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Defensiveness is one of the strategies that children with cancer use against psychosocial difficulties, yet it remains unclear what factors may impact children's use of defensiveness.The aim of this study was to explore the psychological adjustment, including use of defensive behaviors, in children who may or may not be told about the diagnosis of cancer.A total of 58 children and 51 mothers participated in the study. Children answered questionnaires about defensiveness, anxiety, and depression, whereas mothers completed a questionnaire of anxiety, depression, and stress and a question about disclosure of cancer to child.Significant differences were found in the defensiveness and depression scores between children with full disclosure and those with no disclosure about their cancer. Although children's adjustment has been directly related to that of their mother's adjustment, we did not find this variable to be a predictor of child's adjustment. The child's defensiveness scores were a strong predictor of child's anxiety and eventually for a high risk for depression.Mothers' emotional strains and lack of open disclosure about cancer significantly affect the psychosocial well-being of children.It is essential for nurses to assess the emotional adjustment and defensiveness strategies that children with cancer use. We believe that nurses caring for children with cancer have a professional responsibility to identify and understand defensive behaviors and other characteristics of psychosocial distress and advocate for psychological interventions that will help mothers and their children cope with cancer.