Psychological aspects of chronic health conditions.

1. James M. Perrin, MD* 2. Sangeeth Gnanasekaran, MD, MPH† 3. Jennifer Delahaye, MA† 1. *MGH Center for Child and Adolescent Health Policy, Boston, MA. 2. †Massachusetts General Hospital, Boston, MA. The recent report of the American Academy of Pediatrics Task Force on Mental Health provides guidance and tools to aid screening and identification of psychological issues in primary care practice. After completing this article, readers should be able to: 1. Understand psychosocial stressors that affect families who have a child with a chronic condition. 2. Describe the impact of the chronic condition on the family. 3. Understand how a child's developmental stage affects the psychological response to a chronic condition. 4. Address barriers to adherence among children with chronic conditions, especially among adolescents. 5. Describe the role of pediatricians in identification, measurement, and treatment of psychological issues in children with chronic conditions. Chronic illness generally refers to physical, emotional, or developmental conditions that affect the child for a prolonged period of time. Many types of conditions can be considered chronic, including those that lead to a need for prescription medications; additional medical services; physical, occupational, or speech therapy; or treatment for an emotional, developmental, or behavioral problem. Among children, the most prevalent chronic conditions are asthma, obesity, and mental health conditions, including attention-deficit/hyperactivity disorder (ADHD). The category includes many less common conditions, such as leukemia, sickle cell disease, arthritis, and spina bifida, as well as very rare conditions, such as lysosomal storage diseases. This review focuses on the psychosocial stressors and psychological issues associated with any childhood chronic condition for children and adolescents, and their families. Estimates of the prevalence of childhood chronic illness vary considerably owing to differences in the way that the term has been defined and measured. Most reported rates fall between 12% and 30%. The 2007 National Survey of …