Handbook of Psychological Services for Children and Adolescents

By Jan N. Hughes; Annette M. La Greca et al. | Go to book overview

17
Chronically Ill Children
and Adolescents
RONALD T. BROWN
MICHELLE MACIAS

Chronic disease refers to disease states that have symptoms with a protracted course and involvement of one or more organ system (e.g., heart, lung, blood, brain). The percentage of children with severe long-term disease has more than doubled in the past two decades, partly because of technological advances in medical and surgical care. Approximately 10% to 20% of children and adolescents experience one or more chronic health conditions by the age of 18 years; about 2% to 4% of children have a disease of such severity that it regularly interferes with usual daily activities (Behrman & Vaughan, 1996).

Many chronic pediatric disorders are associated with marked medical and psychological morbidity (i.e., disruption of normal developmental processes and adaptive competencies; Roberts, 1995; Routh, 1988; Russo & Varni, 1982). Behavioral factors (e.g., diet, treatment nonadherence, and substance abuse) are important in predicting the onset, course, and prognosis of many disorders and injuries and therefore contribute to disease and injury onset and maintenance (Brannon & Feist, 1997). Table 17.1 presents a summary of disorders from major pediatric sub specialties, the incidence of the disorders, and examples of relevant psychological aspects.


Developmental Precursors and Consequences

Children and adolescents with chronic illness are predicted to have optimal adaptation to their disease state when protective or resistance factors outweigh risk factors (Wallander & Thompson, 1995). Protective or resistance factors include intrapersonal variables (e.g., temperament, problem-solving skills), social-ecological factors

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