Toward Developmental Theory of Compliance
Ronald J. lannotti Patricia J. Bush Georgetown University School of Medicine
Compliance of children with health prescriptions implies different things at different ages. In the toddler it simply may mean assenting to the administration of medications or treatments by a parent or physician. In early childhood it may mean complying with parents' and physicians' recommendations for adherence to healthful behaviors, such as following a prudent diet and avoiding risky behaviors, or cooperating with treatment regimens, including treatment of chronic disorders such as asthma as well as acute problems such as bacterial infections. It is not until the age of 10 years or so, however, that the average parent expects a child to begin to take a more active role in areas such as hygiene, dressing properly, getting enough sleep, taking medicines, and following a treatment regimen prescribed by a physician. By the middle teen years, most adolescents are expected to take major responsibility for their health care and to require only occasional monitoring by a parent or other authority figure. The expectations for adults are actually quite similar to those for adolescents with increased self-responsibility accompanied by occasional monitoring by a significant other, usually a spouse. In old age the pattern begins to reverse, with increasing responsibility for health care falling on others. This chapter focuses on childhood, particularly the period from 5 years of age to early adolescence.
There are a number of excellent reviews of theories of compliance in this volume ( Dunbar, Dunning, ∧ Dwyer; Leventhal; Karoly) and in the literature ( Christensen, 1985; Karoly, 1981; Leventhal ∧ Cameron, 1987; Leventhal, Zimmerman, ∧ Gutmann, 1984; Svarstad, 1986). Therefore, current theories are not reviewed in this chapter. Instead, selected developmental research in three domains is presented that may contribute to a better understanding of compliance behavior across the life span, but particularly in childhood and early adoles-