Risk and resilience among children and youth with disabilities

Objective: To review the literature on risk and protective factors as applied to children with chronic and disabling conditions so as to assist the health care professional in developing clinical strategies and interventions. Design: Literature review. Main Outcome Variables: Risk factors (eg, emotional problems, school failure) and protective variables (eg, family cohesion, school involvement). Results: Both risk and protective factors can be identified at multiple levels: the condition, the child, the family, and the community. Conditions that are invisible have remitting-relenting courses, and where the prognosis is uncertain, these conditions are associated with the greatest emotional problems. Males with chronic conditions appear to have more emotional sequelae than do females. Likewise, personality characteristics of sociability and flexibility and physical characteristics of attractiveness are protective. Families with clear boundaries and a capacity to balance competing family needs, maintain flexibility, and ascribe positive meanings to life events all are protective. Conclusions: As increasing numbers of children with chronic conditions survive through adolescence to adulthood, the creation of environments where children can optimally develop becomes ever more pressing. It is evident that a range of factors, many amenable to interventions, can influence outcomes for these young people.