Abstract
Children with chronic illnesses are called to undertake complicated processes of adjustment and re-organization in their daily lives; as a result, they could experience several internalizing problems. Symbolic play could be a useful way to cope with these difficulties. The main aim of this paper is to assess pretend play, coping, and psychological symptoms in three groups of school-aged children with pediatric chronic diseases. The study involved 44 Italian school-aged, chronically ill children: 16 with type 1 diabetes mellitus (T1DM), 12 with cystic fibrosis (CF), and 15 with Leukemia. All patients were assessed by the Affect in Play Scale–Brief version (APS-Br), and the Children’s Coping Strategies Checklist–Revision1 (CCSC-R1). Children with T1DM and CF also completed the Separation Anxiety Symptom Inventory for Children (SASI-C) and the Strengths and Difficulties Questionnaire (SDQ)–children’s version. Cohen’s d (effect size) was applied between clinical and normative samples, and it showed a more organized play (APS-BR), but a more negative affect tone, comfort, and frequency of affect expression. Comparing APS-BR and CCSC-R1 rates between the three groups, significant differences were found for all the APS-BR dimensions, except for tone, and for CCSC-R1 seeking understanding. Comparing SASI-C score between T1DM and CF, higher scores were found for children with CF. In the end, correlations between all dimensions highlighted several relationships between play, coping, and adjustment problems for children with T1DM, and relationship between affect play and all variables for children with CF. Symbolic play helps chronically ill children to express emotions; helping them, as well as clinicians, to understand the difficulties caused by chronic conditions, and to cope with them.
Highlights
The term “chronic disease” indicates a condition that lasts three months or more, that involves medical care constantly, and/or limits activities in daily lives [1]
The prevalence rates of pediatric chronic conditions range from 13% to 27% [2]; due to scientific progress, many children diagnosed with chronic diseases considered serious and lethal, such as cystic fibrosis or muscular dystrophies, are living into adulthood [3]
Among the different types of chronic diseases, the present paper focused on three pediatric chronic illnesses: an autoimmune disease that can occur at any time, an inherited genetic disease, and a genetic disease that, in most cases, is not hereditary
Summary
The term “chronic disease” indicates a condition that lasts three months or more, that involves medical care constantly, and/or limits activities in daily lives [1]. The prevalence rates of pediatric chronic conditions range from 13% to 27% [2]; due to scientific progress, many children diagnosed with chronic diseases considered serious and lethal, such as cystic fibrosis or muscular dystrophies, are living into adulthood [3]. Among the different types of chronic diseases, the present paper focused on three pediatric chronic illnesses: an autoimmune disease that can occur at any time (type 1 diabetes mellitus), an inherited genetic disease (cystic fibrosis), and a genetic disease that, in most cases, is not hereditary (leukemia). Res. Public Health 2020, 17, 4364; doi:10.3390/ijerph17124364 www.mdpi.com/journal/ijerph
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