Children with chronic physical disorders have twice the risk of psychosocial maladjustment compared with healthy children. This "second handicap" poses a significant mental health problem. This review examines factors related to the child, family, and clinical condition that affect the risk of maladjustment, as well as the manner in which this knowledge has influenced intervention strategies. Much of the research reviewed represents replication of what is already known and important areas of enquiry have been neglected. Investigators are urged to work towards the further identification of high risk characteristics and to apply these to the development and evaluation of new preventive and therapeutic approaches for these children and their families.