Predicting adjustment in children and adolescents with sickle cell disease: A test of the risk-resistance-adaptation model

Objective: A theoretical model was used to examine the impact of risk and r esistance factors on the psychological adjustment of children and adolescen ts with sickle cell disease (SCD). Participants: One hundred eighteen child ren and adolescents with SCD receiving treatment at a comprehensive sickle cell center and their mothers. Measures: Included risk factors (condition p arameters, functional independence, and disability stressors), resistance f actors (stress processing, intrapersonal factors, and social ecological fac tors), and adjustment. Results: Adaptive behavior was associated with child maladjustment, severity of disability was associated with disability stres s, and child competence was associated with child maladjustment. Coping did not moderate the association between stress and maladjustment, and adaptiv e behavior and stress did not mediate the association between severity of d isability and maladjustment, as the model had predicted. Conclusions: Resul ts support the continued use of theoretically driven models to investigate the adjustment of children and adolescents with chronic conditions and to p romote comparisons of different chronic illnesses and disabling conditions. The findings indicate possible avenues for clinical intervention with chil dren and adolescents with SCD.