Psychological Perspectives in Chronic Childhood Illness

Special perspectives in clinical work, consultation, and researchwith chronically ill children are elaborated. Clinical workwith the chronically ill requires a focus on the impact of illness-relatedstress on the entire family, and a consideration of coping asa process which varies with the stage and severity of physicaldisease. Moreover, the comprehensive care of chronically ill,children takes place in a highly charged interpersonal context.This process can disrupt communication among staff, can raisedifficult ethical questions and uncertainties, and should involvea close dialogue among various professional disciplines. Researchin chronic illness has been dominated by a personality-focusedparadigm associated with a counterproductive focus on differencesbetween chronically ill and physically healthy children anda neglect of factors which contribute to successful coping infamily, school, and social settings. Future research might profitablybe directed toward a study of the chronically ill children'sadjustment in various life contexts, the evaluation of the efficacyof psychosocial interventions, and exploration of how the survivorsof childhood chronic illnesses negotiate key developmental transitions.