Chronically ill children tend to be more submissive and less socially outgoing than healthy children, a new study shows. Further, kids who live with pain and physical restrictions may be more likely to have problems relating to their peers.
Study author Susan Meijer, DrS, a behavioral researcher at Utrecht University Medical Center in the Netherlands, and colleagues explored the effect of disease on social development in children 8 to 12 years of age. More than 100 chronically ill children and their parents participated in the study, which was published in the Journal of Child Psychology and Psychiatry.
The children's diagnoses included cystic fibrosis (a hereditary disease characterized by lung disease and problems with the pancreas), diabetes, arthritis, the skin inflammation eczema, and asthma. The children and their parents were asked about the children's social activity, behavior, self-esteem, physical restrictions, and pain.
Compared with healthy Dutch children, the participants had fewer positive peer interactions and exhibited less aggressive behavior. Compared with other chronically ill participants, children with cystic fibrosis and eczema had more social anxiety. And kids with physical restrictions and pain had significantly less social involvement than others.
Researchers say the reasons for these findings are not yet clear. "Sick kids may unconsciously avoid aggressive exchanges that they're unable to deal with," Meijer says. "It's also possible that sick kids don't learn some social skills because they receive less feedback about inappropriate behavior than healthy kids."
Meijer says that intervention programs can boost social development in chronically ill children. Child psychiatrists say school involvement and parental strategies may be even more effective.
"When kids are out of school for long periods, they miss both cognitive and social learning," says Nina Bass, MD, a behavioral medicine specialist and assistant clinical professor of psychiatry at Emory University School of Medicine in Atlanta. "And no matter how hard they try, parents can't give kids the same social experience they get at school."
Bass maintains that chronically ill children need both individual and group social activities. "An example of an individual activity is corresponding with a pen pal; an example of a group activity is participating in a book club," Bass says. "And if the child can't keep pace, parents should identify some better alternatives."
Chronically ill children also are at increased risk for depression. "Kids with chronic illnesses are 30% more likely to become depressed," she says. "And even if it's just a side effect of medication, parents can help with symptom management." But an awareness of factors that may lead to depression helps tremendously, she says.
In fact, parents' intuition may be more useful than record keeping. "Diaries are helpful, but they can turn a child into a guinea pig," Bass says. "It's often more helpful just to compare adverse symptoms to the child's normal rhythms and routines."
Bass says questions remain about the study's findings, and the researchers agree.
"Because parents of the participants were highly educated, the results could be biased," Meijer says. "So in the future, longer studies with more participants may provide more insight."
- Chronic illness can affect a child's social development; children who have physical restrictions and pain are particularly vulnerable.
- Psychiatrists recommend both individual and group social activities for chronically ill children.
- Children with chronic illnesses are 30% more likely to develop depression, but parents can help manage symptoms by being aware of a child's depression and of the factors that may lead to it.