and those with spina bifida

PURPOSE

To describe psychosocial outcomes of children and adolescents with early-onset spinal cord injury (SCI) and spina bifida (SB) and identify differences between them.

METHODS

Eighty-three participants had acquired SCI before age 3 years (mean age 10.6 ± 3.8 yrs), and 54 had SB (mean age 11.7 ± 4.1 yrs). The participants completed standardized assessments of participation, quality of life (QOL), anxiety, and depression. Independent-sample t tests and Mann-Whitney tests were used to assess group differences.

RESULTS

Participants with SCI reported higher school QOL (P = .016) and lower anxiety with social concerns/concentration (P = .037) than did participants with SB. The subgroup of participants with SCI with paraplegia reported higher school (P = .014) and overall (P = .034) QOL, and they participated in more activities (P = .015) than participants with SB.

CONCLUSIONS

Children and adolescents with SCI with paraplegia have greater school and overall QOL and participate in more activities than children and adolescents with SB. Children and adolescents with SB would benefit from increased support at school and in social participation.

Psychosocial outcomes among youth with spinal cord injury and their primary caregivers

BACKGROUND

Past research has found youth with disabilities to experience poor psychosocial outcomes, but little is known about factors related to psychosocial health among youth with spinal cord injury (SCI).

OBJECTIVE

To describe psychosocial health among youth with SCI, examine relationships between psychosocial outcomes and demographic and injury-related factors, and examine relationships between aspects of psychosocial health. Youth activity, participation, quality of life (QOL), coping, anxiety and depression, and caregiver mental health were included.

METHODS

Data were collected as part of a prospective study of 420 youth with SCI ages 1-18 and their primary caregivers. Activity data were also presented from a study developing a computerized adaptive testing (CAT) platform with 226 youth with SCI ages 8-21.

RESULTS

Although relationships varied by factor, youth outcomes were related to youth age, sex, age at injury/injury duration, and level/extent of injury. Caregiver mental health related to child age and age at injury. Further, relationships were uncovered between aspects of psychosocial health: aspects of youth mental health were related to youth participation and QOL, youth coping was related to youth mental health, participation, and QOL, and caregiver mental health was related to child mental health and QOL.

CONCLUSION

Psychosocial outcomes relate to each other and vary by child and injury-related factors and should be understood in a comprehensive, developmental context. Identifying best measures of activity and psychosocial functioning among youth with SCI and understanding factors related to their psychosocial health is critical to improving outcomes for the pediatric-onset SCI population.

Motivational interviewing in adolescent treatment

This paper briefly reviews the research literature on motivational interviewing (MI) and behaviour change in adolescents and then discusses the implications of adolescent cognitive and social-emotional developmental processes for the relational and technical components of MI. Research suggests that MI is efficacious in improving substance use in adolescents. Research has been slower to emerge in other behaviours, but available randomized controlled trials suggest that MI has great promise for improving mental and physical health outcomes in this developmental period. The relational and technical components of MI are highly relevant for the adolescent developmental period, and studies have shown that these components are related to outcomes in this population. There are several ways to include MI in clinical interventions for adolescents, ranging from MI in brief settings to using MI as a platform from which all other treatments are offered. Future research is necessary to test the effects of MI in adolescent group settings and the full integration of MI into other adolescent treatment approaches.

A comparison of parenting stress between mothers of children with spina bifida and able-bodied controls

OBJECTIVES

To compare parenting stress between mothers of children with spina bifida (SB) and able bodied controls.

METHODS

Sixty-six mothers of children with SB and controls (matched for age, sex and ethnicity) completed the Parenting Stress Index Short Form (PSI/SF) and General Health Questionnaire-12 (GHQ-12). Each child's adaptive skills was assessed using the Vineland Adaptive Behaviour Scales (VABS).

RESULTS

Mothers of children with SB had significantly higher scores for GHQ-12 and the Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI) and Difficult Child (DC) sub-scales of the PSI/SF, even after adjusting for socioeconomic and caregiver status. Single parent status, having a child with SB and higher Life Stress scores were associated with higher PD and DC scores. Lower VABS scores were associated with higher P-CDI scores.

CONCLUSION

Factors such as recent life change events, single parent status and the child's adaptive skills modify the impact of spina bifida on parenting stress.

Maternal mental health in families of children with spina bifida

BACKGROUND

this study aimed to compare mental health of mothers of children with spina bifida with mothers of able-bodied controls.

METHODS

eighty-one mothers of children with spina bifida aged 1-18 years completed the General Health Questionnaire-12 (GHQ-12) and Parenting Stress Index Short Form (PSI/SF). The controls were 69 mothers of children with acute, non-disabling illnesses. Each child's adaptive skills were assessed using the Vineland Adaptive Behaviour Scales (VABS). Logistic regression analysis was used to determine factors related to a high GHQ score (≥ 3) in all patients.

RESULTS

compared to the controls, mothers of children with spina bifida had lower educational levels and were more likely to be the main caregivers and not working. Nineteen (23.5%) of them had a high GHQ score compared to 5 (7.2%) of the controls. They also had significantly higher scores for total PSI/SF and the parent domain, difficult child (DC) and parent-child dysfunctional interaction subscales. Children with spina bifida had lower scores for the composite VABS and communication, socialization, daily living skills and motor sub-domain than the controls. Spina bifida (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.30-14.23), higher DC scores (OR 1.1, 95% CI 1.00-1.16), and higher life stress scores (OR 1.1, 95% CI 1.01-1.71) were associated with a high GHQ score.

CONCLUSION

spina bifida, recent stressful life change events and maternal perception of a child as 'difficult' are associated with poor maternal psychological health.

Mother-adolescent agreement regarding decision-making autonomy: a longitudinal comparison of families of adolescents with and without spina bifida

OBJECTIVE

Longitudinal comparison of mother and adolescent agreement regarding decision-making autonomy for adolescents with and without spina bifida (SB).

METHODS

Forty-two mother-adolescent dyads of adolescents with SB and 55 comparison dyads reported on who was responsible for decision-making across five waves of data collection, beginning at age 8 or 9 years through age 16 or 17 years.

RESULTS

The proportion of tasks that dyads agreed were decided by adolescents increased over time for both samples beginning at age 12 or 13 years, but appeared to be delayed by roughly two years for youth with SB and was lower for youth with SB from lower socioeconomic (SES) backgrounds. Mothers and adolescents with low SES demonstrated higher proportions of tasks that dyads agreed were decided by mothers.

CONCLUSIONS

SB and low SES are risk factors for lower levels of agreed-upon decision-making autonomy. Future studies should examine how parent-adolescent agreement regarding autonomy relates to psychosocial outcomes.

Gaps and opportunities: an agenda for further research, services, and program development in spina bifida

In this article an agenda is discussed for further research, services, and program development identified in the development of the Life Course Model Web site for individuals with spina bifida, their families and the health care providers who work with them. The gaps identified during development of the Life Course Model Web site revealed that there has been minimal progress made on the research agenda since the 2003 consensus document, "Evidence-Based Practice in Spina Bifida: Developing a Research Agenda" or the summary document from the First World Congress on Spina Bifida Research and Care gathering, "The Future is Now," in 2009. Gaps are delineated in the three main areas of the transition curriculum (self-management/health, personal and social relationships, and employment/income support), and recommendations for future research and program development are proposed.

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).

Relationships between the psychological characteristics of youth with spinal cord injury and their primary caregivers

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

To describe anxiety and depression among caregivers of youth with spinal cord injury (SCI), examine predictors of caregiver psychological functioning and evaluate relationships between caregiver and child psychological outcomes. The protective factor of youth social relationships was also included to examine its impact on relationships between caregiver and child psychological functioning.

SETTING

Families received services at one of three pediatric specialty hospitals within a single hospital system in the United States.

METHODS

The study included English-speaking youth with SCI, aged between 7 and 17 years, who had been injured at least one year before, and their self-identified primary caregivers. Participants completed surveys assessing their anxiety, depression and youth's perceived social relationships.

RESULTS

The study included 203 youth with an average age of 12.70 years (s.d.=3.15), and among them 70% had paraplegia. Seventy-eight percent of caregivers were mothers, 14% fathers and 8% other family members. In all, 16 and 21% of caregivers scored in the range of moderate/severe anxiety and depression, respectively. Being female and having a child with mental health problems predicted caregiver anxiety and depression. In addition, having a child who was older at the time of injury predicted caregiver depression. Poor social relationships, having a caregiver with mental health problems and having a caregiver with less education predicted both child anxiety and depression.

CONCLUSION

Caregiver sex, child age at injury and child mental health were related to caregiver outcomes; caregiver education, marital status and child age were not. Caregiver mental health and education and child social relationships predicted child outcomes. Neither injury level nor injury severity was related to caregiver or child outcomes.

Associations of ethnicity and SES with IQ and achievement in spina bifida meningomyelocele

OBJECTIVES

We evaluated whether the phenotypic pattern of higher verbal than nonverbal IQ in children with spina bifida meningomyelocele (SBM) is consistent across subgroups differing in ethnicity and SES. We also explored the relation of cognitive and academic performance.

METHODS

Non-Hispanic White (n = 153) and Hispanic (n = 80) children with SBM received the Stanford Binet Test of Intelligence-IV and achievement subtests of the Woodcock-Johnson. Parents completed questionnaires assessing the family environment [socioeconomic status (SES), resources, and educational opportunities].

RESULTS

Multivariate analysis revealed that Hispanic children with lower SES had lower verbal than nonverbal scores. Hispanic children with higher SES and non-Hispanic White children demonstrated the reverse pattern. Verbal and nonverbal IQ interacted to predict reading and math performance.

CONCLUSIONS

Lower SES is associated with lower verbal IQ in economically disadvantaged Hispanic children with SBM. Academic achievement is largely correlated with verbal IQ, but children with lower verbal IQ may partially compensate with higher nonverbal ability.

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.

Course of behaviour problems of children with cerebral palsy: the role of parental stress and support

BACKGROUND

Cerebral palsy (CP) is a well-recognized neurodevelopmental condition persisting through the lifespan. In many individuals with CP, motor disorders are accompanied by other disturbances, including emotional and behavioural problems. Little is known on the course of such problems, also in relation to possible exacerbating or mitigating factors. Aims of this study were to test whether parental stress and support, apart from the severity of CP of the child, played a significant role in the course of behaviour problems.

METHOD

The participants aged 9, 11 and 13 were assessed (baseline) and followed up after 1, 2 and 3 years. Situational and relational sources of support and stress for the primary caregiver were rated with a questionnaire: (CBCL), behaviour problems with the Child Behaviour Checklist. Physicians rated motor ability using the Gross Motor Function Classification System.

RESULTS

Behaviour problems of children with CP started significantly higher than in the general population, but diminished over the 3-year period. Older children showed less problems overall, and girls showed less externalizing problems than boys. Children with the most severe CP had more externalizing problems; effects on internalizing problems were not significant. Across time, an excess of stress vs. support related to parents' socio-economic and living situation and to parents' social relationships was positively related to total behaviour problems, internalizing and externalizing behaviours of children.

CONCLUSIONS

Levels of behaviour problems are elevated but diminish during adolescence for children with CP. Severity of CP plays a role as well as the family context in terms of the stress and support that caregivers experience.

A camp-based intervention targeting independence among individuals with spina bifida

OBJECTIVE

To design and evaluate a camp-based intervention, the goal of which was to increase independence among children, adolescents, and adults with spina bifida.

METHODS

An intervention targeting independence was embedded within a typical week long camp experience. The intervention consisted of the following: collaborative (i.e., parent and camper) goal identification, group sessions consisting of psycho-education and cognitive tools, and goal monitoring by camp counselors. Camper and parent report of demographic variables, goal attainment, spina bifida knowledge, and independence were gathered. Interventionist report of adherence to the treatment manual was also collected.

RESULTS

Campers made significant gains in individual goals, management of spina bifida responsibilities, and independence with general spina bifida tasks, with medium effect sizes observed in goal attainment.

CONCLUSIONS

Results indicated that significant progress was made on individually oriented goals from pre- to post-camp. Design issues are discussed.

Generic and diabetes-specific parent-child behaviors and quality of life among youth with type 1 diabetes

OBJECTIVE

To evaluate associations among parent-child behaviors and generic and diabetes-specific health-related quality of life (HRQOL) in a multi-site sample of youth with type 1 diabetes.

METHOD

One hundred and twenty-one youth and their primary caregivers completed measures of parent-child behaviors, child HRQOL, and participated in an observed family interaction task.

RESULTS

Diabetes-specific parent-child variables were associated significantly with both generic and diabetes-specific HRQOL above and beyond the contributions of demographic and generic parent-child variables, accounting for between 13% and 31% of the variance in HRQOL. Diabetes-specific family conflict and negative diabetes-specific family communication were associated with lower HRQOL. Collaborative parent involvement in diabetes care was associated with higher levels of HRQOL.

CONCLUSIONS

Interventions that target diabetes-specific family interactions will be beneficial to the quality of life of children with type 1 diabetes.

Parents' personality and parenting stress in families of children with spina bifida

BACKGROUND

Spina bifida (SB) can place parents at risk for increased levels of parenting stress. Little is known, however, about the role of parents' intrapersonal resources. Therefore, based on ideas of the Disability-Stress-Coping Model, relations between the severity of SB, parents' personality traits and parenting stress were examined.

METHODS

Forty-six mothers and 37 fathers of children with SB (6-14 years) participated. Severity of SB (physical dysfunctions and cognitive functions), parental personality (Big Five) and parenting stress (Parenting Stress Index) were measured. Multiple regression analyses were performed.

RESULTS

The severity of the child's physical dysfunctions was positively associated with parenting stress. Extraversion (mothers only), emotional stability and agreeableness (fathers only) were negatively related to parenting stress. In the final model, 64% of the variance in mothers' and 67% of the variance in fathers' levels of parenting stress was explained. Parents' personality traits explained the largest proportions of variance in parenting stress.

CONCLUSION

Mobility, bladder and bowel dysfunctions in school-aged children with SB represent ongoing stressors for parents. Parents' intrapersonal resources of positive affectivity, however, are more important determinants of parental adjustment to SB than the child's physical dysfunctions.

Respiratory muscular strength decrease in children with myelomeningocele

STUDY DESIGN

Case-control study.

OBJECTIVE

To evaluate respiratory muscle force in children with myelomeningocele.

SUMMARY OF BACKGROUND DATA

Myelomeningocele is a common spinal cord malformation with limitations linked to central nervous system lesions and abnormalities in respiratory movements. Despite this, little attention has been given to evaluating respiratory muscle force in these patients.

METHODS

Children with myelomeningocele aged between 4 and 14 years (myelomeningocele group; MG, n = 20) were studied and compared with healthy children (control group; CG, n = 20) matched for age and gender. Respiratory muscular force was evaluated by maximum inspiratory (Pimax) and expiratory (Pemax) pressures.

RESULTS

Groups were similar for age [CG = 8 (6-13) x MG = 8 (4-14), P > 0.05]; gender, and body mass index [CG = 17.4 (14.1-24.7) x MG = 19.2 (12.6-31.9), P > 0.05]. The lumbosacral region was predominantly affected (45%). Maximum respiratory pressures were significantly higher in CG than MG (Pimax = CG: -83 +/- 21.75 > MG: -54.1 +/- 23.66; P < 0.001 and Pemax = CG: +87.4 +/- 26.28 > MG: +64.6 +/- 26.97; P = 0.01). Patients with upper spinal lesion (UL) had lower maximum respiratory pressure values than those with lower spinal lesion (LL), [Pimax (UL = -38.33 +/- 11.20 cm H2O x LL = -60.85 +/- 24.62 cm H2O), P < 0.041 and Pemax (UL = +48 +/- 20.82 cm H2O x LL + 71.71 +/- 26.73 cm H2O), P = 0.067]).

CONCLUSION

Children with myelomeningocele at the ages studied presented reduced respiratory muscle force with more compromise in upper spinal lesion.

Parents' social adjustment in families of children with spina bifida: a theory-driven review

OBJECTIVE

Five theoretical hypotheses about the impact of spina bifida (SB) on parents' social adjustment in the parent-child, the marital and the family-level relationship were tested.

METHODS

PsycInfo, Medline and reference lists were searched. This yielded 27 eligible reports. Effect sizes (Hedges' d) were computed to estimate the impact of SB.

RESULTS

Overall, the effects of SB were small to negligible on the affective dimensions of parents' relationships. The few effects that were found tended to be positive. The most important negative effects of SB were found in the parent-child relationship (parenting stress and overprotection).

CONCLUSIONS

Support was found for the resilience-disruption hypothesis, the role-division hypothesis and the miscarried-helping hypothesis, but not for the marital-disruption hypothesis or the marginality hypothesis.