Stress, coping, and adjustment in children with a chronic disease:: a review of the literature

Purpose: To review the literature on the consequences of having a chronic disease on the child's functioning in daily life. Method: A wide search of the literature resulted in the location of around 200 empirical studies with a focus on chronically ill children. This body of literature is discussed in three parts: (1) the academic and psychosocial adjustment of chronically ill children, (2) the ways chronically ill children cope with disease-related stress and other stressors, and (3) the effectiveness of coping strategies. Results: Children with a chronic disease do not show lower school performance despite higher absence rates (an exception is epilepsy). Their self-concept is similar to that of healthy children. However, they show more behaviour problems, especially internalizing problems such as depression and social withdrawal. The authors could not find evidence for the claim that children with a chronic disease are more frequently confronted with stress than their healthy peers. Children with a chronic disease use a variety of coping strategies to deal with various disease-related and common stressors. The coping strategies they use in relation to common stressors appear to be similar to those of healthy children. Conclusion: Incidences of maladjustment vary across studies and different chronic diseases. Most studies on coping lack situational sensitivity, which makes it impossible to compare results. Findings on the effectiveness of these children's coping strategies are still scarce and inconclusive. Recommendations for future research on coping with chronic disease in childhood are given.