Resilience: A New Frontier in Paediatric Chronic Pain

There’s something about resiliency that has always resounded with me. I’m not sure how it started, or when it morphed into something greater than a perfunctory interest in how humanity rebounds in the face of traumatic experiences. Somehow, it thrived and transformed into an all-encompassing need to find out how children cope in the face of extreme circumstances. I am extraordinarily lucky to have channelled that interest into a PhD project for the Child and Youth Research in Psychology Program at NUIG.

To understand resiliency in children, it is imperative to discuss what circumstances and experiences promote the need for resilience and how resilience is defined. A substantial body of developmental psychology research (e.g. Bonanno & Diminich, 2013; Masten, 2011) demonstrates that resilience is the outcome trajectory following major stressors or traumatic events. Despite the negative impact or disruption that the presence of a chronic illness may have on a child and his/her family, research has revealed that many families demonstrate significant resilience. To date, the two most commonly studied risk factors in the paediatric chronic pain literature are fear of pain and pain catastrophizing (Vervoort et al., 2006) however resiliency as an outcome has only just become a topic of interest to researchers.

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In regards to how resilience is defined, there are disagreements across the field of psychology. Recently, the Journal of Paediatric Rheumatology highlighted an article by Hilliard, McQuaid, Nabors, & Hood (2015) that attempted to unite researchers under one definition. They proposed that resilience is a dynamic and multi-systemic process that allows the individual to respond effectively when faced with risk or adversity (e.g. medical condition or trauma). The process originates within the individual and is enhanced through developmental, social, cultural, and environmental factors. In the context of childhood, a key aspect of resilience is the demonstration of emotional, behavioural, or health outcomes that match or surpass normative developmental milestones, behavioural functioning, or emotional well-being (Hilliard, McQuaid, Nabors, & Hood, 2015).

My project aims to combine the ideology of resilience in children with chronic illness or traumatic experiences and the innovative definition proposed by Hilliard et al. (2015) with the awareness that families demonstrate resilience as a unit. Because pain experienced by a child does not only impact the child itself, it is important to look at how others related to the child (e.g. siblings, parents) cope with this pain as well. In my study I want to explore how the child and their family find positivity through resilience despite a chronic illness diagnosis or traumatic experience. How do they cope together as a family unit? How does positive coping through resiliency affect the quality of life of the family unit and its individual members (i.e. parents, child, & siblings)? Or in layman’s terms, how do they bounce back?

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To achieve answers to these questions, I plan interview both families of children who have been diagnosed recently with a chronic illness, specifically Juvenile Idiopathic Arthritis (JIA), and those who have had the condition for some time. We are also planning to follow these families up 1 year using questionnaires assessing their coping experiences. The study design will be a mixed methods longitudinal design and it is broken into the following two parts:

Part 1: Qualitative interviews with families of a child with JIA

Part 2: Longitudinal, quantitative study in families of a child with JIA with 3 assessment points over the span of 1 year.

My hope is that we can identify and isolate the resilience resources and mechanisms that these families display. Specifically, I hope to contribute to the explanation behind long-term positive adaptation (i.e. post-traumatic growth instead of post-traumatic stress) in families of a child with a chronic illness. Through this, I want to strengthen the efficacy of family resilience and develop positive family responses to paediatric chronic pain while enhancing the field.

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