Discuss the impact of chronic medical conditions on adolescents and identify ways of promoting resilience or positive development The Australian department of health and aging (2013) defines a chronic medical condition as one that has persisted or is likely to persist for at least 6 months. This essay aims to use developmental theories as a vehicle to discuss a variety of impacts that chronic medical conditions can have on adolescents. It will discuss the fragility of the pubertal stage of development and how chronic conditions threaten the psychosocial tasks of this phase. It will present interventions aimed at promoting positive development. It will also be argued that loss and grief impact significantly on chronically ill adolescents and their families and discuss therapy for promoting resilience. This essay hopes to offer an understanding of the value of various interventions and importance of correct application and continual development.
Human adolescence is the period between the ages of 12 and 18. It is characterised by the onset of puberty and dramatic physiological and psychological development (Martini, Nath, & Bartholomew, 2012). Erik Erikson’s theory of psychosocial development describes adolescence as the Fifth stage where the youth is faced with a crisis of identity. During this delicate period adolescents begin to separate themselves from their guardians and invent identities of their own (Kroger, 1996). The opinions of their peers begin to take priority and susceptibility to peer pressure is at its highest (Sumter, Bokhorst, Steinberg, & Westenberg, 2009). Self consciousness takes hold and appearance, social anxiety and social acceptance become motivational forces (Forbes & Dahl, 2010). The principle task of adolescence is the formation of a personal identity and a concrete self concept. Self concept is made up of self image, self esteem and the ideal self.
Failure to develop this construct is to diverge from the human goal of self actualisation and to risk emotional instability in adulthood (Gill, 2012). Adolescents suffering chronic medical conditions are at risk of low self esteem. They will often find themselves burdened with social isolation and cognitive dysfunction (Yeo & Sawyer, 2005). Cognitive disfunction brought on by a medical conditions or medication used to treat a condition impacts directly on self esteem (Wallace, Harcourt, Rumsey, & Foot, 2007). The potential for illness-induced peer isolation further exacerbates self esteem issues and consequently, youths suffering chronic medical conditions are at high risk of developing depression due to the inability to form healthy relationships with peers (Wallace, Harcourt, Rumsey, & Foot, (2007). The formation of healthy relationships is also a fundamental requirement in Maslow’s hierarchy for development healthy personally (Gill, 2012).
Chronic illnesses therefore impact on the primary developmental tasks of adolescence and impact on the development of a healthy identity. Chronic medical conditions suffered during adolescence have a negative impact on body image (Pinquart, 2013). Illnesses and treatments can leave scarring and disfigurement. Therapies may affect growth and other physical features such as weight loss/gain and hair loss (Wallace, Harcourt, Rumsey, & Foot, 2007). The pubertal stage of development increases a young person’s sensitivity to their appearance. Thus physical disfiguration threatens the psychosocial development of the self, at this stage, and therefore impacts on their developmental trajectory (Sumter et al., 2009). Disruptions to the developmental trajectory of adolescents due to chronic medical conditions will impact their future educational and vocational success (Maslow, 2011).
Within his sample group, Maslow (2011) showed that adults who suffered a chronic condition during their adolescent years were less likely to finish high school, less likely to go graduate college, less likely to be currently employed and considerably more likely receive assistance from the government at the rate of 40.6% vs. 22.8%. Thus the literature shows a need to provide adolescents suffering chronic medical conditions with interventions and treatments to promote positive development and safe guard their future (Maslow, 2011). Mentoring programs have been shown to promote positive development for adolescents suffering chronic illnesses. Maslow et al., 2013 revealed that regular contact with mentors who have achieved vocational success despite their own adolescent illnesses, is likely to promote positive development in afflicted teenagers. Alternatively, Pini, (2009) explains that by allowing learning mentors access to chronically ill youth in healthcare environments, they are able to facilitate a continued education alongside treatment.
The prospect of being able to keep up to date with study promotes confidence and resilience in students suffering absenteeism due to treatment. However after the cessation of treatment, patients can feel neglected even though not formally discharged from the mentor’s load for five years (Pini, 2009). Despite blatant sampling weaknesses in both the afore mentioned studies, they suggest that mentor program alumni are more likely to finish high school, graduate college and be gainfully employed as a result of participation (Maslow et al., 2012). Support groups provide valuable support for adolescence suffering from chronic medical conditions. Support groups help adolescents positively integrate a chronic illness status into their identity (Risio, Ballantyne, Read, & Bendayan, 2011). Contact with youth in similar situations can offer lateral and/or downward social contrast with others in comparable and/or worse condition and help the youth take steps towards developing a positive self concept (Pinquart, 2013). Specialized camp programs also offer a chance for positive social comparison and promote resilience.
Camps offer a stress free and recreation orientated environment in which chronically ill young people can build lasting friendships and learn new skills, both practical and developmental (Gillard, Witt and Clifton, 2011). Gillard et al., (2011) explain that camps create an atmosphere where young persons with chronic medical conditions feel at ease and free of judgment. They experience a lack of isolation and, through group work and training, develop confidence in their ability to cope with adversity, building resiliency (Gillard et al., (2011). It has also been shown that participation in recreational and physical activities offers a reprieve for parents and families for whom adolescent chronic illness is also a burden (Moola, Faulkner, Kirsh, & Schneiderman, 2011) An adolescent’s chronic medical condition can impact on the emotional state of the family unit. Both the afflicted young person and their family have both experienced severed attachments.
Bowlby’s attachment theory gives us an understanding of a person’s tendency to create emotional attachments to not only people, but to concepts, roles and beliefs. Broken attachments lead to a sense of loss and ultimately grief (Worden, 2009). The chronically ill teenager may grieve the loss of acceptance from peers, an ideal future, an ideal body, physical dexterity or the loss of their autonomy due to dependency on care givers and family. Additionally family members may mourn the loss of their child’s health, the future they had imagined for their family or the roles they once had as care givers. The ill youth may also sense the family’s grief, exacerbating their own (Boss, 2006). Depression is a direct consequence of grief and flag marked by both Kübler-Ross and Park & Bowlby in their renowned stage theories on grief and death (Gill, 2009).
Therefore all chronically ill youths should be marked as being at risk of depression and must be assessed carefully and regularly to monitor health and well being (Greydanus, Patel & Pratt, 2010). Grief therapy is evolving to accommodate the unique needs of adolescents and families suffering chronic conditions. Worden J, W. (2009) describes grief therapy as of a series of tasks to be actively undertaken by the bereaved in order to reach resolution. However according to Boss (2006) grief counsellors and therapists are often at a loss as to how to treat patients with the ambiguous loss caused by a fluctuating chronic medical condition. The lack of a cure or closure blurs any foreseeable resolution, thus the therapeutic intention is directed towards managing the daily stress and anxiety inherent in coping with a chronic condition in order to promote resilience (Boss, 2006). Being first published, by Dr Pauline Boss in 1999, ambiguous loss is a concept still in its infancy (Boss, 2012).
There is therefore a lack of empirical research into its longterm implications and treatment. However, academics acknowledge its relevance and recommend that understanding a client’s experience of ambiguous loss is essential to the development of professional care for families and patients for facilitating their resilience and wellbeing (Brien, 2007; Blieszner, Roberto, Wilcox, Barham & Winston, 2007; Kean, 2010). Abraham H. Maslow is often quoted as saying “if the only tool you have is a hammer, you tend to see every problem as a nail.” (as cited in Boss, 2006)
The impacts of chronic medical conditions on adolescents are as varied as the interventions promoting positive development and resilience. In conclusion it is fortunate that a variety of interventions exists and that the academic community actively seeks to refine and develop them. As it has been shown throughout this paper, there is no uniform experience of a chronic medical condition. Therefore no single theory, or remedy, can be applied to every case. The road to resilience begins with finding the most appropriate tool for the job.
Australian. Department of Health and Ageing (2013). Chronic disease management (CDM) medicare items. Retrieved 4/10/2013, 2013, from http://www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare-