Internalizing and externalizing behaviors in chronically ill adolescents in the context of family system functioning
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Department of Pediatric Cardiology and Congenital Heart Diseases, Medical University of Gdansk, Gdansk, Poland
Institute of Psychology, University of Gdansk, Gdansk, Poland
SWPS University of Social Sciences and Humanities, Sopot Campus, Poland
Prof. Tadeusz Bilikiewicz Psychiatric Hospital in Gdansk, Poland
Jadwiga Titz-Kosko Provincial Rheumatology Clinic in Sopot, Poland
Submission date: 2019-03-19
Final revision date: 2019-07-16
Acceptance date: 2019-08-05
Online publication date: 2019-09-11
Publication date: 2019-09-11
Health Psychology Report 2019;7(3):213–228
Diagnosis of chronic illness, which constitutes a life-threatening situation such as in Marfan syndrome or dis-ease with periods of remission and severity such as in juvenile idiopathic arthritis (JIA), leads to problems with the functioning of the adolescent and the whole family system. Therefore the aim of the study was to determine the differences in severity of internalizing and externalizing problems and in the perception of the family sys-tem between adolescents with Marfan syndrome, with JIA, and without chronic disease, as well as to determine whether characteristics of the family system are associated with externalizing and internalizing behaviors in those groups.

Participants and procedure:
The study involved three groups of adolescents: 1) with Marfan syndrome (n = 25), 2) with JIA (n = 29), and 3) without chronic illness (n = 20). We used the adolescent version of the Child Behavior Checklist (CBCL) Youth Self-Report (YSR) and the Family Assessment Scale.

Our results indicated that adolescents with Marfan syndrome have similar scores compared to adolescents without illness on all subscales concerning both internalizing and externalizing behaviors, as well as the family system’s characteristics. Compared to adolescents with JIA, adolescents with Marfan syndrome had lower scores on externalization symptoms and Attention Problems and they also perceive their families as less bal-anced. Additionally, in the perception of adolescents with Marfan syndrome and with JIA the weaker the family bond, the stronger the intensity of externalizing behaviors.

Although in the light of our novel research, adolescents with Marfan syndrome do not present behavioral prob-lems different from healthy peers, it is worth continuing such research in order to verify the results. Adolescents with JIA present more externalizing behaviors than peers without chronic illness, which is consistent with some previous research. Research on families of an adolescent child with Marfan and JIA are quite novel and they should be continued.

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