Gender and

Studies have demonstrated significant differences in the emotional and behavioral adjustment of males versus females with SCD. Across most studies, males have exhibited higher rates of symptoms and more severe difficulties with respect to both internalizing and externalizing symptoms, particularly as children enter adolescence (Baskin et al. 1998; Brown et al. 1995). Some data suggest that this gender difference may be due to higher rates of disease complications in males (Barakat et al. 2002) and to decreased self-esteem and social problems related to delayed puberty and limitations in physical activity (Barakat et al. 2006; Hurtig and White 1986).

Adjustment difficulties of young people with SCD often increase with age (Brown et al. 1993b, 1995). Adolescents report more social difficulties and lower self-esteem than younger children (K.D. Scott and Scott 1999). Especially in adolescents with more severe SCD, increasing difficulties could be associated with decreased daily living skills, which limit activity level, independence, and peer acceptance (Brown et al. 1993b). Additionally, adolescents exhibit lower treatment adherence (Baskin et al. 1998) and report significant worries related to the process of transitioning from pediatric to adult health care systems (Telfair et al. 1994).

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