Responses of Children with Chronically Ill Siblings Essay Example

Responses of Children with Chronically Ill Siblings Essay Example Responses of Children with Chronically Ill Siblings Paper Responses of Children with Chronically Ill Siblings Paper Chronic illness to any of the member of the family actually affects the whole family. And when a child diagnosed is diagnosed with a chronic illness, it has its effect not only on the suffering child but the entire family as a whole which includes his/her siblings. Though the children in most of the cases have been found to adapt their siblings’ chronic illness but the complete picture indicates that they have to experience stress and psychological problems (Association for Children with Disability, 2003). They have to suffer changes in the form of various aspects of life beginning with relationship with their parents in form of both quantity and quality, especially the mother who is so much preoccupied with ill child that there occurs an unintentional negligence in the amount of support to be provided to the other children (Cloues, 2006). The family being a system tends to maintain a sense of stability while resisting forces or changes that could cause a disruption to this stability. Chronic illness to a member especially child is a major disruption of family with stability being the first victim with later effects on other children (Cloues, 2006). In the United States, number of children suffering from chronic illness ranges between 4 and 7 million and about one-half to one million of them are actually patients of severe chronic childhood disability (Newacheck Halfon, 1998; Patterson, 1988). The extremely high variation of data makes way for something between 5% and 40% of children suffer from a chronic illness (Newacheck Halfon, 1998; Perrin MacLean, 1988). The variation itself is a proof of underestimation and the actual number might be much higher if we go along with the definition by P. D. Williams (1997), according to which â€Å"chronic illness is an ailment with a duration of 6 months or longer showing little change or slow progression† (p. 132). With the presence of a child with some chronic illness, the circumstance under which the family grows is quite unfamiliar. In the solution phase while coping with the problem, a process of change begun within the family with varying emotional responses effecting considerable sibling adjustment to manage the influx of strong and conflicting emotions (Association for Children with Disability, 2003). Background A siblings response to growing up in a family that has a child with a disability needs to be understood in their context of their stage of development. Children respond to the events of day-to-day life based on their stage of physical, mental and emotional development. Children learn from their environment and through their relationship with their parents and siblings. The sibling relationship, which is life long, has an important influence on the development of a persons identity. In later life, it can be a source of mutual support, depending on the quality of the early relationship. C. Purpose D. Research Question II. Review of the Literature III. Methodology Quantitative Reviews of the Literature A recent methodological advance to resolve discrepant findings across studies is meta-analysis. This quantitative review strategy is employed to assess factors both substantive and methodological that produce inconsistencies across studies (Schmidt, 1992). Howe (1993) employed a vote-count meta analysis strategy to review 21 studies with control groups or normative reference groups that examined siblings of children with chronic illness. A vote count meta-analysis is a simple tabulation of studies by their outcomes. Howe concluded that siblings of children with a chronic illness were at higher risk than other children for psychological problems, that neurological conditions produced more negative effects than nonneurological conditions, and that negative effects were most often manifested as internalizing behaviors. Summers, White, and Summers (1994) conducted a vote-count meta-analysis of 13 studies of siblings of children with a chronic illness or an intellectual disability. These 13 studies were assessed for their methodological quality and research methodology, and study results were categorized as positive, negative, or nonsignificant. These researchers concluded that being the sibling of a child with a disability had both negative and positive consequences, that parent surveys and direct observation generated more negative findings than child self-reports, and that higher quality studies found fewer differences between siblings and comparison samples. Like Howe’s (1993) review of the literature, the Summers et al. meta-analysis was constrained by the limitations to the vote-count review strategy: no estimation of effect size magnitude, no consideration of sample size, and no mechanism for evaluating systematically the impact of moderator variables. A recent meta-analysis of 25 studies and 79 effect sizes from the literature on the siblings of individuals with intellectual disabilities (Rossiter Sharpe, 2001) revealed a small negative effect for having a sibling with an intellectual disability that could not be attributed to a publication bias or some other artifact. This negative effect was most pronounced for measures of psychological functioning, especially depression, and adult reports versus child self reports. This meta-analysis pertains to the siblings of children with a chronic illness. Based on the findings from traditional literature reviews and the vote count meta-analyses, a negative effect was anticipated for having a sibling with a chronic illness. A number of hypotheses based on methodological and substantive issues were then derived. Methodological Issues. The first methodological hypothesis was that studies published more recently would show fewer negative and more positive outcomes than earlier studies. Lamorey (1999) observed more recent studies to show fewer negative effects and more variation in outcomes. A second methodological hypothesis was that more negative effects would be found for parental reports than sibling self reports (Summers et al. , 1994). The third methodological hypothesis was that studies employing normative data for comparison to the sibling samples would produce negative effects of greater magnitude than found for studies that employed matched control groups (Lavigne Faier-Routman, 1992). Substantive Issues. A number of hypotheses were also made that related to substantive variables. First, a larger negative effect was expected for internalizing over externalizing behaviors. Howe (1993) found four of eleven studies of siblings of children with chronic illness showed a negative effect for internalizing behavior compared to only one of eight studies for externalizing behaviors. Second, sibling outcomes were anticipated to vary by the chronic disease and its features. One view is many chronic conditions of childhood produce similar psychological and behavioral effects (Vessey Mebane, 2000). Childhood chronic illnesses, however, vary on dimensions such as etiology, age of onset, impact on functioning, and prognosis (see Lobato, Faust, Spirito, 1988). More severe chronic illnesses place greater restrictions on the child’s activities (Newacheck Taylor, 1992), and perhaps greater demands on parents, siblings, the family system, and the community (Patterson, 1988). Third, the interaction of sibling gender and birth order was considered (Howe, 1993; Williams, 1997). Method Fifty published studies from 1976 to 2000, representing over twenty-five hundred siblings of children with chronic illness, were identified from computer searches of databases such as PsycLit and MEDLINE, using key words such as â€Å"siblings† and â€Å"illness,† from previous reviews of the literature and from the reference sections of located studies. Excluded from the meta-analysis were case studies, nonempirical or qualitative studies, or studies without an appropriate comparison group or normative data. Studies were also excluded that evaluated the reactions of healthy siblings to the illness or death of a brother or sister or pertained to the adult siblings of individuals with a chronic illness. Studies that employed no comparison group but that provided normative data were included in this meta-analysis. Unpublished studies were not sought for inclusion in this meta-analysis. First, it is almost impossible to collect all published studies in all languages, much less all unpublished studies. Second, the peer review process for published studies serves as an albeit imperfect form of quality control. Third, there is evidence that publication bias is less serious than once feared (Sharpe, 1997). Publication bias, the socalled â€Å"file-drawer† problem, is the belief that the failure to include unpublished studies in the metaanalysis might inflate the magnitude of effect sizes, given that published studies may overrepresent statistically significant findings. To ascertain the likelihood of such a publication bias, statistical and graphical analyses of effect sizes were conducted. Studies by the same author(s) that appeared to examine the same participants (e. g. , Breslau Prabucki, 1987; Breslau, Weitzman, Messenger, 1981) were treated as a single study for the purposes of this meta-analysis. Three of the primary studies (Faux, 1991; Stawski, Averbach, Barasch, Lerner, Zimin, 1997; Wood et al. , 1988) provided separate data for the siblings of children with distinctly different chronic illnesses. These sub samples were treated as separate studies. In total, 51 study-level effect size statistics were evaluated. Each study was coded for method of data collection (child self-report, parent report, or direct observation), chronic illness, age of siblings, gender of siblings, number of sibling and comparison participants, and dependent measure category: psychological functioning (e. g. , Internalizing subscales of the Child Behavior Checklist), self concept (e. g. , Piers-Harris Self-Concept scale), caretaking, sibling relationship, peer activities (e. g. , Social Competence subscale of the Child Behavior Checklist), cognitive functioning (e. g. , intelligence test scores), and cognitive development (e. g. , school performance). Parent and teacher reports were combined because only five studies asked teachers to complete a dependent measure. Four of the five comparisons based on teacher reports were not statistically significant. All codings were completed by the first author and checked independently by the second author. Disagreements were resolved by discussion. Effect Size Calculations. An effect size statistic d (Hedges Olkin, 1985) was calculated for each relevant outcome by subtracting the mean score for comparison participants from the mean score for siblings with a chronic illness and by dividing that sum by a pooled standard deviation. Normative data provided by the primary authors in the published studies were substituted for data from comparison participants when the latter were not provided. If means and standard deviations were not reported, effect sizes were calculated from summary statistics (e. g. , t statistics, p values) by employing the metaanalysis software package D-Stat (Johnson, 1989). Effect sizes were weighted by the reciprocal of their variance as recommended by Hedges and Olkin (1985). When no data were reported in a primary study but the difference between the sibling and comparison groups was said to be nonsignificant, an effect size of zero was recorded. For all analyses, negative effect sizes reflect less positive functioning for siblings of children with a chronic illness relative to comparison children or normative data. Effect sizes from the same study, chronic illness, dependent measure category, and method of data collection were combined and averaged. The resulting set of 103 outcome-level effect sizes was evaluated for their statistical significance (95% confidence interval around zero) and their homogeneity (Hedges Olkin, 1985). The effect sizes from the 51 studies were also examined where appropriate to do so. The overall test for homogeneity (QT) assesses whether a set of effect sizes is internally consistent. For most meta-analyses, homogeneity of the set of effect sizes is not achieved without some combination of outlier analysis and partitioning of effect sizes into smaller clusters on the basis of moderator variables. The identification and removal of outliers are appropriate if homogeneity can be achieved by deleting no more than 20% of the effect sizes (Hedges Olkin, 1985). Regardless of the outcome of the overall test of homogeneity, however, tests of moderator variables are justified when based on theoretical considerations (see Hall Rosenthal, 1991). After the overall test for homogeneity, effect size clusters were created on the basis of moderator variables (e. g. , method of data collection). The homogeneity of effect sizes within clusters (QW) and differences between mean effect sizes across clusters (QB) were calculated. A significant QB value implies differences in the mean effect sizes associated with the effect size clusters. Interpretation of such an outcome is less clear if there are significant differences in effect sizes within one or more clusters (the QW statistic for each cluster). When moderator variables were continuous (e. g. , sample size), correlations between effect sizes and the moderator variables were calculated. Results The results are divided into three sections. The first section reports on tests of effect sizes: tests of the magnitude of mean effect sizes, tests for publication bias, and tests of homogeneity of effect sizes. The second section examines the role of methodological moderator variables, specifically, year of publication, method of data collection, and comparison group versus normative data. The third section considers substantive moderator variables, specifically, categories of dependent measures, differences by chronic illness, and effects of gender, birth order, and age of sibling.