Children coping with a serious illness
A solid empirical base is needed to expand our understanding of coping in children who are seriously ill. The six studies reported were designed to describe the ways seriously ill children cope with their illness and treatment, and to explore factors (both individual and familial) which influence their coping. The choice of instniments and design were influenced by the Lazanis and Folkman transactional model of stress and coping (1984), especially their concept of coping. In the first study the Kidcope Checklist (Spirito et at, 1988) was adapted to a younger British sample by adjusting the language and by producing a colour coded response sheet. Validity and test-retest reliability were established. In the five hospital based studies 53 children (7-16 years) and their parents took part. All the children had leukaemia or aplastic anaemia. Children's coping was examined in detail by applying a variety of research methods, which included observation during a medical procedure (Observation Scale of Behavioural Distress and coping behaviour), a questionnaire about children's perception of competence and selfworth (Self Perception Profile for Children) and a semi-structured interview about their coping strategies (Kidcope). Parental coping and the social environment of the family were studied through Coping Health Inventory for Parents and the Family Environment Scale. Results show that the children's coping was significantly related to the context of the problem (everyday-life difficulty, illness related and medical treatment) but much less to the individual differences (sex, age, experience with the illness and self esteem). Children who rated themselves at interview as more distressed during the blood test were observed to show more distress behaviour; this validated the distress assessment of Kideope. Children who were observed taking an active interest in the blood test displayed less distress behaviour and had higher self esteem than children who showed no interest in the procedure. Results from parents and the family are discussed with reference to the children's self reported and observed coping. Some relationships were found between parents' coping with their child's illness, the social climate of the family and the children's way of coping. The findings contribute to our understanding of children's coping processes and help to bridge the gap between theory and research.