Adolescent Adjustment

Adolescence is a critical developmental period fraught with challenges that may be exacerbated in the presence of a chronic illness such as SCD (Baskin et al. 1998; Pinckney and Stuart 2004). Not only do adolescents with chronic illness face the normative tasks of transitioning to young adulthood, such as living independently, finishing school, starting a career, and establishing long-term romantic attachments (Arnett 2000), but they must continue to engage in the regular responsibilities inherent in the management of a chronic illness. Additionally, they must face new health care challenges, such as transitioning from pediatric to adult care clinics (Baskin et al. 1998; Telfair et al. 2004). Exacerbating these transitions is the fact that in addition to having increased rates of cognitive deficits described earlier, adolescents with SCD often experience a delay in physical maturation, which may further impact their psychosocial adjustment (Pinckney and Stuart 2004).

Studies have suggested that adolescents with SCD are at particular risk of having social difficulties, as reflected in the association between SCD-related pain and increased social anxiety that is not found in younger patients (Wagner et al. 2004). One study compared parent-, teacher-, and self-report findings of psychosocial functioning of children and adolescents with SCD. Results showed that adolescents with SCD experienced more difficulties in peer relationships, particularly as indicated by adolescent self-report (Rodrigue et al. 1996). These difficulties may be related to delayed puberty, increasing academic problems, and decreased participation in social activities secondary to pain crises and hospitalizations (Morgan and Jackson 1986; Wagner et al. 2004). Therefore, assessment of peer relationships is particularly important when evaluating psychosocial adjustment in adolescents with SCD (Rodrigue et al. 1996).

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