Feb. 4, 2002 -- Very sick little girls and boys often amaze us
Feb. 4, 2002 -- Very sick little girls and boys often amaze us with their sunny disposition and upbeat attitude. But when researchers looked more closely at brave and seemingly well-adjusted children battling debilitating illness, they found that the kids scored quite high on tests of defensiveness. Could these children be endangering their health by denying their distress?
Sean Phipps, PhD, from St. Jude Children's Research Hospital, and Ric Steele, PhD, from the University of Tennessee College of Medicine, both in Memphis, compared 130 kids with cancer, 121 kids with a chronic illness (diabetes, cystic fibrosis, or rheumatoid disease), and 368 healthy peers. Each child completed standard questionnaires on depression, anxiety, and defensiveness.
The findings appear in the Jan. 29 issue of the medical journal Psychosomatic Medicine.
"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," the researchers write.
Defensiveness is a tendency to avoid or deny any negative thoughts about oneself. For example, the children might characterize themselves as "always polite, even to people who are not nice to me."
Children who scored high in defensiveness, but seemed otherwise well-adjusted despite their difficult situation, were dubbed "repressors." According to the researchers, "Children classified as repressors reported significantly less expression of anger than did nonrepressors."
In other words, these very ill children, who have quite a bit to be worried and angry about, routinely expressed less anxiety, and less anger, than their healthy counterparts. At the same time, they were significantly more likely to be defensive.
So what might this mean for these kids, their parents, and their doctors?
That remains unclear for now, the researchers say. It could be that defensiveness is, in fact, a healthy way of dealing with the difficulty and demands of serious or lingering illness. But it could also be that by ignoring their feelings, these children also ignore important warning signs of worsening illness or emotional distress -- signs their caregivers need to know.
The researchers conclude that even if chronically ill children don't say that they're anxious, upset, scared, depressed, or in pain -- even if they say they feel fine -- parents, doctors, and other caregivers should remain vigilant.
