Cognitive Coping Strategies of Children with Chronic Illness

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ABSTRACT.Children with chronic illness need to adapt to more stresses than do healthy children. Research highlights the problems of children with chronic illnesses but not how they cope in response to the stress created by these problems. Cognitive appraisal of a stressor and of response options is an important aspect of coping. Our cross-sectional study investigated whether children with chronic illness used cognitive strategies for coping as often as did healthy children. One hundred seventy five children from summer camps with juvenile arthritis, asthma, or diabetes were compared with 145 healthy school children. Spontaneous responses to common painful and stressful events were categorized into coping or catastrophizing ideation. Data on anxiety, disease severity, and other sociodemographic variables were obtained. Coping strategies were reported by 64% of children with chronic illness and 63% of healthy children and varied significantly with age (p < .05) in both groups. Children with different chronic illnesses performed similarly except for a trend among children with severe juvenile rheumatoid arthritis who had higher rates of coping. For the individual stressful events, the rate of coping varied from 46% to 86%. The highest rates of coping responses were found with the child's recent personal stressful event where adolescents with chronic illness were twice as likely to offer more complex coping responses. More children with chronic illness than healthy children offered coping strategies in response to venipuncture (p < .001) but not to dental injection. Children with chronic illness report coping as their predominant strategy for adapting to common painful and stressful events. We need to recognize the role of cognitive strategies and how their use varies as a function of the different stresses faced by children with chronic illness.J Dev Behav Pediatr 14:217–223, 1993. Index terms:chronic illness, coping, arthritis, asthma, diabetes.

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