Debra Lobato

Siblings of handicapped children A review

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

NEURODEVELOPMENTAL AND MEDICAL STATUS OF LOW‐BIRTHWEIGHT SURVIVORS OF BRONCHOPULMONARY DYSPLASIA AT 10 TO 12 YEARS OF AGE

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

Psychosocial characteristics of preschool siblings of handicapped and nonhandicapped children

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

Discordance Between Sibling and Parent Reports of the Impact of Chronic Illness and Disability on Siblings

This study compared sibling and parent reports of sibling adjustment to chronic illness/developmental disability (CI/DD) in 51 siblings (ages 8 to 13). Discordance between sibling and parent reports on the Sibling Perception Questionnaire was common, with parents tending to report more sibling adjustment problems than did siblings. Siblings who reported more problems than parents tended to be younger and male. There was a trend for parents who reported more problems than siblings to also report greater negative impact of CI/DD on family social functioning than other parents. Findings highlight the importance of obtaining sibling self-reports in research and clinical settings.

Preschool siblings of handicapped children: interactions with mothers, brothers, and sisters.

The purpose of this investigation was to examine similarities and differences between young (aged 3 years to 6 years 9 months) siblings of handicapped and nonhandicapped children in their behavioral interactions with their mothers, brothers, and sisters. Behavior of mothers toward the different groups of children also was examined. Results revealed few differences between sibling groups in the quantity or quality of their interactions with family members. In comparison to the matched control children, siblings of handicapped children engaged in more parallel play and social play, and were more nurturing but no more likely to interact aggressively or to be commanding or directive with their brothers or sisters. Mothers in the experimental group were found to target significantly more nurturant behaviors toward their children compared to control mothers and were significantly more likely to deliver commands, directives, and reprimands to siblings of handicapped children than to any other child. Results are discussed in terms of their correspondence to previous observational and interview research.

Psychological Treatments for Pediatric Functional Gastrointestinal Disorders

Our objective was to systematically review and evaluate behavioral and psychological treatments applied to pediatric functional gastrointestinal disorders. Electronic searches were conducted in bibliographic databases including PubMed, PsychInfo, and Medline. Psychological and behavioral interventions were classified into the following 5 primary treatment modalities: psychoeducation, behavior therapy/contingency management, relaxation-based therapies (including biofeedback and hypnotherapy), and cognitive-behavioral therapy (including cognitive-behavioral family therapy). There was a wide variation in the quality and quantity of studies within each treatment category. Effective interventions generally involved multiple therapeutic components and included elements of both individual and family treatment. Psychological interventions that combine psychoeducation, relaxation-based therapies, and cognitive-behavioral therapy appear superior to standard care (reassurance or dietary manipulation) in the elimination of pain and reduction in functional disability. Although many psychological treatments demonstrated evidence of positive effects, few well-designed randomized controlled trials of psychological treatments for functional gastrointestinal disorders exist. More work is needed to determine the most potent, essential elements of psychological treatments alone or in combination with standard medical intervention, and to establish their applicability with diverse populations. Clinical and research implications are discussed.

Latino sibling knowledge and adjustment to chronic disability

Forty matched healthy Latino and non-Latino siblings (ages 8-14 years) of children with developmental and physical disabilities completed interviews and questionnaires assessing sibling knowledge of and adjustment to disability and sibling global psychological functioning. One-way analyses of variance revealed Latino siblings to have significantly less accurate information about the disability and more internalizing problems than non-Latino siblings. Sibling and parent wishes for the healthy sibling reflected cultural values. The results indicate that Latino siblings of children with chronic disabilities may be at risk for internalizing psychological problems. Future research regarding cultural factors affecting sibling adaptation to childhood disability is encouraged.

Social Skills and Nonverbal Behavior

Social skills are an important aspect of individual difference among children. Variously conceived of as “social competence,” “impression management,” or “interpersonal competence,” social skills generally refer to the complex set of behavioral and cognitive skills that are used to direct and facilitate social behavior (Eisler & Frederiksen, 1980). Implicit in the concept of social skills is the notion that social behavior is comprised of both verbal and nonverbal skills.

Patterns of Medical and Developmental Comorbidities Among Children Presenting With Feeding Problems: A Latent Class Analysis

Objective: Children with feeding problems often have multiple co-occurring medical and developmental conditions; however, it is unknown whether patterns of comorbidity exist and whether they relate to important feeding-related health outcomes. The main objective of this study was to examine (1) the relationship between the number of medical and developmental comorbidities and important feeding-related health outcomes; (2) how various comorbidities interact and form empirically derived patterns; and (3) how empirically derived patterns of comorbidity relate to weight status, nutritional variety, and child and parent mealtime behavior problems. Methods: The medical records of 286 children (mean age = 35.56 months) seen at an outpatient feeding disorders clinic were reviewed. Child weight status, nutritional variety, and child and parent mealtime behavior problems were assessed using standardized measures. The lifetime occurrence of medical and developmental conditions was reliably coded. Empirically derived patterns of comorbidity were generated via latent class analyses. Results: Latent class analyses generated 3 comorbidity patterns: “Behavioral” (58% of cases), “Developmentally Delayed” (37%), and “Autism Spectrum Disorder” (ASD, 5%). The Autism Spectrum Disorder group was found to have less nutritional variety compared to the Behavioral and Developmentally Delayed groups. No differences were found between groups in terms of percent ideal body weight, or severity of child or parent mealtime behavior problems. Conclusion: Multiple co-occurring conditions of children with feeding problems were empirically reduced to 3 patterns of comorbidities. Comorbidity patterns were largely unrelated to weight status and child or parent mealtime behavior problems. This suggests that medical and developmental conditions confer general, rather than specific, risk for feeding problems in children.

Immigration and Acculturation-Related Factors and Asthma Morbidity in Latino Children

OBJECTIVE This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. METHODS Latino children with asthma (n = 232), ages 7-16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. RESULTS The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. CONCLUSION Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children.