(PS5-89) You’re Different! – Demographic Factors and Peer Victimization in Youth with Visible Chronic Conditions: A Systematic Review

Bullying and p</span>eer victimization (PV) have been linked to children’s maladjustment (e.g., depression, anxiety). Youth perceived as “different” and who struggle defending against peers are more likely to be targeted (Thornberg, 2015). Youth with chronic conditions (CC; e.g., disability, impairment) may be susceptible to PV (Pittet et al., 2010). CCs with visible markers may exacerbate social risk by highlighting features attracting peers’ attention.  

This review explored how visible conditions differentiate youth from peers, and if key demographic and contextual factors increment their PV risk. Extant work (Pinquart, 2016; Sentencac et al., 2011) has given limited attention to visibility level. We hypothesized a) youth with visible chronic conditions (VCCs; e.g., burn scars, muscular dystrophy) may be at greater risk for PV and maladjustment. Novel in this review is our focus on demographic factors (e.g., race, ethnicity) that might increase the “othering” of youth with such CCs. We hypothesized b) minoritized racial/ethnic identity would moderate PV risk and maladjustment in this population. This submission is a substantial revision and extension of a preliminary review presented at ABCT 2022.  

Using Boolean operators, we conducted a systematic search in EBSCOhost and PubMed and developed a PRISMA diagram on key terms: 1) youth; 2) condition; broad (illness, disability), specific (e.g., visual impairment) and 3) PV. Exclusion criteria for conditions: a) invisible/not changing morphology (e.g., intellectual disability); b) typically invisible (e.g., diabetes); and c) visible, but potentially transitory (e.g., obesity). Included VCCs: hearing/visual impairment, Down syndrome, achondroplasia, hydrocephalus, cystic fibrosis, scoliosis, broad physical disabilities, muscle/joint disorders, amputation/limb loss, cerebral palsy, spina bifida, cleft palate, neurofibromatosis, alopecia, and albinism. After screening 5329 articles at the title, abstract, and text levels, 57 quantitative articles remained. 

Findings indicated increased PV risk for specific VCCs (visual impairment, hearing impairment, Down syndrome, cerebral palsy, alopecia), and lower rates risk for cystic fibrosis. Only 37% of studies reported samples’ race/ethnicity; only one examined differences in PV by race/ethnicity, finding that Latinx/e orthopedic populations reported highest rates of PV (48%) compared to other ethno-racial groups. Of 57 articles, 84% were conducted in the United States or Europe. Results suggest the peer relations field has lacked a focus on the visibility of CCs and its intersection with personal characteristics. Are youth with the same condition but who differ on identity-salient factors treated differently? Do condition (e.g., visibility) and demographic (e.g., region) exacerbate the risk conferred by CCs?  

Our findings highlight the importance of screening youth with VCCs for PV and clarifying the roles of demographic and contextual factors as contributors to PV in these youth. Results are relevant for scholars and providers; we discuss reframing condition-related PV as an identity-based stressor and the benefits of advancing affirming and responsive practices for youth with chronic conditions.