Ostracism in pediatric populations: review of theory and research.

Ostracism, ignoring and excluding a target individual, has recently emerged as one of the more common and damaging forms of social exchange. This article reviews the theoretical and empirical foundations of ostracism and its impact on the targeted individual, especially threats to the fundamental psychological needs of belonging, self-esteem, meaningful existence, and sense of control. Ostracism in children and adolescents is under-researched compared to bullying in general, in both the general youth population and in populations of children and youth with special health care needs (CYSHCN). Basic and applied studies on ostracism and its impact are reviewed with special emphasis on recent findings about ostracism in CYSHCN. Evidence is presented that ostracism may pose an even greater threat to children's adjustment and need-threat levels than bullying. Resources for clinician and researcher engagement in this emerging area are provided.

Bullying and ostracism experiences in children with special health care needs.

OBJECTIVE: Bullying experiences are becoming increasingly common in children and can have devastating consequences. Ostracism threatens a child's need for self-esteem, sense of belonging, sense of control, and meaningful existence. Recent literature suggests that children with special health care needs may be at risk for these negative events and consequences. This study compares bullying and ostracism experiences in children with and without various special health care needs. METHODS: Participants aged 8 to 17 years completed questionnaires during a routine primary care or subspecialty clinic visit. Children with learning disabilities (N = 34), attention deficit or hyperactivity disorder (N = 100), autism spectrum disorders (N = 32), behavioral or mental health disorders (N = 33), and cystic fibrosis (CF, N = 22) were compared with 73 control children with no diagnosis on Reynolds' Bully-Victimization Scale scores and a 15-item pilot ostracism scale. RESULTS: Compared with the control group, children in the learning disabilities, autism spectrum disorders, and attention deficit or hyperactivity disorder groups exhibited significant victimization scores on the Bully-Victimization Scale, whereas the behavioral or mental health disorders group had increased mean victimization scores. The learning disabilities group also reported clinically significant bullying. The CF group did not report involvement as bullies or victims. All children with special health care needs groups had increased mean frequency of threats to basic needs related to ostracism, and children with attention deficit or hyperactivity disorder and autism spectrum disorders were at higher risk for ostracism experiences. CONCLUSION: Children with special health care needs may be at higher risk for bullying, victimization, and ostracism. Further research is needed to explore this relationship, especially as it relates to child adjustment. Children with special health care needs should be asked about bullying and ostracism experiences and potential effects as part of mental health screening.

Exposure to potentially traumatic life events in children with special needs.

A series of studies of potentially-traumatic life-events (PTLE) in children and youth with special needs (CSN) was conducted after parents of 102 CSN from interdisciplinary pediatric clinics listed PTLE at significantly higher rates on the Pediatric Emotional Distress Scale (PEDS) compared to parents 58 students with no diagnoses. Subsequent studies replicated this disparity in 213 5-15 year-olds sampled through school-distributed parent PTLE checklists instead of PEDS. Results from school samples suggested significantly more PTLE in CSN, t (211) = -3.39, p < .001. In both studies some of PTLE reported significantly more in CSN were potentially related to the special needs of the child (e.g., hospitalizations, school problems) but others were not (e.g., traumatic events such as vehicular accidents and disasters). Children exposed to more PTLE were rated as having significantly more behavior problems across measures. Suggested cost-effective screening for PTLE may enable clinicians to enhance differential diagnosis, medical management, and psychosocial interventions for CSN by taking into account PTLE and symptoms related to recent disruptive events.

Paternal correlates of cognitive and behavioral functioning in children with myelomeningocele.

This study examined paternal correlates of the cognitive and behavioral functioning of children with myelomeningocele, when controlling for maternal and biological/child correlates as possible sources of variance. Participants were 48 parent dyads of children with myelomeningocele (21 males, 27 females) between the ages of 4 and 12 years (mean 8y, 2mo, SD 2y 3mo). Lesion levels of participants ranged from the thoracic to sacral (thoracic-L3: n=15; L4-L5: n=15; sacral or lipomeningocele: n=18), of whom 38 had been shunted for hydrocephalus. Half of the participants (n=24) were community ambulators. Potential predictors of cognitive and behavioral functioning included paternal and maternal parenting stress, as assessed by the Parenting Stress Index - Short Form paternal, and maternal perceptions of support and resources, as assessed by the Family Resource Scale and the Family Support Scale, and child medical severity. Paternal variables significantly correlated with behavioral functioning but not with cognitive functioning. Regression analyses revealed that paternal personal distress and maternal perceived adequacy of social support accounted for significant variance in overall child behavioral functioning. Only child medical severity and annual household income explained significant variance in overall child cognitive functioning. These findings add to the growing body of theory and research documenting that fathers make unique and significant contributions to child adjustment in children with myelomeningocele. Both fathers and mothers need to be considered in interventions supporting development and adjustment of children with myelomeningocele and their families.

Toileting concerns, parenting stress, and behavior problems in children with special health care needs.

This study examined the relationship between toileting concerns, behavior problems, and parenting stress in parents of children with special health care needs (CSHCN). Participants included parents of 99 males and 71 females aged 4 to 12 years with neural tube defects (NTD), developmental-behavioral disabilities (DBD), or history of perinatal intraventricular hemorrhage (IVH). Parents completed the Achenbach Child Behavior Checklist (CBCL) and the Parenting Stress Index-Short Form (PSI-SF). Parents expressing toileting concerns on the CBCL reported significantly more personal distress and more externalizing problems versus those with continent children. Variation within subsamples suggested that expectations based on nature of disability may be a factor in parent adjustment. Direct assessment and intervention of toileting issues should be a high priority in secondary stress prevention with CSHCN and their families.

Social skills and behavior problems in children with disabilities with and without siblings.

This study examined social skills and behavior of children with disabilities (CWD) and the impact of siblings on these behaviors. Eighty-five CWD diagnosed with Attention-Deficit Hyperactivity Disorder only (ADHD-o), Learning Disability or Learning Problems (LD/LP), ADHD and LD combined (ADHD/LD) or Spina Bifida (SB) and their siblings were evaluated using standardized social skills and behavior rating scales. The ADHD-o group had significantly lower social skills and more behavior problems than the other groups. There was no recognized effect of the sibling relationship on the social skills and behavioral problems of either the CWD or their siblings. Birth order of the sibling dyads and diagnos(es) of siblings did not have significant influence on the social skills or behavior of CWD. ADHD is a significant risk factor for poor social skills and behavior problems, even when compared with other diagnoses that carry an increased risk of these same problems.

Caretaker perception of child vulnerability predicts behavior problems in NICU graduates.

This study explores parental perception of child vulnerability (PPCV) and parent overprotection (POP) and their relationship to neonatal medical problems, child development and behavior. Participants included 90 lower income parents of NICU graduates ages 22-81 months consecutively enrolled at a high-risk neonatal developmental follow-up clinic. Parents completed the Child Vulnerability Scale (CVS), the Parent Protection Scale (PPS) and the Child Behavior Checklist (CBCL) regarding their children. Step-wise regression analysis revealed the CVS as the sole predictor of child behavior, accounting for 13% of the variance in the CBCL Total T-score (R(2) =.13, $be =.86, p <.006). Neonatal medical problems, Child DQ, and most parental demographic variables did not correlate with CVS or PPS scores. A significant correlation between CVS and the separation subscale of the PPS was noted (r =.31, p <.01). We conclude that NICU graduates perceived vulnerable by their caretakers have significant behavioral difficulties compared to those perceived as not vulnerable. Future research should address early parental antecedents of PPCV, the persistence of PPCV, and its effects on behavioral outcomes.

Early predictors of school-age behavior problems and social skills in children with intraventricular hemorrhage (IVH) and/or extremely low birthweight (ELBW).

RESEARCH FINDINGS: Child and family characteristics from early infancy (birth-3 months adjusted age, AA) and toddler period (24-30 months) were examined as potential predictors of behavior problems and social skills at 7.5 years of age in 90 LBW infants with IVH and/or ELBW who were part of a longitudinal study of early intervention effectiveness. Severity of medical problems at birth and child temperament at 3 months AA were associated with future social skill levels, but not with behavior problems. Family variables in the first months of the child's life including low income, single parent household, and high parenting stress were significantly correlated with behavior problems at 7.5 years of age. Difficult temperament and elevated parenting stress in the toddler period were strongly associated with later behavior problems. Toddler developmental quotient (DQ) was a strong predictor of future social skills. PRACTICE OR POLICY: These data highlight the importance of early intervention that targets child behavior and emotional adjustment along with cognitive development, especially in low income and single parent households. Interventions that target parent-child interaction and parent stress are also crucial in these populations, even beyond the birth-three period.

Age-related parenting stress differences in mothers of children with spina bifida.

This study examined whether ages of child and parent were risk factors for general parenting stress and disability-specific stress in families of children with spina bifida. Parents of 64 children with spina bifida completed the Parenting Stress Index-Short Form, Parents of Children with Disabilities Inventory, and measures of family support and resources. Scores of families with children under 6 years (preschool) versus 6- to 12-yr.-old children (school age) were compared, as were scores of mothers above or below Age 35. Parents of school-aged children reported significantly higher stress on the Concerns for the Child domain of the Parents of Children with Disabilities Inventory. Mothers over 35 tended to report higher stress in the Concerns for the Child and Medical/Legal Concerns domains of the Parents of Children with Disabilities Inventory. No associations with medical severity, socioeconomic status, family resources, or family support were detected. As the children age and disability-related differences become more apparent, the same level of functioning and severity of disability may be associated with additional parenting stress. Older mothers and those with school-age children may need more resources than current social support systems typically provide.