Child Adjustment

Research suggests that children with SCD are at higher risk for psychological adjustment difficulties than are children without chronic illness. Studies have estimated that one-third to over one-half of children with SCD exhibit clinically significant emotional or behavioral problems (Barbarin et al. 1994; Cepeda et al. 1997; Thompson et al. 1993, 1995; Trzepacz et al. 2004). The majority of these studies used parent and child report measures of psychological and behavioral functioning to compare the adjustment of children with SCD to that of same-age peers. Results have documented higher rates of internalizing problems (e.g., symptoms of anxiety and depression) but much lower rates of externalizing problems (e.g., aggressive or defiant behaviors) in children with SCD (Barbarin et al. 1994; Britto et al. 1998; Brown et al. 1993b; Hurtig et al. 1989; Kell et al. 1998). Studies conducted by Thompson et al. (1993, 1995) included structured diagnostic interview assessment of symptoms in addition to questionnaires. Results showed that 50% of a sample of 50 children ages 7-14 with SCD met criteria for an emotional or behavioral disorder; the most frequent diagnoses were anxiety, phobias, or obsessive-compulsive disorders (Thompson et al. 1993).

In addition to evaluating rates of emotional and behavioral disorders in children with SCD, re searchers have examined psychosocial adjustment related to broader aspects of well-being, including quality of life and functioning in social and school settings. Findings suggest that children with SCD experience challenges in their daily lives that interfere with their ability to engage in academic, physical, and social activities as easily as other children (for reviews, see Barbarin and Christian 1999; Edwards et al. 2005). For example, Palermo et al. (2002) measured health-related quality of life in children with SCD to assess domains of functioning often affected by illness and ongoing medical treatments. In this study, caregivers' reports suggested significant impairment related to their children's physical, psychological, and social well-being.

Research examining social functioning has suggested that SCD symptoms, such as lethargy and pain crises, affect children's ability to participate in academic and extracurricular activities as actively as their peers (Bonner et al. 1999; Eaton et al. 1995; Gil et al. 2000; Noll et al. 1996). In a series of studies, Noll et al. (1992, 1996, 2007) reported that children with SCD were rated by peers as having fewer friends and being less athletic than other classmates; females were also rated as being less well liked and as having fewer leadership qualities (Noll et al. 1996). However, other studies in younger children with SCD have not found evidence of parent-, teacher-, or self-reported social problems, suggesting that social competence in young children may serve as a protective factor against disease-related stress (Lemanek et al. 1994). However, social skills for complex peer interactions may be particularly difficult for children with central nervous system and neurocognitive effects of SCD (Boni et al. 2001; Nassau and Drotar 1997). These difficulties could be attributed, at least in part, to difficulties in understanding the content of social interactions, a task that requires emotional decoding and social information processing (Boni et al. 2001).

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