Chronically Ill Children Face Adjustment Difficulties

August 06, 1998

Children who have a chronic illness are more likely than healthy children to show signs of poor adjustment, such as hostility or withdrawal, regardless whether their illness is physical or mental, researchers have found.

"Pediatricians need to be aware of the potentially heightened mental health needs of children with chronic conditions whom they treat," Ruth E.K. Stein, MD, of the Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, and colleagues report in the August issue of the Journal of Developmental and Behavioral Pediatrics.

Adjustment problems among these children persist, the investigators say, "despite the enormous changes in medical care and educational opportunities that have occurred in the last two decades for children with chronic conditions."

Dr. Stein and her colleagues reached their conclusions after conducting a national survey of more than 700 mostly white households and another of more than 650 inner-city households in Bronx, NY. They examined in detail the responses from 184 families from the national sample and 170 families from the Bronx. About half the families had a child with a chronic physical illness, such as asthma, or a chronic mental health disorder, such as attention deficit hyperactivity disorder (ADHD).

In both groups of families, children with chronic conditions were not as well adjusted as healthy children, according to their scores on a standard psychological rating scale. Even when the investigators excluded children with mental health disorders, such as ADHD or autism, adjustment remained poorer among children with chronic physical illnesses than among healthy children in both samples.

The researchers also ruled out one other potential explanation for the differences between healthy and chronically ill children -- the social and economic status of their parents. When investigators controlled for the number of years of education achieved by parents, a factor that correlates with earnings, they still found that children with chronic illnesses in both samples were more likely to experience poorer adjustment than were healthy children.

It is difficult to predict the precise outcome for chronically ill children based on the scores obtained from the psychological scale, Dr. Stein cautions. "Most children with chronic conditions adjust well," she says, "but the magnitude of the differences between chronically ill and healthy children is expected to be clinically significant."

Stein and her colleagues recommend further research "to identify subgroups at highest risk and to develop successful interventions to reduce the risk of mental health problems among children with chronic conditions."

The Journal of Developmental and Behavioral Pediatrics is published bimonthly by the Society for Developmental and Behavioral Pediatrics. For information about the Journal, contact: Paul Dworkin, MD, at (860) 714-5020.

Posted by the Center for the Advancement of Health For information about the Center, contact Richard Hebert at or 202-387-2829.

Center for Advancing Health

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