Coping Strategies: Children and Adolescents

                                                          Health Psychology

This goal of this paper is to compare the treatment and coping strategies of McCrae in Laureate Education, Inc. (2012), explain how health psychologists may have to work differently with children and adolescents than they do with adults, and why noncompliance may be a significant issue with children and adolescents. In addition, it will describe an intervention for this age group and why it might be successful.

                                                               Asthma

Asthma is a condition wherein the lungs do not effectively move air to and from the lungs during occasional constriction of air passages (Levy, 2006). This makes breathing an adequate amount of air difficult. Between these occasions called asthma attacks, the individual is usually healthy and breathes normally. Asthmatic symptoms can be triggered by allergies, but can be provoked by infections, hormonal changes, environmental factors, or other irritants (Levy, 2006). The prevalence of asthma has dramatically increased and has become the single most common illness for school absences (Clark, 2003).

            Treatment Planning and Coping Strategies: Comparing Adolescents and Adults
Typically, parents and children cope through different mechanisms; adults use problem-focused coping and children use emotion-focused coping. Clark (2003) found children utilize imaginal coping, a strategy which employs imagination to ease fear, pain, uncomfortable situations, and boredom. However, in Laureate Education, Inc.(2012), McCrae utilized a more adult coping mechanism with problem-focused strategies that included developing a plan for keeping his medications available when away from home, and realistically and practically contending with the restrictions placed on him by having asthma. He was matter-of-fact with his thoughts about stigmatization and isolation from his peers.

His adult-like perceptions and strategic problem solving may have been, at least in part, a product of his parents' coping styles and their management of his disease. McCrae mentioned that his parents fostered his independence and autonomy by letting him make decisions about his treatment and other needs related to his asthma, although they supported him when he needed their help (Laureate Education, Inc., 2012). This parental attitude may have contributed to his maturity and his adult-like tendency to utilize problem-focused strategies to cope. When patients have a sense of autonomy and independence, they are more likely to adhere to their treatment strategies (Rapoff, 1999b). However, although perpetuating a sense of autonomy and independence are positive characteristics in any age group, it is prudent to maintain closer supervision of younger children. Other factors that may have contributed to McCrae's treatment adherence may have been his parents' higher level of education or higher economic status, both of which have been associated with increased adherence in adolescents and children.

                       Noncompliance as an Issue for Children and Adolescents
Children with chronic diseases, especially adolescents with asthma, do not ordinarily utilize avoidant behavior to cope with their illness (Hampel, Rudolph, Stachow, Laβ-Lentzsch, & Petermann, (2005). This may partly explain McCrae's ability to employ a straight forward problem-focused strategy to cope with his condition. McCrae's ability to adequately comply with his albuterol and nebulizer treatments for asthma may not be the norm, however (Rapoff, 1999a). Nonadherence is particularly problematic for patients with chronic disease as compared to patients with acute disease (Rapoff, 1999a). Adolescent boys are particularly less adherent with treatment regimens (Rapoff, 1999a). In general, children and adolescents may have a difficult time with treatment adherence because they forget and may not understand the importance of following the prescribed plan (Rapoff, 1999b).

                                            An Effective Intervention
Effective interventions for children and adolescents must include parental support, supervision, and constant monitoring (Rapoff, 1999b). Additionally, it must include educating the child or adolescent and the family to increase their knowledge about the disease as well as its treatment. Rapoff (1999b) advises parental supervision to be sensitive to the developmental capabilities of the child, with a higher level of supervision for younger children, lessened as they demonstrate their ability to adequately self-monitor. In addition, Rapoff recommends being sympathetic to the child during treatment, enlisting their ideas for consistent adherence, and communicating to them that they are there to help and support the child. A reward system such as the Exchange Program may encourage better adherence. The program is based on the idea that individuals will increase rewarded behaviors and behaviors that help them avoid unpleasant circumstances (Rapoff, 1999b). In the Exchange Program, praise, as well as special treats and privileges, are offered in return for compliance and adherence to treatment.

When non-adherence is a symptom of other family issues and patient problems, they need to be addressed prior to or concurrent with the non-adherence problems (Rapoff, 1999b). Rapoff (1999b) is careful to point out however, that family dysfunction is not usually the primary contributor to treatment non-adherence, so other factors should be ruled out prior to making this assessment. To identify barriers to compliance, a health psychologist may utilize interviews to help the patient identify barriers to compliance. Once the barriers are identified, the psychologist can help the patient utilize problem solving to design interventions that will help the patient overcome the barriers. This type of intervention may be effective because it enlists the patients' help in developing strategies for success, fosters independence and autonomy, and does not utilize punishment (Rapoff, 1999b).

                                                         Conclusion

Chronic diseases in children and adolescents can interfere with childhood and family health and well-being, and non-adherence can be a significant deterrent to maintaining that health. Successful interventions, which must be tailored to the unique characteristics of the patient and family should be utilized to educate the family and develop a program to help the child circumvent barriers to non-adherence as well as help the family to foster independence and autonomy.

                                                       References
Clark, C. D. (2003). Imaginal coping. In In sickness and in play: Children coping with chronic illness (pp. 91–138). New Brunswick, NJ: Rutgers University.

Carver, C. S. (2011). Coping. In R. J. Contrada & Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 221–229). New York, NY: Springer Publishing Company.

Hampel, P., Rudolph, H., Stachow, R., Laβ-Lentzsch, A., & Petermann, F. (2005). Coping among children and adolescents with chronic illness. Anxiety, Stress & Coping: An International Journal, 18(2), 145–155. doi: 10.1080/10615800500134639

Laureate Education, Inc. (Executive Producer). (2012). Child and adolescent health: Coping with child and adolescent illness. Baltimore, MD: Author.

Levy, M. (2006). Asthma [electronic resource] : the "at your fingertips" guide / Mark Levy. London : Class Publishing, 2006.

Rapoff, M. A. (1999a). Strategies for improving adherence to pediatric medical regimens. In Adherence to pediatric medical regimens (pp. 103–128). New York, NY: Springer.

Rapoff, M. A. (1999b). Medical nonadherence: Prevalence, consequences, and correlates. In Adherence to pediatric medical regimens (pp. 1–22). New York, NY: Springer.