Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

There is increasing interest in measuring quality of life (QL) in children and adolescents, but this interest has developed without careful attention given numerous important issues. Consequently, there is much diversity and confusion in this measurement area. We discuss at a conceptual level herein how to construe and define QL, approach its measurement, and the implications of for whom this is done. Methodological issues pertaining to validation, proxy report, and child development are also discussed. Guidelines for selecting QL measures are provided and a set of generic QL measures is recommended for further consideration. Finally, applications of the QL concept in the policy, service and care, and science areas are delineated.

Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

The hypothesis that their psychological adjustment is related in part to resources present in their families was investigated in 153 children, age 4-16, who had one of five chronic physical disorders: juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy. Their mothers completed standardized psychometric instruments to measure specific dimensions of family psychological and utilitarian resources and of child adjustment. Variation in children's psychological adjustment was related both to their psychological and utilitarian family resources. Psychological family resources contributed uniquely to the prediction of adjustment beyond that provided by utilitarian family resources. These results are discussed as having implications for the identification of chronically ill and handicapped children at risk for adjustment difficulties.

• Children deserve to experience a good quality of life (QOL).• We examine three main approaches for understanding children's QOL.• Issues and opportunities in research on children's QOL are discussed.• We conclude social indicators and subjective well-being best capture children's QOL.• QOL should be a universal indicator when we intend to advance well-being of children. a b s t r a c t a r t i c l e i n f o The quality of children's life is important both as an investment in the future of our society and because children constitute an important group of themselves and deserve to experience well-being presently. Quality of life (QOL) has been conceptualized and studied in children for several decades, but with disparate approaches that have rarely been discussed jointly with application to children in general. Here we describe and critically examine the three main approaches to children's QOL: health-related QOL (HRQOL), social indicators, and subjective wellbeing (SWB). Although this is not a review of instruments per se, we illustrate these approaches by describing their most prominent measures. Issues and opportunities in research on children's QOL are then discussed related to conceptual clarity, content specification, range of experience, subjective and objective perspectives, development in childhood, reporting source, and malleability of QOL. Finally, directions for advancing children's QOL are considered. We highlight the benefits of focusing on social indicators and SWB, rather than HRQOL, when representing this concept for children in general, the need for applying more sophisticated research strategies, and using QOL as a universal indicator of success whenever we intend to advance the well-being of children through intervention, programs, and policy.

Background: Providing family care to children who have a chronic physical condition is often a stressful experience, yet a portion of maternal caregivers are able to do so without psychological distress. Specific Aims: On the basis of the multivariate conceptual model proposed by J. L. Wallander, J. W. Varni, L. Babani, C. B. , perceptions of hope and social support were hypothesized to serve as resilience factors against distress in mothers of children with chronic physical conditions. Direct, moderating, and mediating relationships among these variables were tested. Participants: One hundred eleven mothers of 5to 18-year-old children who had cerebral palsy, spina biflda, or insulin-dependent diabetes mellitus. Main Outcome Measures: Hope Scale, Social Support Questionnaire-6, Brief Symptom Inventory, Parents of Children With Disabilities Inventory. Results: There were no differences in distress among mothers raising children with different conditions. Both hope and social support were associated negatively and uniquely with distress in these mothers. Perceptions of hope moderated the relationship between disability-related stress and maladjustment, sug-

We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.).

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