Analysis Abstract

Purpose

Studies consistently have shown that although most children with chronic conditions are well adjusted, as a group they are at increased risk for emotional and behavioral problems. In order to develop interventions that support healthy adaptation in children with chronic conditions, researchers must first understand what variables contribute to healthy adaptation and what variables put children at risk for poor outcomes. The purpose of this analysis was to examine the relationship between child functional status, family functioning, selected demographic variables, and child psychosocial adaptation to a chronic condition.

Methods

The report is based on data from 446 parents (333 families) in which a child between the ages of 2-18 years had a chronic physical condition. Data were collected through telephone interviews with parents from the Midwest, Middle Atlantic, and New England states. Parents provided demographic information and completed measures of the child's functional status (Functional Status Measure II - FSII), family functioning (Family Assessment Device - FAD), and child adaptation (Eyeberg Child Behavior Inventory - ECBI). The analysis addressed the relationship between child and family functioning and child adaptation to a chronic condition. We also explored differences in child adaptation and functioning in one and two-parent families, and extent to which parents in two-parent families had shared views of the child and family life. Mixed modeling was used to account for intra-familial correlations in families in which there were two parents.

Results

The sample included children with a wide variety of chronic conditions (e.g. sickle cell disease, diabetes, asthma, hemophilia, gastro-intestinal disorders). Most children were male (54%), school age (62%) and rated by their parents as in excellent or good health. In 126 families (38%) both parents participated, and in 207 families (62%) the mother participated. The sample was predominantly Caucasian with 77% of the mothers and 70% of the fathers having at least some college. Thirty-nine percent of the mothers and 89% of the fathers were employed full time. Approximately one third of families had incomes under $50,000, with another third having incomes between $50,000 and $100,000.

Parents' ratings of their child's adaptation as well family and child functioning generally were positive. There was a significant correlation (r=.63; p<.001) between mothers' and fathers' evaluations of their child's adaptation. Both child and family functioning had a significant positive impact on child adaptation. Moreover, the impact of family functioning and child functioning on child adaptation were independent of one another. There were no differences in child adaptation based on the child's gender, the marital status of the respondent, or the biological relationship to the child. One the other hand, child adaptation was related to age, with older children showing better adaptation.

Conclusions

The analysis provides support for the pivotal role the family can play in supporting optimal child adaptation, a role that is independent of the child's actual physical functioning. The results also suggest that adaptation improves over time as children and families learn to live with the challenges of a chronic condition.

Parent Study

Assessing Family Management of Childhood Chronic Illness