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Adaptation to Chronic Childhood Illness. By Robert J Thompson Jr and Kathryn E Gustafson. (Pp 382; £39.95 hardback.) American Psychological Association, 1996. ISBN 1-55798-327-5 .
Advances in biomedical science and health care have made it possible to treat children for a range of chronic conditions, many of which would have been fatal in the past. However, the long term nature of treatment and aggressiveness of modern therapy create many difficulties for children and their families. These include the physical demands of treatment as well as psychological concerns and uncertainties about the future. Approximately 10–20% of children experience chronic conditions and continue to live full lives; some 1–2% are more severely affected and experience much interference with daily activities.
Despite treatment demands, many children seem to cope well, though social, family, and cultural influences are determining factors. The authors adopt a largely ‘non-categorical’ approach which emphasises that children with chronic conditions face common life experiences and difficulties based on generic dimensions rather than idiosyncratic characteristics of a specific disease. Although much of the book focuses on processes of adaptation to chronic disease, separate chapters are given over to specific topics, including compliance. The book scores in its approach of introducing some of the basic assumptions underlying psychological methods and theories.
Interest in psychosocial issues in chronic disease is currently high, fuelled by increases in survival in many conditions, and newer emerging issues (for example quality of life in children undergoing new treatments). In addition, recent NHS research and development initiatives have done much to raise the profile of quality of life in patients.
Research concerned with psychosocial consequences of chronic illness should not, however, be an academic exercise. There are implications for policy decisions, especially with regard to the education and follow up care of sick children. As an exposé on contemporary issues (at least as viewed by the US health services), this book is an excellent review. Straightforward extrapolations to the British context are difficult. First, there are obvious differences in organisation and delivery of health care services. Second, there are differences in research methods. Outcome measures and questionnaires tend to be developed for US samples and are not always appropriate for work here. US samples appear to be much more compliant than British; commonly used measures tend to be much too long and cumbersome to be acceptable here. Third, there are differences in theoretical approach. In this, approaches in the US appear more sophisticated than here, at least at present.
Much has been written in recent years about the difficulties faced by children and this book provides an up-to-date summary of many of the key findings. There is also some attempt to suggest what can be done—though this literature is inevitably smaller. Interventions focus largely on reintergrating the child into school or helping families cope, particularly where compliance is a problem. The chapter dealing with pain is specially helpful, perhaps because in this context, psychological interventions seem to be particularly promising.
Psychology and paediatrics share a commitment to the realisation of the child’s full potential. In developing a comprehensive service for the child with a chronic disease, there is much scope for collaboration.