Discuss the impact of chronic medical conditions on adolescents (12-18yo) and identify ways of promoting resilience or positive development (1300 min-1500 max words).

A chronic or long-term illness results in major physical and psychological changes to the individual. The illness requires them to adjust to the burdens of the therapy implicated to treat the condition. There are multiple emotional, cognitive, motivational and behavioral factors that are stressed during the ongoing illness that hinders the individuals ability to develop and function healthily within Sigmund Freuds psychodynamic structure. Additional theories according to B.F Skinner, Mccrae & Costa and Carl Rogers compliment the idea that chronic illness will impact the individual’s ability to keep a positive self-esteem and develop socially and autonomously through adolescents. We will look into the specific factors that are impacted by chronic illness’, how exactly they relate to the responses of adolescent individual, how it affects their relationships with families and medical staff, and identify ways in which we can promote positive development despite the burden of a wide range of chronic illness’.

For Adolescents and young adults, gaining autonomy is essential which is imposed while enduring management of a chronic illness. Obviously with illness’ such as cancer, Sickle cell disease, Cystic Fibrosis and asthma; the vulnerability involved with daily activities directly affect ones confidence in behaving in line with social norms. As S.Morgan states these chronic illnesses ‘require constant monitoring and strict adherence to a medical regimen, with little room for the risky behaviors and experimentation that is often a part of peer relationships at this stage’ (Morgan, Davies, Palmer, & Plaster, 2010; Sawyer, Drew, & Duncan, 2007). This peer relationship stage is crucial in adolescents, confirmed by Stang and Story who state ‘peer influence is a dominant psychosocial issue during adolescents’. The chronically ill adolescent will find it hard to relate to peers due to ‘medical events (which act) as constant reminders of vulnerability for future episodes, which may complicate the developmental task of planning the future (Taylor, Gibson, & Franck, 2008). Simple social events such as going out on the weekends or participating in recreational activities can be a rarity amongst ill adolescents due to the distant relationship they must take for the safety of their own physical health. Being somewhat out casted in this way can lead to feelings of isolation and loneliness, attributes which Mccrae and Costa believe to be one of the big five personalities; the neurotic personality, where the individual will feel isolated therefore be vulnerable, self conscious, insecure and anxious (Barkaway 2009). This extract compliments Carl Rogers ‘self-concept’ who states ‘The image we have of ourselves can change with disease, injury or treatment’ (Gross &Kinnison,2007). Additionally, this constant confliction with the want to enjoy life as a healthy young adult, and the reality of not being able to, can result in anxiety, a theory created by Sigmund Freud who claims the ID (the want) and The Ego (reality principle) can conflict, which will lead to anxiety, resulting in the reliance of different ‘defence mechanisms’ (Weiten, 2011) to deal with the problems they are facing socially. It ultimately affects their ability to socialise and relate to others. The feelings of seclusion can disappoint us and we can feel alone and unwanted. Our self-esteem, which Coopersmith defines as ‘a personal self-judgement of worthiness’ can be dramatically decreased which could lead to an additional chronic illness: depression. Additionally, dealing with the illness alone can also add to emotional frustration.

"For about 2 to 3 months, whenever I had them [epileptic fits], I would get angry all of the time. Frustrated. " (16-year-old male) (Olsson)

Simultaneously with Cystic Fibrosis and other life expectancy shortening chronic diseases, one can feel hopeless for the future, especially during adolescents. The reality of a closely supervised future could make the individual hopeless for their future. There might not be a future according to their beliefs. They might ask themselves What’s the point? Or Why has God punished me? (Nina Reynolds,2012). Of course this isn’t the case with other less life threatening conditions such as asthma or diabetes, but the future can feel significantly impacted based on their current medical condition.

Secondly, the impact of chronic illness on an adolescent can deteriorate the individuals ability to sustain healthy relationships within the family setting and even with medical staff. Like all teenagers, chronically ill adolescents want to gain independence from their parents too, yet simultaneously with certain chronic diseases such as cystic fibrosis or sorts of cancer, they rely heavily on the support of the very same people they wish to escape from. At a time of increasing independence chronic illness’ may lead to great dependence on the family further increasing a sense of social isolation. Adolescents relationships with parents affect their progress in forging an identity (Emmanuelle,2009. Kroger,2007. Waterman,1982).Although the support of parents is rarely questioned, sometimes it can have ramifcations. ‘Ed’, a 15 year old cancer patient wrote in his journal ‘We had a little scrap tonight….Mom kinda makes me wonder why she’s here everyday cause she doesn’t do much’. (Flavelle, Shauna C. MD,2011) Although not a hugely inappropriate remark to make, it highlights that the individual can be somewhat sheltered by their parents through such times. This can have multiple effects on the family and the individual. The adolescent can start to feel rebellious and want to distance themselves from their family and fall in the diffused status of identity formation (GILL,2012). On the other hand they could be so reliant on them they may fall into the foreclosed status. ‘Because foreclosed adolescents love their parents and have little opportunity to make decisions on their own, they may never question parental authority or feel a need to forge a separate identity.’(Gill,2012). Adolescents, like many youth dealing with an illness, can also feel forgotten about even from the medical staff assisting them. As their parents continue to support them, the young adult can feel helpless and impartial “Some doctors still think that dad or mum is more important than me, and they have to talk to them instead of me... I’m the one with the cough.” (Girl with cystic fibrosis). Doctors can make the young adult feel precluded in important conversations: “He (doctor) doesn’t talk at my level. He ignores me and talks to my mum.” (Boy with muscular dystrophy, age 13 years). The loss of control can lead to many other problems including anger, frustration and anxiety; “Parents and health professionals alike emphasised the importance of keeping the illness under control through adherence to medical treatments and dietary regimens. The demands of illness management often place constraints around the young person. “(Olsson, C. A., Bond)
The combination of a poor relationship with medical staff, family and also at a social level can result in an overwhelming feeling of loneliness and frustration which can deteriorate existing relationships and make it a challenge to embrace new ones. This confirms B.F Skinner’s theory that environmental consequences, reinforcement, punishment and extinction determine peoples patterns of responding.(Gill,2012).

With most chronic illness’, the reality is that this will be a burden for the rest of their lives. Therefore ‘positive coping approaches may serve to strengthen belief in the efficacy of self and assist in building core self-esteem.’ (Olsson, C. A., Bond). The ability to embrace the illness and accept their perceived faults as a part of their identity seems to be the most effective way of gaining resilience. As Olsonn states in reference to their Royal Melbourne hospital study, “Acceptance of self and a healthy detachment of self from the opinions of others seemed an important element of any system of meaning in which the young person had discerned a core of personal worth.”. Promoting this acceptance can be achieved by getting them to talk about their problems, which most can do with others that are experiencing it. That can help the individual not feel alone and even make friends.
"I don't like meeting new people...they don't know what to say and I really have only got one friend that I can talk to because he has the same thing as me." (l7-year old female )
The weakness’ of enforcing such a group like Chronic Illness Peer Support (ChIPS) programme is that it can further categorize the individual as different and belong to a certain group of other disadvantaged people. It is separating them from healthy adolescents, which could further damage their emotional wellbeing. More importantly, getting them to accept their illness is more of a priority.
An important component of resilience appears not to be the absence of difficult life experiences, but rather the ability to determine a positive perspective within the experiences (Olsson,2000)

The initial cognitive, behavioural, motivational and emotional issues that adolescents with chronic illness’ face affect their happiness and ability to connect with peers. It affects their perceived ability to gain their ideal self, which if they believe to be a great distance from their self image, can lower their self esteem stated by Carl Rogers(Gross,2005). In turn it will have an affect on their social and family life as well as complying with treatment and working effectively with medical staff. However approaches to assist the individual accepting themselves for who they are such as support groups can really help them talk about the issues they are facing with other persons facing he same problems. This will help them feel less isolated and feel more comfortable being who they are and who they want to be.

26. Olsson C A, Bond L, Johnson M W, Forer D, Sawyer SM. Adolescent resilience: a conceplllal review. J Adolesc (in press).
27. LutharSS,CicchettiD,BeckerB.Theconstructofresilience:acritical evaluation and guidelines for future work. Child Dev 2000; 71 :543-62.

pg212 ailish gill
(Blling,Terry and Kohlenberg,2006) many young people made comments about the impact of illness management on developing and maintaining friendships and an active social life:
"I'm managing well bllt I feel that I dOll 't have an)' social life at all." (17-year-old female) had them [epileptic fits], I would get allgl)' aff the time. Frustrated. " (16-year-old male)
Olsson, C. A., Bond, L., Johnson, M. W., Forer, D. L., Boyce, M. F. and Sawyer, S. M. 2003, Adolescent chronic illness : a qualitative study of psychosocial adjustment, Annals of the Academy of Medicine Singapore, vol. 32, no. 1, pp. 43-50.