Well-Being of Children with Juvenile Arthritis

Chronic illness can have consequences that reach far beyond physical damage. Arthritis Foundation-funded researcher Kelly K. Anthony, PhD, and her colleagues at Duke University Medical Center in Durham, N.C., are investigating the social and emotional influences of juvenile arthritis (JA) on young people’s lives.

The Duke University team, which includes Laura E. Schanberg, MD, and Maggie Hood, BA, has conducted several related studies and has presented their results in abstract form at the American College of Rheumatology’s annual meeting and at the Arthritis Foundation’s research conference.

Parental Stress Predicts Depression in Children

In this study, 51 children with polyarticular JA and one of their parents completed various psychological questionnaires, and information on the child’s disease was gathered from their physicians. Of the children, 10 (20 precent) scored in a range that suggested a clinically meaningful depression. After analyzing the relationships between the variables, Dr. Anthony was able to determine that disease severity was not related to children’s depression. Rather, parental stress most significantly predicted symptoms of depression in the child. Dr. Anthony concludes, “It may be important for parents to learn techniques for managing their own stress related to both the management of their children’s disease and other daily hassles, as parents’ experience of stress appears to negatively impact children’s adjustment.”

Cognitive Functioning in JA

Little is known about whether and how JA may affect mental ability. To find out, 31 children with JA completed abbreviated IQ tests among other questionnaires that pertained to another aspect of the study. The children’s IQs fell within the average range. In addition, disease severity and duration were not related to children’s mental abilities. Therefore, Dr. Anthony and her colleagues conclude that children with JA are likely not at risk for cognitive impairments due to disease processes.

Parental Responses to Pain

Pain is a significant symptom for children with JA, but little is known about pain in toddlers and preschoolers with JA. In this study, one parent of 14 young children with JA participated in an unstructured interview with a researcher and completed questionnaires regarding pain episodes and pain measurements. Children’s verbal signals (whining, complaining, crying) and physical cues (limping, seeking comfort) were the most commonly used indicators for parents to recognize their child’s pain. Parents responded to the children’s pain with physical interventions (massage, heating pads), over-the-counter pain medications, distraction, encouraging rest and giving hugs. The researchers hope this information can be used to design pain interventions and parent programs as well as facilitate communication between parents and physicians about children’s pain.

Social and Nonverbal Functioning in JA

In this study, 21 school-age children with JA and one of their parents completed questionnaires that measure social skills and the children’s ability to understand facial expressions and exhibit appropriate body language in social interactions. On average, the children displayed age-appropriate social competence, social behaviors and nonverbal social skills. Differences in social skills among children in the study were related to aspects of the disease and facial decoding skills. Specifically, children who had their arthritis longer tended to have more problematic social behaviors (e.g., loneliness, more easily angered). Also, children who made fewer errors in reading facial expressions rated themselves as more socially competent, and children who were good at nonverbal interpersonal skills (eye contact, body language) were rated by parents and themselves as being more socially competent.

What Does This Mean for Families?

In general, these studies suggest that most children with JA don’t behave or feel all that differently than their peers without chronic illness. However, there are some children with JA and their families who do experience social and emotional difficulties. The research by Dr. Anthony and her colleagues highlights some important areas in which health care professionals could intervene to help these children and families. For example, parents could learn ways to handle their stress more effectively. Also, children could learn to read and react appropriately to the nonverbal cues of their peers as well as learn skills for coping with such stressful aspects of their disease as isolation, physical disability or deformity.

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