Correlates of Psychosocial Adjustment

Condition Parameters

Among health conditions that do not involve the brain, such as heart disease and asthma, few differences have been found with regard to child psychosocial adjustment (E.C. Perrin et al. 1993). Findings

Figure 2-2. R. J. Thompson's (1985) stress and coping model of adjustment.

Source. Reprinted from Wallander JL, Thompson RJ, Alriksson-Schmidt A: "Psychosocial Adjustment of Children With Chronic Physical Conditions," in Handbook of Pediatric Psychology, 3rd Edition. Edited by Roberts MC. New York, Guilford, 2003, p. 153. Copyright 2003, Guilford Press. Used with permission.

from research on the impact of condition severity and functional status also have found few differences (Wallander et al. 2003). However, if a child's condition involves the brain (e.g., epilepsy) or sensory systems (e.g., deafness or blindness), the risk of behavior problems and social adjustment difficulties is significantly greater (Mitchell and Quittner 1996; Walker et al. 1989). In addition, the level of intellectual functioning is an independent predictor of psychological adjustment across a variety of physical illnesses (DeMaso et al. 1990).

Longer condition duration appears to be associated with more psychological adjustment problems. In longitudinal studies of youth with juvenile rheumatoid arthritis and diabetes (Daniels et al. 1987; Kovacs et al. 1990), longer disease duration was as sociated with more internalizing problems and the perception of one's illness as more unmanageable and stressful.

Child Parameters

Studies of demographic parameters, such as gender, age, and age at illness onset, have yielded mixed findings with regard to child adjustment (Wallander et al. 2003); however, studies that focus on temperamental and cognitive factors have yielded more consistent results. Difficult child temperament, such as very high child activity level or reactivity, is associated with more behavior problems in children with cerebral palsy and spina bifida (Wallander et al. 1988). In terms of cognitive factors, perceived stress (Kovacs et al. 1990), negative perception of physical appearance (Westbrook et al. 1992), and depressive attributional style (Mullins et al. 1997) are related to poorer adjustment. By contrast, the many studies conducted on health locus of control—that is, to what a person attributes the power to influence his or her health—have yielded mixed findings (R.J. Thompson et al. 1992, 1993).

Family Factors

Family functioning is perhaps the most commonly investigated social influence on child adjustment to a chronic physical condition (Wallander et al. 2003). Studies on this topic provide strong, consistent support for the role of a variety of family characteristics in shaping child adaptation. Two models of family variables have been most commonly used: 1) Moos and Moos's (1981) dimensions of cohesion, expressiveness, organization, independence, and control, and 2) Olson et al.'s (1979) circumplex model of adaptability and cohesion. Studies looking at groups of these dimensions in combination have found strong support for their role (e.g., Wallander et al. 1989). In addition, studies examining these characteristics independent of one another have often found that family cohesion plays a particularly important role in child social functioning (Lavigne et al. 1988) and that family conflict influences child adjustment problems (Manne and Miller 1998). In addition to having direct effects, family factors may interact with aspects of a child's illness experience to affect child adaptation. For instance, in a study of families of children with spina bifida, Murch and Cohen (1989) found that low conflict, high control, and high cohesion buffered depression in children with uncontrollable life stress, whereas high inde pendence exacerbated depression in the context of controllable life stress.

Peer Relationships

Few studies examined peer relationships of children with chronic health conditions until the 1990s (Lavigne and Faier-Routman 1993). Today, although more studies exist on peer relationships, the role of these relationships in child adjustment has rarely been examined in the context of these conditions. One study, however, found that chronically ill children with high levels of social support from both family and peers had significantly better adjustment than those with social support from only one of these sources (Wallander and Varni 1989). Further research is needed to determine the causal relationships involved in these types of associations.

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