Models of Adaptation and Coping

The trend in the coping literature has been toward developing integrative models of adaptation to pe-diatric illnesses that are inclusive rather than reduc-tionistic (R.J. Thompson and Gustafson 1996). Both Wallander and Varni (1992) and R.J. Thompson (1985) have developed such models, which display the interconnectedness of child and parent adaptation and child and parent adjustment.

The model of Wallander and Varni (1992) builds on simpler models of factors influencing children's coping with chronic illnesses (Pless and Pinkerton 1975) and on a more general understanding of adjustment (Masten and Garmezy 1985) (see Figure 2-1). This model presents a risk and resilience framework of responses to stress. In this model, children with chronic illnesses display adjustment problems because they are exposed to negative life events. These negative events stem from both their physical illness and from other general stressors in their lives that may or may not be related to the illness (Wallander and Thompson 1995). This model has guided a number of research studies (e.g., Varni et al. 1989), but, because of its complexity, some aspects of it have yet to be evaluated.

R.J. Thompson (1985) used an ecological-systems theory perspective to develop a transactional model of stress and coping (see Figure 2-2). Childhood chronic illness is seen as a stressor to which the child and family must adapt, and the relationship between illness and adjustment depends on biomedical, developmental, and psychosocial processes

Condition parameters e.g., Diagnosis Visibility

Brain involvement Severity

Psychosocial stress

Disability-related problems Major life events Daily hassles

Intrapersonal factors e.g., Temperament Competencies Effectance motivation Problem-solving skills

Social-ecological factors e.g., Family environment Social support Parental adjustment Utilitarian resources

Intrapersonal factors e.g., Temperament Competencies Effectance motivation Problem-solving skills

Social-ecological factors e.g., Family environment Social support Parental adjustment Utilitarian resources

Figure 2-1. Wallander and Varni's (1992) disability-stress-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. 152. Copyright 2003, Guilford Press. Used with permission.

(Wallander and Thompson 1995). The model focuses on child and parental adaptational processes rather than on biomedical or demographic factors, due in part to the importance of the former in intervention efforts. Several studies have been conducted to test relationships within this model, particularly with regard to child health locus of control and self-esteem (e.g., Gil et al. 1991).

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