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Repressive Adaptive Style in Children With Chronic Illness

From the Division of Behavioral Medicine, St. Jude Children’s Research Hospital (S.P.), and Department of Pediatrics, University of Tennessee College of Medicine (R.S.), Memphis, TN.

Address reprint requests to: Sean Phipps, PhD, Division of Behavioral Medicine, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794. Email: sean.phipps{at}stjude.org

OBJECTIVE: The primary objectives of this study were 1) To assess whether previously reported findings of high levels of repressive adaptation in children with cancer are unique to the cancer population or are generally characteristic of children with serious chronic illness and 2) to assess the utility of including a new measure of anger expression in the adaptive style measurement paradigm.

METHODS: Measures of defensiveness, trait anxiety, and anger expression were obtained from three groups of children: those with cancer (N = 130), those with chronic illnesses (diabetes, cystic fibrosis, and juvenile rheumatoid disorders; N = 121), and healthy control participants (N = 368). Based on their self-reports, participants were categorized according to the adaptive style paradigm as either high anxious, low anxious, defensive high anxious, or repressor. The prevalence of these categories was compared across groups.

RESULTS: Children in the cancer and chronic illness groups both reported significantly higher levels of defensiveness and lower levels of anxiety than did the healthy control participants. Application of the adaptive style paradigm produced a significantly higher percentage of children identified as repressors in the both cancer and chronic illness groups relative to healthy children. Children classified as repressors also reported significantly less expression of anger than did nonrepressors.

CONCLUSIONS: An increased prevalence of repressive adaptation is not unique to children with cancer, but may be generally characteristic of children with serious chronic illness. Use of anger in place of anxiety as the repressed affect produced a similar distribution of adaptive styles in the study populations.

Key Words: adaptive style, • childhood cancer, • chronic illness, • repression, • children.

Abbreviations: AESC = Anger Expression Scale for Children;; CDI = Children’s Depression Inventory;; CF = cystic fibrosis;; CSD = Children’s Social Desirability Scale;; DM = diabetes mellitus;; JRD = juvenile rheumatoid disorders;; STAIC = State-Trait Anxiety Inventory for Children.

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