Social Networks in Pediatric-Onset Multiple Sclerosis are Associated with Less Negative Peer Pressure
Micky Bacchus1, Wendy Vargas2, Michael Glendinning2, Seth Levin3, Kaho Onomichi2, Philip De Jager2, Brenda Banwell1
1Neurology, The Children's Hospital of Philadelphia, 2Neurology, Columbia University Irving Medical Center, 3Massachusetts General Hospital, Brigham, Harvard
Objective:
To analyze social networks in children with pediatric-onset MS (POMS) compared to healthy adolescents (HCs).
Background:
In adult-onset multiple sclerosis (AOMS), smaller and close-knit social networks have been associated with worsened physical function. 
Design/Methods:
We developed a pediatric version of an established questionnaire used to evaluate social networks in AOMS. We asked participants (81 adolescents: 48 POMS, 33 HCs) to identify persons with whom they discuss important matters and included questions related to peer pressure. To establish internal validity, we deployed the questionnaire to a focus group of ten HCs before extending to our study cohort. Using graph theoretical statistics, we calculated three structural metrics for each individual’s social network: size (number of network members, excluding the participant), maximum degree (highest number of ties by a network member), and mean degree (average number of ties by a network member). We assessed differences between groups using two-tailed student t-tests.
Results:
Among POMS, mean age was 18 years (±4.5); 74% female; median grade: college freshman. For HCs, average age was 19 years (±2.1); 67% female; median grade: college sophomore. POMS have smaller average networks (POMS: 13.1, HC: 16.1, p=0.03) and smaller mean degrees within their networks (POMS: 4.5, HC: 5.4, p=0.01). HCs reported a greater proportion of network members who encourage them to use marijuana and alcohol compared to POMS (p<0.001). In a composite score assessing negative health behaviors (staying out past curfew, skipping class, not completing homework, using marijuana and alcohol, eating junk food), HCs reported higher proportion of network members encouraging negative behaviors (POMS: 0.03, HC: 0.075, p=0.04).
Conclusions:

Unlike AOMS, where smaller social networks associate with isolation and reduced health outcomes, we found that the smaller networks of our POMS cohort were preferentially inhabited by positive peer influences. Our future work will explore whether these smaller networks associate with better quality of life.