The Moderating Role of Social Support in Siblings' Negative Feelings Toward Children with Neurodevelopmental Disorders.

The Role of Social Network and Support in Mental Health Service Use: Findings From the Baltimore ECA Study

BackgroundSocial support is a protective factor for siblings of children with neurodevelopmental disorders. AimsWe reviewed studies on social support received by siblings of children with neurodevelopmental disorders. Methods and proceduresWe conducted a pre-registered systematic review (CRD42020207686), searching PsycINFO, MEDLINE, Web of Science, and Scopus. Outcomes and resultsFifteen articles were eligible for the review, 13 of which used cross-sectional designs. Two studies investigated sibling social support after an intervention. Multiple variables were negatively related to social support (e.g., sibling depression, loneliness, stress). Variables that were positively related to social support included prosocial behavior, competence (academic, social, and activity-related), problem-focused coping, and family quality of life. Potential moderators of the relationship between social support and psychosocial adjustment included the type of disorder of the affected sibling and the type of social support provider. We conclude with an overview of the reliability and validity of the seven social support measurements used across the studies. Conclusions and implicationsLower levels of social support are associated with more negative psychosocial adjustment among siblings of children with neurodevelopmental disorders. We encourage future researchers to further investigate ways to increase social support for siblings to improve outcomes.

Liza M. Suarez and Bruce L. Baker** We studied the role of social support (marital adjustment, spousal support, and global support) in the relationship between child externalizing behavior problems and mothers' and fathers ' well being. Seventy-five first grade children were classified into three groups (control, moderate externalizing, and high externalizing) based on parent and teacher reports of behavior problems. Outcome measures were parents' perceived negative impact of the child on social relationships, as well as negative and positive feelings toward parenting. There was evidence for main, moderating (buffering), and mediating effects of social support indicators on outcome measures. Implications of these findings for family intervention are discussed. Key Words: child externalizing problems, family marital adjustment, parenting, social support, spousal support. he everyday responsibilities of are stressful for many adults (Cox, Owen, Lewis, & Henderson, 1989). When a child has behavior problems, daily childrearing tasks can affect parental functioning to an even greater extent (Anastopoulos, Guevremont, Shelton, & DuPaul, 1992; Eyberg, Boggs, & Rodriguez, 1992; Fischer, 1990). Hyperactive, aggressive, or defiant child behaviors are often associated with, for example, ineffective discipline strategies, complaints from teachers, social embarrassment, sibling conflicts, and strain in the marital relationship. The pile up of these types of incidents results in greater levels of stress (Webster-Stratton, 1990), and may result in negative parental perceptions of their children. It has been established that child behavior problems are related to higher levels of stress in their parents (Barkley, 1985; Barkley & Cunningham, 1979; Eyberg, Boggs, & Rodriguez, 1992; Humphries, Kinsbourne, & Swanson, 1978; Mash & Johnston, 1990; Mouton & Tuma, 1988). Although we generally employ the commonly used term parenting stress, we are interested in child impact, which is a more general domain that encompasses stress. Impact, however, can be positive or negative, and it can include different aspects of family life. Moreover, one can ask parents directly about the impact of their child, rather than infer this from a correlation between child behavior and parental stress. Donenberg and Baker (1993) assessed parental perceptions of child impact on social, marital, and sibling relationships, on finances, and on positive as well as negative feelings about parenting. Compared with mothers of non-problem children, mothers of children with externalizing behavior problems reported more negative impact in several domains and less positive feelings about parenting. Surprisingly, reported impacts of children with externalizing behaviors on the family were comparable to those reported by mothers of children with autism. The perceived impact of these children's behavior on their families, however, may depend on the resources available to parents for managing problems. A resource domain of particular interest is perceived social support, especially as it relates to childrearing. Researchers have suggested that parents' perceived support, as well as other resources such as education and psychological adjustment, serve to lessen the negative impact of child problems on parental functioning (e.g., Webster-Stratton, 1990; Belsky, 1984). A large body of research has been generated on the role of social support on psychological adjustment. In a literature review, Cohen and Wills (1985) found evidence for both main and buffering effects of social support. The purpose of this study was to examine the mechanisms through which children with externalizing behaviors impact parents' feelings of stress and perceptions of parenting. We were particularly interested in the role of perceived support, including marital adjustment, spousal support, and global social network support. …

Sense of entitlement is gaining more scientific attention as a multidimensional concept that includes adaptive as well as maladaptive components that may make a unique contribution to the life satisfaction of parents of children with developmental disabilities (DD). Social support is an important resource that can alter the different relationships between the components of entitlement and life satisfaction. However, the moderating role of social support in the relationship between entitlement and life satisfaction among parents of children with DD has not yet been explored. Ninety-four parents of children with DD completed sense of entitlement, social support, and life satisfaction questionnaires. Results showed that social support was related to greater satisfaction with life and had a moderating effect on the relationship between all three of the components of sense of entitlement and life satisfaction. The active component of entitlement was positively associated with life satisfaction only where there were high levels of support. The revenge component was negatively related to life satisfaction only where there were low levels of support. The passive component was negatively related to life satisfaction in the context of low levels of support, while the reverse trend was demonstrated in conditions of high and medium levels of support. Interventions that enhance the perception of social support and adaptive aspects of entitlement can be valuable in terms of the life satisfaction of parents of children with DD.

Can social support protect bullied adolescents from adverse outcomes? A prospective study on the effects of bullying on the educational achievement and mental health of adolescents at secondary schools in East London

Role of child demographic, executive functions, and behavioral challenges on feelings about parenting among parents of youth with Down syndrome

Background: Behaviors related to early childhood nutrition are influenced by a mother's social environment. In many low- and middle-income countries, breastfeeding rates have steadily declined. At the same time, many communities have a history of domestic or international migration that affects the family support systems for women and children remaining in these communities. While social support has been shown to be important to health behaviors conducive to maternal and child health, scant research examines whether social support moderates the impact of an absent father on breastfeeding. Objective: We aim to assess the relationship between father absence and breastfeeding duration and test whether social support moderates the impact of father absence on breastfeeding duration. Methods: We use data from the Social Networks and Health Information Survey (n = 292), a random household survey conducted in a municipality in Guanajuato, Mexico, to estimate Poisson regression models of breastfeeding duration. Results: In multivariate models, an absent father is negatively associated with breastfeeding, whereas social support is positively associated. A significant and positive interaction between father absence and social support suggests that at high levels of support, breastfeeding duration for women with absent fathers does not appear to be meaningfully different from women with present fathers. This suggests that receiving high levels of social support during pregnancy may mitigate the absence of the child's father. Conclusions: Social support interventions for mothers of infants should target mothers and children in households without a father. More research should also be directed at understanding how social support processes during pregnancy can affect breastfeeding in other low- and middle-income countries with high rates of emigration.

Siblings of children with type 1 diabetes mellitus: Psychosocial health, coping

Introduction: Stress is associated with multiple adverse health outcomes, including hypertension. The impact of stress on health may be moderated by social support. The distribution of stress, support, and their association with hypertension have not been well described in low-income countries that face severe poverty. Over the past decade, Haiti has suffered massive natural disasters including the 2010 earthquake, cholera outbreak, COVID-19 pandemic, and recurrent civil instability—all of which may act as prolonged stressors. Hypothesis: We assessed the hypotheses that 1) there are high levels of both stress and support in Haiti, and 2) high support would moderate the relationship between high stress and hypertension. Methods: We measured stress and social support using validated instruments in a population-representative cohort of adults living in urban Port-au-Prince, Haiti between March 2019 and April 2021. Stress was measured using the Perceived Stress Scale, while social support was measured using the Multidimensional Scale of Perceived Social Support. For visualization, continuous scores were categorized using equal-width groups (stress: low (1-5), moderate (6-10), high (11-16); support: low (7-21), low-moderate (22-35), moderate (36-49), moderate-high (50-64), high (65-77)). Linear regression models were used to quantify the associations between: 1) stress and support adjusting for age and sex, 2) blood pressure and stress adjusting for age and sex. A formal moderation analysis was conducted to assess if support moderated the relationship between stress and blood pressure. Results: Among 2,817 adults, 59.7% female and the median age was 40 years (IQR 28-55). The majority had an income of less than 1 US dollar a day (69.7%). The median stress score was 8 out of 16 points, and median support score was 61 out of 77 points. Stress was higher with older ages (60+ years versus 18-29 years: +0.79 points, 95% CI 0.51 to 1.08) and in females (+0.85 points, 95% CI +0.65 to +1.06). Support was higher in males (+3.29 points, 95% CI 2.19 to 4.39). Support was inversely associated with stress, adjusting for age and sex (-0.04 points, 95% CI -0.04 to -0.03). Stress was not associated with systolic or diastolic blood pressure after adjustment for age and sex. Support did not moderate the association between stress and blood pressure. Conclusion: In this urban cohort of Haitian adults living with chronic civil instability, stress was moderate and support was high. While support was associated with lower stress, it did not moderate the relationship between stress and blood pressure. Despite the high levels of instability in Haiti, participants displayed resiliency through high levels of support, which may be an underutilized resource in reducing stress and long-term negative health outcomes.

To explore the presence of shared underlying causes of cerebral palsy (CP) and other neurodevelopmental disorders, by examining risks of other disorders in siblings of children with CP. We used Norwegian national registries to identify 1.4 million pairs of full siblings (singletons) and 28 000 sets of twins born from 1967 to 2006, identify stillbirths and neonatal deaths, and find individuals with CP, epilepsy, intellectual disability, autism spectrum disorders, attention-deficit/hyperactivity disorder, blindness, deafness, schizophrenia, and bipolar disorder. Associations between CP in 1 sibling and neurodevelopmental disorders or early death in other siblings were estimated using logistic regression models. There were 5707 neonatal survivors (beyond 28 days) with CP (2.5/1000). These children had substantial comorbidity (eg, 29% had epilepsy). Singleton siblings of (singleton) children with CP had increased risks of neurodevelopmental problems, including epilepsy (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5-2.5]), intellectual disability (OR, 2.3 [95% CI, 1.8-2.9]), autism spectrum disorders (OR, 1.6 [95% CI, 1.1-2.2]), attention-deficit/hyperactivity disorder (OR 1.3 [95% CI, 1.1-1.6]), blindness (OR 2.4 [95% CI, 1.1-5.4]), and schizophrenia (OR 2.0 [95% CI, 1.2-3.2]). There was no increase in risk of bipolar disorder (OR 1.0 [95% CI, 0.6-1.6]). Families with children with CP also had increased risk of losing another child in the perinatal period (stillbirth OR, 1.8 [95% CI, 1.5- 2.3]; neonatal death OR, 1.7 [95% CI, 1.3-2.2]). Associations were stronger within sets of twins. Siblings of a child with CP were at increased risk for a variety of other neurodevelopmental morbidities, as well as early death, indicating the presence of shared underlying causes.

The concept of sibling rivalry is well known, but what about sibling empathy? Is this the positive side of the construct, and for whom? Two papers in the current issue focus on the relationship between siblings when one of these has a developmental difficulty. The effect of a disabled child on his or her ‘well’ siblings is significant, and importantly the reciprocal nature of this relationship also affects the index child. Lobato and colleagues (2011) investigated the effects of having a sibling with intellectual disability in a very interesting study comparing Latino and Caucasian children living in the US. Intellectual disability (ID) was defined as having general cognitive ability more than 2 SDs below the mean. The study involved a large sample of 100 siblings from ‘affected’ families and a comparison group of 100 children from each sub-population (Latino vs Caucasian) whose siblings were free of learning disabilities. The rationale for including Latino children was that it is known that sibling relationships are close and intimate in this culture and the rate of internalising disorders is relatively high. The design allowed the investigators to examine the effects both of a disabled sibling and of the sub-culture on the psychosocial functioning of their sibling. Demographic differences between subgroups were controlled statistically. The findings were striking. Consistent with previous research, the Latino group showed more internalising behaviours and experienced more agoraphobia than the Caucasian group. Importantly, however, in both cultures, there were differences between siblings of index children and siblings of non-ID controls in self-reported internalising and emotional symptoms. Moreover, more of the siblings of children with ID scored within the ‘at risk’ or clinical range for anxiety disorders; the exception was agoraphobia which was more common for all siblings in the Latino group. In contrast, there were no differences in self-reported externalising behaviour and no group differences in parent or teacher reports of adaptive functioning. A limitation of the study was that there were no objective measures of the educational attainments of the siblings; however, according to teacher judgements, the siblings of the Latino children with ID did less well in Language Arts and were less likely to have above average or excellent grades; they also experienced more school absences. O’Brien, Slaughter, and Peterson (2011) take a different look at siblings and ask if Theory of Mind (ToM) in autism spectrum disorders is shaped by sibling relationships. It is well established that children with ASD suffer delay and difficulties in the acquisition of ToM. On the other hand, for typically developing children, the development of ToM appears to advance more quickly for children in larger families, though there is debate as to whether the advantage depends upon the relative ages of siblings within families. Drawing on these findings, the present study tested the ‘Sibling Interaction Opportunity Hypothesis’: that the ToM deficit in ASD would be moderated by the presence of a sibling; it also assessed whether the relative age of the sibling (older or younger or both) was important. The sample comprised 60 children, aged 3–12 years, with a clinical diagnosis of ASD. To provide an estimate of the severity of autism symptomatology, each index child was assessed on the Autism Diagnostic Observation Schedule (ADOS), and on tests tapping verbal and executive function skills. The key dependent variable was a composite describing performance on six ToM tasks. In contrast to the findings from typical development, there was no correlation between the total number of siblings in a family and ToM performance. However, the position of the index case in the family mattered. When the child with ASD had an older sibling, their ToM was lower than when their sibling was younger. This finding is intriguing: it seems that having an older sibling leads to poorer ToM in the index child (and this effect was maintained when younger siblings were also present). The authors consider a number of possible explanations. First, it is possible that older siblings over-compensate for the index child’s poor social skills and this may inadvertently undermine their progress towards a mature concept of ToM. Second, a tendency to be over-protective of children with ASD would not be conducive to them encountering the more complex or negative social interactions which foster a more advanced ToM. Alternatively, the impact may be mediated by parental behaviour: first-born children with ASD may receive more attention from their parents (and perhaps more service provision), whereas later born children may have less interaction with parents by virtue of their position in the sibling constellation. Clearly this study throws up a number of unanswered and difficult questions, all of which underline the complexity of the family structures around children with neurodevelopmental disorders. Nonetheless, together with the findings of the study of Latino siblings, it highlights the under-researched role that siblings play within families of children with mental health issues. Rather than the stereotypical view that ‘well’ siblings of children with disabilities may show rivalry and aggression towards the index child, these findings highlight issues of empathy and how they affect both parties. Aside from this, it is important to point out that neither of these studies of siblings takes proper account of the probability that siblings of children with neurodevelopmental disorders share some of the same traits as index cases. It would not be surprising if the marginally worse educational outcomes of the Latino siblings of children with ID were attributable to some mild cognitive impairments of their own. It is noteworthy here that the parents of the children in this subgroup had lower rates of employment and lower household income than controls, suggestive of poorer educational achievement and perhaps lower IQ. In similar vein, siblings of children with ASD often display the broader autism phenotype (BAP) which, arguably, may reduce their own ability to take the perspective of their affected sibling. Within this view, the detrimental effect on ToM of having an older versus a younger sibling may be confounded with severity of the BAP and should be tested. More generally, as evidence from genetic and family studies moves us towards greater recognition of the dimensional nature of disorders (see, for example, Rutter, 2011), there is growing interest in studying endophenotypes in siblings of affected children. Endophenotypes can be defined as dimensions or traits which are closer to the genotype than the behavioural phenotypes; which are heritable, associated with the disorder and present in unaffected relatives albeit reduced in severity (Bearden & Freimer, 2006). While such an approach can potentially inform understanding of the genetic bases of disorders, the present findings remind us of both passive and active gene–environment interactions which will also need to be taken into account.

ABSTRACTChildren affected by HIV and AIDS have significantly higher rates of mental health problems than unaffected children. There is a need for research to examine how social support functions as a source of resiliency for children in high HIV-prevalence settings such as South Africa. The purpose of this research was to explore how family social support relates to depression, anxiety, and post-traumatic stress (PTS). Using the ecological model as a frame, data were drawn from a 2011 cross-sectional study of 1380 children classified as either orphaned by AIDS and/or living with an AIDS sick family member. The children were from high-poverty, high HIV-prevalent rural and urban communities in South Africa. Social support was analyzed in depth by examining the source (e.g. caregiver, sibling) and the type (e.g. emotional, instrumental, quality). These variables were entered into multiple regression analyses to estimate the most parsimonious regression models to show the relationships between social support and depression, anxiety, and PTS symptoms among the children. Siblings emerged as the most consistent source of social support on mental health. Overall caregiver and sibling support explained 13% variance in depression, 12% in anxiety, and 11% in PTS. Emotional support was the most frequent type of social support associated with mental health in all regression models, with higher levels of quality and instrumental support having the strongest relation to positive mental health outcomes. Although instrumental and quality support from siblings were related to positive mental health, unexpectedly, the higher the level of emotional support received from a sibling resulted in the child reporting more symptoms of depression, anxiety, and PTS. The opposite was true for emotional support provided via caregivers, higher levels of this support was related to lower levels of all mental health symptoms. Sex was significant in all regressions, indicating the presence of moderation.

For patients participating in trauma-focused psychotherapies for posttraumatic stress disorder (PTSD), such as cognitive processing therapy (CPT), pretreatment characteristics may moderate treatment effectiveness. For instance, preexisting supportive relationships may encourage skill utilization or provide contrasts to maladaptive cognitive biases highlighted in trauma-focused treatments for PTSD. Such pretreatment characteristics are important to study in rural individuals, who may experience barriers to initiating and completing treatment. The aim of this study was to examine whether pretreatment social support, measured using the Medical Outcomes Study Social Support Survey, would moderate the association between CPT duration (i.e., number of sessions attended) and change in PTSD symptoms, using data from a pragmatic randomized controlled trial of a telemedicine-based collaborative care intervention for rural veterans (N = 225). Social support moderated the association between CPT duration and PTSD symptom change, B = -0.016, SE = -.006; 95% CI [-0.028, -0.005], such that increased duration was associated with more PTSD symptom change only at average or higher levels of support. This effect was found for overall and emotional support but not tangible support. Additionally, on average, among participants who attended eight or more CPT sessions, only those at or above 1 standard deviation above the mean social support score demonstrated a reliable change in PTSD symptoms. The results indicate that the link between CPT treatment duration and treatment outcomes may be stronger for veterans with higher levels of pretreatment social support.

ObjectivesTo examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults.DesignCross-sectional analysis of the International Mobility in...

Siblings of children with neurodevelopmental conditions have unique experiences and challenges related to their sibling role. Some develop mental health concerns as measured by self-reported surveys or parent report. Few data are available at the population level, owing to difficulties capturing wide-scale health data for siblings. Data linkage is a technique that can facilitate such research. To explore the application of population data linkage as a research method to capture health outcomes of siblings of children with neurodevelopmental conditions. Peer reviewed papers that captured health outcomes for siblings of children and young adults with neurodevelopmental conditions using population data linkage. JBI Scoping review methods were followed. Papers were searched within CINAHL, Ovid, Scopus, and Web of Science from 2000 to 2024 using search terms relating to 'data linkage' 'neurodevelopmental conditions' 'siblings' and 'health outcomes'. The final data extraction included 31 papers. The neurodevelopmental conditions of index children were autism, attention deficit hyperactivity disorder, intellectual disability, cerebral palsy and developmental delay. The mean follow-up time was 31 years, and the majority of studies originated from Scandinavia. Sibling health outcomes observed were psychiatric diagnoses, self-harm and suicide, other neurodevelopmental conditions, and medical conditions such as atopic disease, cancer and obesity. Data linkage can help capture sibling health outcomes quickly across large cohorts with a range of neurodevelopmental conditions. Future research could be enhanced by focusing on siblings as the primary group of interest, increased integration of genealogical data, and comparisons between diagnostic groups and severity levels. Adoption of established rigorous reporting methods will increase the replicability of this type of research, and provide a stronger evidence-base from which to inform sibling supports.