Adaptational problems of children and adolescents with cystic fibrosis

This paper reviews the common adaptational disturbances of children and adolescents with cystic fibrosis at a major treatment center. Common presenting problems included learning disturbances, problems of behavioral control, somatic symptoms, anxiety, and depression. These disturbances, which often reflected maladaptive family adaptation to the stresses of the disease, posed difficult diagnostic dilemmas and necessitated a range of mental health and consultation services. The implications of these findings for mental health professionals who work with chronically ill children and their families are reviewed. Many once lethal childhood diseases have become chronic con-ditions which pose complex psychosocial challenges for families and physicians (Artiss & Levine, 1973; Crane, 1975; Mattsson. 1972). Cystic fibrosis is among the most frequent and stressful of all chronic childhood illnesses. Modern physical treatment for cystic fibrosis includes numerous antibiotic medications, mist tent therapy, and daily postural drainage treatments which present signifiant financial and physical burdens to parents (McCollum & Gibson, 1970). The physical treatments, medical care, and repeated hospitalizations increase parental vigilance far beyond normal developmental requirements (Freud, 1952). Cystic fibrosis poses the additional psychological hazards of delayed puberty, compromised physical appearance, and frequent sterility in males. Cystic fibrosis is one of the few chronic childhood illnesses which is frequently diagnosed at birth, involving gradual physical deterioration and death in early adulthood. The marked intra-psychic conflict, severe anxiety, depression, and unusual family distress described by clinicians were consistent with the previous prognosis of death in early childhood or adolescence (Lawler