Family functioning in children with chronic illness compared with healthy controls: a critical review.

dvances in medical care and technology have increased the lifespan and decreased the disease-related suffering of children with chronic illnesses. In addition to physical health outcomes, health care professionals are increasingly evaluating other parameters, such as child and family adjustment. Among these psychosocial factors, family functioning s a key variable that has been shown to play an essential role in children’s adjustment to chronic illness. Family functioning is a broad concept and is often used as an umbrella term encompassing numerous constructs, ncluding parents’ satisfaction with their parenting role, positive parent– child interactions, family communication, family daptability, and family cohesion. Research has shown that families of a child with a chronic illness may have deficits in amily cohesion, family adaptability, parent-child interactions, family conflict, and family problem-solving skills. nderstanding the nature and development of these problems in family functioning is critical to formulating effective nterventions. Although we know that family functioning is related to the well-being of children with chronic illness, we lack a clear nderstanding of whether families of chronically ill children are significantly more likely to have difficulties in functioning ompared with families of healthy children. In this article we review the research into the functioning of families with children ith a range of chronic illnesses compared with healthy controls, critique these studies, highlight parallels across the literature, nd provide directions for future study. The inclusion of demographically matched healthy control groups allows researchers to eliminate a number of ethodological limitations and draw strong conclusions regarding the impact of childhood illness on family functioning. his is particularly important with measures of family functioning that were not recently normed, or were normed with group that is significantly different from the sample being studied. For example, researchers examining family functioning n the predominately African-American sickle cell disease (SCD) population have stressed the importance of including a emographically matched healthy comparison sample rather than relying on the norm-group statistics for comparisons. ncluding this group allows researchers to better distinguish the disease-specific effects on family functioning independent rom the sociocultural influences, such as ethnic minority socioeconomic status. A review of studies of chronic illness djustment and family functioning indicates that previously established differences are not significant when healthy ontrols are included. We selected cystic fibrosis (CF), juvenile rheumatoid arthritis (JRA), type 1 diabetes/juvenile-onset diabetes, asthma, emophilia, and SCD for this review because these are some of the most common chronic childhood illnesses and represent a road spectrum of disease. Although there are differences across these 6 groups, there are imilarities in chronicity, creation of disability, and need to adhere to demanding regiens.