Basic Assumptions 441specialty of pediatric psychology (Routh, 1975). Through
efforts of psychologists who identi“ed themselves as inter-
ested in pediatric psychology, the Society of Pediatric Psy-
chology was founded in 1969. The Society achieved division
status (54) within the American Psychological Association in
- Wright propounded that the success of the “eld would
rest, in part, on the construction of a new body of knowledge
in pediatric psychology. In this chapter, we present examples
of how an impressive body of knowledge in child health has
been amassed and increasingly used in practice.
Assumption 3
Competence and stress-and-coping paradigms, rather than
deficits and psychopathology, define our understanding of
child health psychology. The commonalities in orientations
and approaches between child health psychologists and pedi-
atricians include a solid developmental orientation and em-
phasis on normal child development, interests in treating and
advocating for improvements in the health care available to
children and families, and prevention. These aims are con-
gruent with stress-and-coping models that are prominent in
child health psychology and re”ect the drive to understand
competence (resilience) in concert with risks associated with
childhood illness.
Childhood illness is often conceptualized as a stressor or
trauma with the potential to impact children•s short- and long-
term functioning. The stressor may be associated with the ill-
ness itself (e.g., pain in sickle cell disease [SCD] and recurrent
headache) or with the required treatment (e.g., bone marrow
aspirations in childhood cancer, blood glucose testing, insulin
injections, and dietary restrictions in insulin-dependent
diabetes mellitus [IDDM], or surgery in solid organ transplan-
tation). In addition, some childhood illnesses and their treat-
ments lead to long-term medical problems after the children
are considered •cured,Ž including late effects of cancer treat-
ment, cognitive de“cits associated with brain tumors, and
rejection in solid organ and bone marrow transplantation.
Early research in child health psychology (pre-1980)
approached children with illness (generally mental retarda-
tion or chronic physical handicaps) by asking the question,
•How do these families dif fer from •normal• families?Ž The
answer expected was that children with illness and their fam-
ilies would show increased evidence of distress, including
psychopathology (e.g., depression, adjustment dif“culties,
marital discord and divorce). Some of the early literature sup-
ported this view, although closer examination of the research
methodologies indicated that many samples were not repre-
sentative and were based on families referred for psycholog-
ical consultation and/or treatment.
Asking the same general question but with samples care-
fully recruited to re”ect the complete spectrum of child and
family functioning, a different picture began to emerge in the
mid- to-late 1980s. Along with groups from other laborato-
ries, our earlier teams found relatively few consistent differ-
ences between families with and without children with
myelomeningocele, phenylketonuria, and mental retardation
(Barakat & Linney, 1992; Kazak, 1988; Kazak & Marvin,
1984; Kazak, Reber, & Carter, 1988; Kazak, Reber, &
Snitzer, 1988; Kazak & Wilcox, 1984).
Based on our work and that of others, some key “ndings
when comparing families with and without children with a
chronic pediatric illness are:1.As a group, mothers of children with chronic illness show
evidence of increased distress but not psychopathology.
2.Fathers, who continue to be neglected in research
(Seagull, 2000), experience less distress than mothers, but
show ongoing psychological reactions to their child•s ill-
ness and its impact on the family.
3.In nonclinical representative samples, it is a myth that
marriages necessarily falter and dissolve in the course of
childhood illness. Some marriages improve.
4.Children with an illness and their siblings evidence the
complete range of emotional, social, and behavioral con-
cerns as other children, although children whose illness
and/or treatment are linked to central nervous system
damage have more dif“culty adjusting over time.
5.There are differences in parents• social networks in fami-
lies with and without ill children that suggest heightened
social isolation and its associated physical and mental
health implications.Recognizing these vulnerabilities while focusing on com-
petence has been a helpful pathway in guiding child health
psychology through the 1990s and into the 2000s. Child
health psychologists have turned to describing and testing
stress-and-coping models for understanding what leads to
successful adaptation in childhood chronic illness and what
interferes with or impedes such adaptation. Through these
models, demographic (child age and gender), disease/
functionality (severity, course, brain involvement), intraper-
sonal (temperament, coping strategies, health beliefs), and
interpersonal variables (family functioning, social support)
have been proposed to impact child functioning (Rolland,
1990; see Wallander & Thompson, 1995, for a summary). A
survey of “ndings provides support for the basic assumption
that illness, child, and family factors impact the psychosocial
functioning of children with chronic illness and their families.