Robert Louis Stevenson, a victim of pulmonary tuberculosis, once wrote, “Life is not a matter of holding good cards, but of playing a poor hand well.” Children with a chronic physical disorder who have successfully mastered the physical, social, and emotional hardships associated with their illness well illustrate his point. This paper intends to review the common forms of emotional stress experienced by the child with a long-term illness and by his parents. It also describes the major adaptational techniques enabling the sick child and his family to achieve a satisfactory psychosocial adaptation.

Long-Term Physical Illness in Childhood: A Challenge to Psychosocial Adaptation

Psychiatric disorders and behaviour problems were found lo be commoner in children and adolescents with inflammatory bowel disease (IBD) than in matched comparison groups with tension headache and diabetes as well as in healthy children. Depression, anxiety and low self-esteem were common. Many children denied their problems. This may be due to the type of illness, its social consequences and the embarrassment experienced by the children. Discrepancies were found between the children's and their mothers' replies. These results are discussed in terms of their implication fur paediatric practice.

Mental Health and Psychological Functioning in Children and Adolescents with Inflammatory Bowel Disease: a Comparison with Children having Other Chronic Illnesses and with Healthy Children

Psychiatric disorder in 304 children with four congenital conditions was compared with that of 360 normal children and across conditions, three that involve the brain and one that does not. Children with physical disability were at increased risk for psychiatric disturbance. Those with conditions involving the brain had greater psychopathology than children with cystic fibrosis. Severity of physical disability had little effect on psychopathology. The risk of psychiatric disturbance in children with conditions involving the brain varied directly with level of mental retardation. In addition, brain involvement conferred a risk of social isolation independent of mental retardation. The unique feature of severe psychopathology secondary to physical disorder was marked social isolation accompanied by a low level of aggressive behavior outside the home.

Psychiatric Disorder in Children with Physical Disabilities

Familial coping with chronic and severe childhood illness: The case of cystic fibrosis

Chronic physical illness is a major life stressor for increasing numbers of children and their families (Pless & Douglas, 1971; Pless & Roghmann, 1971). Owing to advances in medical treatment, children with such chronic conditions as cancer, cystic fibrosis, myelodysplasia, and endstage renal failure are now living longer than ever before and facing unforeseen problems as adolescents and adults (Dorner, 1976; Gogan, Koocher, Fine, Foster, & O’Malley, 1979; Grushkin, Korsch, & Fine, 1973; Rosenlund & Lustig, 1973). In concert with these developments, growing numbers of pediatric psychologists are engaged in clinical work with chronically ill children and their families, chronic illness-related research, and consultation with medical and nursing staff. To facilitate their work, psychologists must grapple with a complex and unfamiliar body of knowledge, including the physical aspects of disease as well as the psychological assessment, clinical intervention, and research methods uniquely suited to chronic illness populations.

Psychological Perspectives in Chronic Childhood Illness

Family adaptation to the child with cystic fibrosis.

Social work and the mourning parent

Circular Interaction Between the Young Psychotic Child and His Mother

A Clinical Caseworker in Interdisciplinary Research

"The tragedy of motherhood . . . consists in mastering the painful breaking of [the mother-child] unity, the cutting of the psychic umbilical cord that ties the mother to the child. The problem concerns both members of the union, but their aims are opposite: the child strives for the breaking of the tie , the mother for its preservation" (Deutsch, 1945). This is naturally not to suggest that these aims form the exclusive matrix of the mother-child relationship. The separation process itself is marked by the vicissitudes and permutations of both the child's development and the mother's attachment to him. The aims of each may be paralleled by opposing tendencies: the child, with varying intensity, may strive for the preservation of the tie; the mother may also promote its loosening. However, it seems reasonable to say that the task of mutual separation constitutes a nuclear componen t in the relationship. In Greenacre's (1960) words: "During the first two years of life after birth, one of the main tasks of the infant undoubtedly has to do with making a sound separation from the mother and the commencement of an individual exist ence. . . ." The literature is rich in the attention paid to maternal behavior around crucial situations such as weaning and toilet training, with

Audrey T. McCollum

Papers

Family adaptation to the child with cystic fibrosis.

Social work and the mourning parent

Circular Interaction Between the Young Psychotic Child and His Mother

A Clinical Caseworker in Interdisciplinary Research

Maternal responses to the infant's emerging autonomy as illuminated by home observations: a case report