Socioemotional outcomes in siblings of children and adolescents with chronic conditions and special care needs-the role of parenting.

Objectives: This study investigated factors associated with socioemotional outcomes in preschool-aged siblings of children and adolescents/youth with chronic conditions and special care needs (CYSHCN) and examined whether parenting influences these outcomes.

Methods: This cross-sectional study included 123 healthy preschool-aged siblings of CYSHCN receiving care in Brazil. Socioemotional outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), and parenting was measured using the Parenting Sense of Competence Scale (PSOC). Data analysis included bivariate tests to explore associations between predictors and socioemotional outcomes followed by structural equation modeling (SEM) to examine direct and mediated pathways via parental sense of competence. Final model demonstrated satisfactory fit (χ2/df = 2.24, CFI = 0.969, TLI = 0.950, SRMR = 0.073, RMSEA = 0.082).

Results: Half of the preschoolers scored in the "abnormal" range (according to SDQ classification) for socioemotional difficulties, with conduct problems most prevalent. Socioemotional problems were associated with greater clinical severity of the CYSHCN. The analysis using SEM showed that parental competence mediated the relationship between CYSHCN clinical severity and healthy sibling's socioemotional outcomes (indirect effect a*b = 0.075, p = .046; 21.3% mediation).

Conclusions: This study focused on preschool-aged children, a sensitive period for socioemotional development that remains underexplored in research on siblings of CYSHCN, and demonstrated that they are at an increased risk for socioemotional difficulties, especially when the condition of the CYSHCN is more severe. Parental competence plays a mediating role and may buffer this association, highlighting the need for interventions that strengthen parenting to promote better child outcomes.