Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy.
Department of Women's and Children's Health, Hospital-University of Padua, 35128 Padova, Italy.
Int J Environ Res Public Health. 2020 Jun 18;17(12):4364. doi: 10.3390/ijerph17124364.
Children with chronic illnesses are called to undertake complicated processes of adjustment and re-organization in their daily lives; as a result, they could experience several internalizing problems. Symbolic play could be a useful way to cope with these difficulties. The main aim of this paper is to assess pretend play, coping, and psychological symptoms in three groups of school-aged children with pediatric chronic diseases. The study involved 44 Italian school-aged, chronically ill children: 16 with type 1 diabetes mellitus (T1DM), 12 with cystic fibrosis (CF), and 15 with Leukemia. All patients were assessed by the Affect in Play Scale-Brief version (APS-Br), and the Children's Coping Strategies Checklist-Revision1 (CCSC-R1). Children with T1DM and CF also completed the Separation Anxiety Symptom Inventory for Children (SASI-C) and the Strengths and Difficulties Questionnaire (SDQ)-children's version. Cohen's d (effect size) was applied between clinical and normative samples, and it showed a more organized play (APS-BR), but a more negative affect tone, comfort, and frequency of affect expression. Comparing APS-BR and CCSC-R1 rates between the three groups, significant differences were found for all the APS-BR dimensions, except for tone, and for CCSC-R1 seeking understanding. Comparing SASI-C score between T1DM and CF, higher scores were found for children with CF. In the end, correlations between all dimensions highlighted several relationships between play, coping, and adjustment problems for children with T1DM, and relationship between affect play and all variables for children with CF. Symbolic play helps chronically ill children to express emotions; helping them, as well as clinicians, to understand the difficulties caused by chronic conditions, and to cope with them.
患有慢性病的儿童在日常生活中被要求进行复杂的调整和重组过程；因此，他们可能会经历一些内化问题。象征性游戏可能是应对这些困难的一种有用方式。本文的主要目的是评估三组患有儿科慢性病的学龄儿童的假装游戏、应对策略和心理症状。该研究涉及 44 名意大利学龄期慢性病儿童：16 名 1 型糖尿病（T1DM）患儿、12 名囊性纤维化（CF）患儿和 15 名白血病患儿。所有患者均采用游戏中的情感评估量表-简表（APS-Br）和儿童应对策略检查表-修订版 1（CCSC-R1）进行评估。患有 T1DM 和 CF 的儿童还完成了儿童分离焦虑症状量表（SASI-C）和长处和困难问卷（SDQ-儿童版）。在临床和规范样本之间应用科恩氏 d（效应量），结果显示游戏更具组织性（APS-Br），但情感基调更消极，表达情感的舒适度和频率更高。比较三组之间 APS-Br 和 CCSC-R1 的比率，除了基调外，APS-Br 的所有维度和 CCSC-R1 的寻求理解维度均存在显著差异。比较 T1DM 和 CF 之间的 SASI-C 评分，CF 患儿的评分较高。最后，所有维度之间的相关性突出了 T1DM 患儿游戏、应对和适应问题之间的关系，以及 CF 患儿情感游戏与所有变量之间的关系。象征性游戏帮助慢性病儿童表达情感；帮助他们以及临床医生了解慢性病引起的困难，并应对这些困难。
