Handbook of Positive Psychology Phần 9 potx

663 48 Positive Psychology for Children Development, Prevention, and Promotion Michael C. Roberts, Keri J. Brown, Rebecca J. Johnson, & Janette Reinke You have brains in your head You have feet in your shoes You can steer yourself Any direction you choose. —Dr. Seuss Although the specialties of psychology deal- ing with children recognize the serious prob- lems encountered during their development, much of the recent orientation involves moving away from viewing the psychological and be- havioral deficits resulting from a developmental challenge. Instead, the focus increasingly has become one of perceiving the competence of the child and his or her family and enhancing growth in psychological domains. The clinical child, school, and pediatric psychology litera- tures frequently address concepts of stress and coping, generally accepting that coping is a pos- itive response to the stress of a negative envi- ronmental situation or life event such as a chronic illness or parental divorce. As noted by Siegel (1992), “individual- differences factors can influence both a child’s response to stress and his or her use of coping strategies” (p. 4). He called for increased atten- tion to the individual differences in children’s behavioral, emotional, and physiological re- sponsiveness to their environment. Siegel indi- cated that each child may respond quite dif- ferently to an environmental stressor. An important aspect of coping is that the same mechanisms of responding to stress are involved in life events that are not as significant as di- vorce or disease but are the daily hassles of hu- man existence. For example, in pediatric psy- chology, several resilience and coping models have emerged to frame issues of children who have a chronic illness such as diabetes, cystic fibrosis, or sickle-cell disease. In much of the earlier literature and still to some extent today, coping or resilience concepts are thought of only as responses to a stressor, usually a major one, not as a positive behavioral style of ad- justing, adapting, accommodating, and assimi- lating to an ever-changing environment in a child’s life. In a positive psychology orientation, however, a comprehensive and inclusive concep- tualization of coping views these adaptations as 664 PART IX. SPECIAL POPULATIONS AND SETTINGS normal developmental events with much com- mon origin and function. Additionally, there is an increasing recognition that growth and en- hancement to achieve physical and psychologi- cal well-being occur through these adaptations. Others have noted the need, particularly working with adolescents, to examine the strengths and positive assets of the develop- mental stage rather than focusing on the mul- titude of stressors and potential negative out- comes (Johnson, Roberts, & Worell, 1999). Johnson and Roberts (1999) recognized that “looking at strengths rather than deficits, op- portunities rather than risks, assets rather than liabilities is slowly becoming an increasing pres- ence in the psychotherapy, education, and par- enting literature” (p. 5). Similarly, Dryfoos (1998) reviewed the programs aimed at assisting adolescents and concluded that successful ones emphasized optimism and hope and were growth-enhancing for the adolescents and their families. All too often, a “pathology model” has been applied to studying how children develop. That is, children with significant behavior disorders pose major problems for parents, teachers, and peers, such that their pathology gets the greatest attention. More recent conceptualiza- tions have focused attention on more “normal” development for most children, but also to con- sidering how pathology might be avoided through early intervention and enhanced envi- ronments for all children. Frequently the focus has been on taking children with problems and doing something to change them. Positive psy- chology has something to offer this process, but a larger application of positive psychology would be to view it in terms of prevention and promotion. Additionally, the pathology model typically takes an adult-oriented perspective. By assuming that the goal of all human develop- ment and any intervention is intended to pro- duce a fully functioning adult, only adult out- comes are considered important. The positive psychology alternative is to focus on the child while a child is in development and attempt to enhance functioning, competence, and overall mental health at any particular time. Further- more, psychological conceptualizations of pa- thology have historically been formulated for adults and then, in a downward extension, applied to children and adolescents (Maddux, Roberts, Sledden, & Wright, 1986). This ap- plication, all too frequently, does not fit. Adult- oriented theories and intervention techniques “have never sufficed in other areas of mental health intervention work with children re- quires a developmental perspective which rec- ognizes the process of continual change over time in the psychology of children” (Roberts & Peterson, 1984, p. 3). In our view, well- formulated positive psychology literature takes a developmental perspective. In this chapter, we will describe the three ma- jor conceptualizations of optimism, hope, and quality of life as related to positive psychology for children and adolescents. This examination of the extant literature is descriptive and not exhaustive, but it does illustrate the potential utility of positive psychology in child develop- ment. In the final section, we propose that in- tegrating a positive psychology orientation with a developmental perspective creates a catalyst for prevention. Optimism Definition and Concepts One conception of optimism defines it in terms of explanatory style and how an individual thinks about causality of an event. That is, an optimist is defined as a person who sees defeat as temporary, confined to a particular case, and not his or her direct fault (Seligman, 1991). A pessimist, on the other hand, believes bad events will last a long time and undermine everything he or she does, and that these events were his or her fault. Thus, the way that a per- son explains positive or negative events to him or herself determines whether he or she is op- timistic or pessimistic. This explanatory style is evident in how an individual thinks about the causes of events. A pessimist dwells on the most catastrophic causes for the event, whereas an optimist can see that there are other possible, less catastrophic causes for the same event. For example, two children may receive poor grades on a test. The pessimistic child might say to himself, “I’m stupid and can’t get anything right,” whereas the optimistic child might say to herself “I need to study a little harder next time.” In summary, Seligman stated that the way in which a person explains events has three dimensions: permanent versus temporary, uni- versal versus specific, and internal versus exter- nal. These dimensions determine whether a person is pessimistic or optimistic. This explan- atory style can be acquired by children and CHAPTER 48. POSITIVE PSYCHOLOGY FOR CHILDREN 665 adults and has been labeled learned optimism. Seligman and his colleagues have studied the concept of learned optimism with children as well as adults. Considerable research has been conducted on the benefits of optimism and the costs of pes- simism. Optimists tend to do better in school and college than pessimists. Optimists also per- form well at work and in sports. The physical and mental health of optimists tends to be bet- ter, and optimists may even live longer than pessimists (Seligman, 1991). Optimists also tend to cope with adverse situations in more adaptive ways (Scheier & Carver, 1993). Ado- lescents who are optimistic tend to be less angry (Puskar, Sereika, Lamb, Tusaie-Mumford, & McGuiness, 1999) and abuse substances less of- ten (Carvajal, Clair, Nash, & Evans, 1998). Con- versely, pessimists tend to give up more easily, get depressed more often, have poorer health, be more passive (Seligman, 1991), have more failure in work and school, and have more social problems (Peterson, 2000). Seligman, Reivich, Jaycox, and Gillham (1995) described four sources for the origins of optimism. The first possible source is genetics (Schulman, Keith, & Seligman, 1993; Seligman et al., 1995). A second source is the child’s en- vironment, in which parents seem to be a strong influence on the level of optimism in their chil- dren. Researchers have found that there is a strong relationship between a mother’s explan- atory style and that of her child (Seligman et al., 1995). Children may imitate parents’ ex- planatory style. A third source for optimism is also an environmental influence, in the form of criticism that a child receives from parents, teachers, coaches, or other adults. If an adult criticizes a rather permanent ability of a child (e.g., “You just can’t learn this”), the child is more likely to develop a pessimistic explanatory style. A fourth way in which optimism develops is through life experiences that promote either mastery or helplessness. Life events such as di- vorce, death in the family, or abuse can affect how a child describes causes to him- or herself. Events such as these tend to be permanent, and many times the child is unable to stop or re- verse the event. In light of all the benefits of being optimistic and the costs of being pessimistic, is it best for a child to be optimistic all the time? Seligman and other researchers have not advocated that parents mold their children to be the more ex- treme “Pollyanna.” Instead, Seligman et al. (1995) noted that there are limits to optimism. Children must see themselves in a realistic light in order for them to successfully challenge their automatic negative thoughts. Teaching children to be realistic helps them perceive the begin- nings of negative self-attribution (e.g., “I flunked the test because I am stupid”) and chal- lenge that thought, and also to see where they might be able to overcome a fault (e.g., “I flunked the test because I didn’t study enough. Next time I’ll study harder”). Disputing auto- matic thoughts only works when the thoughts can be checked against reality. Measurement One assessment tool for measuring optimism in children is the Children’s Attributional Style Questionnaire (CASQ; Seligman et al., 1995). This instrument is a 48-item forced-choice questionnaire that assesses explanatory style for both positive and negative hypothetical events. The questions measure whether the child’s at- tributions about positive or negative events are stable or unstable, global or specific, and inter- nal or external. Example items include: “You get good grades: (A) School work is simple; or (B) I am a hard worker.” The CASQ gives an overall picture of the child’s explanatory style and whether that style is positive or negative. The book The Optimistic Child (1995), by Se- ligman et al., contains an in-depth description of the CASQ, including administration, scoring, and interpretation. The Life Orientation Test (Scheier & Carver, 1985) is a measure developed for assessing optimism of adults and has been used with adolescents (e.g., Carvajal et al., 1998; Puskar et al., 1999) Interventions The Penn Prevention Program is an inter- vention-oriented research project that has in- vestigated the costs of pessimism in children (Jaycox, Reivich, Gillham, & Seligman, 1994; Gillham, Reivich, Jaycox, & Seligman, 1995). The goal of this program has been to prevent depressive symptoms in children at risk for this pathology using a treatment that addresses the child’s explanatory style and social-problem- solving skills. The children in the prevention group were taught to identify negative beliefs, to evaluate those beliefs by examining evidence for and against them, and to generate more re- alistic alternatives. They were also taught to 666 PART IX. SPECIAL POPULATIONS AND SETTINGS identify pessimistic explanations for events and to generate alternative explanations that were more optimistic. These children also learned so- cial problem solving, as well as ways to cope with parental conflict, and behavioral techniques to enhance negotiations, assertiveness, and re- laxation. The results of this project are encour- aging. The researchers found that the children who were in the prevention condition had half the rate of depression as the control group. Im- mediately after the prevention program, the control group had more depressed symptoms than the treated group. Also of considerable in- terest is the finding that the benefits of the pro- gram seemed to maintain over time. Children who completed the prevention program in pre- adolescence were able to deal with the chal- lenges they faced in adolescence more effec- tively and had less depression than children in the control group. This study demonstrates the importance of teaching children the skills of learned optimism before they reach puberty, but late enough in childhood for them to un- derstand the concepts. The study of optimism in children is fairly new, and many areas have yet to be researched. Results thus far seem to indicate that optimism can be taught, and learned optimism can be helpful in alleviating and even preventing some of the problems of childhood and adolescence. Optimism may be a very valuable tool that chil- dren can use to negotiate the challenges and ad- versity they are sure to face. Hope Definition and Concept Snyder and his colleagues have defined hope as a cognitive set involving an individual’s beliefs in his or her capability to produce workable routes to goals (waypower or pathways) and be- liefs in his or her own ability to initiate and sustain movement toward those goals (will- power or agency; Snyder, 1994; Snyder et al., 1991; Snyder, Hoza, et al., 1997). With this def- inition they have suggested that hope is an important construct in understanding how chil- dren deal with stressors in their lives, avoid be- coming mired down in problem behaviors, and use past experiences to develop strategies for working toward goals in an adaptive, effective manner. Hope is not correlated with intelligence, and Snyder, Hoza, et al. (1997) have proposed that most children have the intellectual capacity to use hopeful, goal-directed thinking. Children’s hope does appear to moderately predict cogni- tive and school-related achievement. Boys and girls have similar levels of hope. Children tend to be biased somewhat positively in their per- ceptions of the future, although it has been ar- gued that this is typical and rather adaptive (Snyder, Hoza, et al., 1997). This bias may be appropriate to help children develop and sustain positive outcome thoughts even if they are re- alistically untenable, because it appears that high-hope children do this as they successfully deal with stressful events in childhood. The re- search thus far indicates that, for most children, hope is relatively high, and that even children with comparatively low hope rarely indicate that they have no hope, and they tend to have hope in at least some of their thoughts (Snyder, McDermott, Cook, & Rapoff, 1997). Measures of children’s hope correlate positively with self- reported competency, and children with higher levels of hope report feeling more positively about themselves and less depressed than chil- dren with lower levels of hope. Snyder, Feld- man, Taylor, Schroeder, and Adams (2000) present some experimental evidence to support the idea that self-esteem results from the de- velopment of hope (through identification of goals and pathways). Measurement A measure of children’s hope, the Children’s Hope Scale (CHS), was developed by Snyder, Hoza, et al. (1997). The guiding assumption be- hind the development of the CHS and subse- quent versions of the scale (Snyder, Hoza, et al., 1997) was that the acquisition and usage of goal-directed thinking are critical for effective functioning in children and adolescents. Therefore, the purpose of the measure is to identify children who need nurturance and ed- ucation in order to improve their hopeful think- ing, especially during times of illness and stress (Snyder, McDermott, et al., 1997). The scale also identifies children who exhibit hope at high levels and who can serve as models for other children. Several versions of the CHS have been designed for different age-groups and for dif- ferent purposes. These versions include the Young Children’s Hope Scale (YCHS) Story CHAPTER 48. POSITIVE PSYCHOLOGY FOR CHILDREN 667 Form (aged 5–8 years); the Young Children’s Hope Scale (YCHS) Self-Report Form (aged 5– 9 years); the Young Children’s Hope Scale (YCHS) Observer Rating Form (for teachers, parents, and other adults), the Children’s Hope Scale (CHS) Self-Report Form (aged 9–16 years); and the Children’s Hope Scale (CHS) Observer Rating Form. Adolescents aged 16 and over can complete the Trait Hope Scale or the State Hope Scale, which have been designed for adults and also come with observer rating forms. Data collected during the development of the original Children’s Hope Scale indicate that the CHS demonstrates high test-retest reliability for intervals up to 1 month (Snyder, Hoza, et al., 1997). Research with the hope scales for children has shown that the agency (willpower) and pathways (waypower) subscales tend to cor- relate .50 to .70. Snyder, McDermott, et al. (1997) have labeled four different patterns of scores that tend to describe children’s hope based on the combination of their agency and pathways subscores: small hope (low agency and low pathways), half hope (one low and one high), and high or large hope (high agency and high pathways). It has been suggested that in- terventions may be tailored to address either low agency or low pathways, or both, but re- search has not addressed this possibility (Sny- der, McDermott, et al., 1997). Increasingly more research has explored hope in children. In particular, hope has been intro- duced as a useful concept to examine in pediatric populations, because children who are seriously ill or injured are often required to cope with or adjust to difficult conditions. In this section, we will examine the handful of studies that have investigated hope in children. In the first study, Lewis and Kliewer (1996) investigated the role that coping strategies play in the relationship between hope and adjust- ment in a group of children with sickle-cell dis- ease (SCD). Results revealed that hope was neg- atively related to anxiety, but that coping strategies moderated this relationship. Specifi- cally, hope was negatively related to anxiety when active support and distraction coping strategies were high. In other words, children with SCD who had high levels of hope and who reported using primarily active, support, and distraction coping strategies reported less anxi- ety. Hope did not appear to be associated with a reduction in anxiety by affecting coping ef- forts. Hope and coping were related to anxiety but did not make unique contributions to func- tional adjustment or depression once control variables were considered. The authors con- cluded that knowing both a child’s level of hope and the types of coping behaviors he or she is using may be important for understanding var- iations in psychological adjustment, especially when talking about a disorder like SCD, where stress and anxiety can exacerbate physical con- ditions. In the second study, Barnum, Snyder, Rapoff, Mani, and Thompson (1998) hypothesized that high-hope thinking may serve a protective function, allowing children to function effec- tively in spite of obstacles and challenges in their lives. They examined predictors of adjust- ment in adolescents who suffered burns as chil- dren and their matched controls. Variables that were selected as possible predictors of adjust- ment included social support, family environ- ment, burn characteristics, demographics, and hope. There were few differences between the burn survivors and the comparison group. For both groups, hope was the only significant pre- dictor of externalizing behavior problem scores: Higher hope scores predicted lower externaliz- ing behavior scores. In addition, social support and hope both significantly contributed to the prediction of global self-worth. Barnum et al. suggested that adolescents who report higher levels of hope may think in ways that generate positive solutions, and they may feel more ca- pable of enacting a variety of behaviors to solve problems, possibly reducing the need to act out in problematic ways. In a third study using the CHS, Hinton- Nelson, Roberts, and Snyder (1996) gathered information from junior high students attend- ing a school in close proximity to a high crime area in order to explore the relationship be- tween stressful life experiences, hope, and per- ceived vulnerability. In addition to measuring the children’s hope, they also measured the children’s exposure to violence and their per- ceptions of their vulnerability to victimization. Hinton-Nelson et al. hypothesized that children who had been exposed to violence would have lower levels of hope, but this was not the case. The children in this study reported levels of hope similar to that of other groups. Adoles- cents who had witnessed violence around them but had less personal or direct experience with violence reported the highest levels of hope, and 668 PART IX. SPECIAL POPULATIONS AND SETTINGS adolescents with higher hope perceived that they would be less likely to die a violent death. Adolescents with direct exposure to violence tended to predict violent deaths for themselves. The authors concluded that, while these young people acknowledged the violence surrounding them, they were able to sustain high hope as long as they did not experience violence di- rectly. Intervention A few preliminary projects are being reported in which an intervention has been designed to influence children’s hope. Snyder, McDermott, et al. (1997) proposed that hopeful stories are important for constructing and maintaining a sense of hope in children. They viewed hopeful stories as reflections of past experiences and ar- gued that these stories are used to guide future action. McDermott et al. (1996; and described in McDermott & Hastings, 2000) discussed a pro- gram in which schoolchildren (grades 1–6) were read stories of high-hope children, and class- room discussions addressed how these children might incorporate hope into their own lives. Modest positive changes were found on mea- sures of hope. These authors noted that a more comprehensive inclusion of teaching hope in the classroom might have greater effect. Lopez (2000) conducted another pilot project in a jun- ior high school in which hopeful stories (e.g., from a Harry Potter book) were read. Children were engaged in structured exercises, goal- oriented discussions, and the assignment of a “Hope Buddy” to discuss goals, pathways to achieve goals, and ways to navigate around bar- riers. Future research needs to examine the use- fulness of hope-filled curriculum as an inter- vention technique. Other projects have examined whether psy- chosocial interventions are associated with chil- dren’s hope (but where hope was not the prime target of the intervention). McNeal (1998) con- ducted a study of children and adolescents’ hope before and after they had been in psychological treatment in a residential setting over 6 months. He found that significantly higher levels of hope were developed over that period. In an- other study of hope with children in an inter- vention program, Brown and Roberts (2000) as- sessed hope in children who were participants in a summer day camp after being identified as being at risk for a number of psychosocial prob- lems. In the 6-week camp, the children were given intensive training in dance and perform- ing arts. They also participated in group ses- sions on a variety of psychosocial issues related to their life experiences. During the day camp, the participants wrote essays answering ques- tions similar to those proposed by Snyder, McDermott et al. (1997). The results during the camp and afterward indicated that hope scores increased significantly as a result of the 6-week experience. Mean hope scores remained elevated and stable at a 4-month follow-up. The study could not isolate what contributed to the hope changes, so the comprehensive camp experience as a whole may be viewed as an intervention. These types of intervention can indicate the vi- ability of hope as a dependent measure indicat- ing change as a result. Most important, these studies into children’s hope demonstrate that hope in children is an essential element of de- velopment. Quality of Life Definition and Concept The concept of quality of life (QOL) takes a multidimensional view of well-being and in- cludes physical, mental, spiritual, and social as- pects (Institute for the Future, 2000). However, QOL has not been well defined or consistently utilized in the literature. Other terms, such as psychological well-being or adjustment are also used to represent constructs similar to QOL. Walker and Rosser (1988) defined QOL as “a concept encompassing a broad range of physical and psychological characteristics and limitations which describes an individual’s ability to func- tion and derive satisfaction from doing so” (p. xv). One QOL measure for pediatric cancer patients includes five domains: disease and treatment-related symptoms, physical function- ing, social functioning, cognitive functioning, and psychological functioning (Varni, Seid, & Rode, 1999). In addition to exploring QOL as a general concept, research has examined health-related quality of life (e.g., determination of whether new and invasive treatments to increase chances of survival are worthwhile given the deleterious nature of the treatment side effects). Health- related QOL reflects an individual’s personal perceptions of his or her own well-being. For example, a child with asthma may successfully pass a pulmonary function test but may have CHAPTER 48. POSITIVE PSYCHOLOGY FOR CHILDREN 669 fears of an attack and thus limit the physical activities he or she is willing to try. Those in- terested in the delegation of limited health re- sources also have recognized the utility of mea- suring health-related QOL. Measuring QOL in the medical setting may assist health profes- sionals in demonstrating to third-party payers the effectiveness of particular interventions. In addition to measuring QOL in health sit- uations, QOL measures are used to assess im- pact of health-related diseases and procedures on one’s daily life. However, one of the most frequently noted concerns is that the various QOL measures lack theoretical foundations. Much of the philosophy behind the measure- ment of health-related QOL has been based on the notion that the medical treatment itself is the primary determinant of a patient’s QOL. Varni (1983) suggested that this biomedical model does not encompass all aspects of a pe- diatric patient’s life or situation that might af- fect his or her perceptions of QOL. Varni pro- posed that, in addition to the traditional biomedical model, a biobehavioral conceptuali- zation should guide assessment. In this model, a patient’s problem-solving skills and ongoing level of symptom control are important. Kaplan, Sallis, and Patterson (1993) proposed a biopsy- chosocial model that emphasizes the important roles of social, psychological, and biological fac- tors in the conceptualization of health-related QOL. To date, conceptualization and measure- ment of health-related QOL in children has lagged behind that of adults (Spieth & Harris, 1996). Measurement QOL measures were developed for adults, so many of the measures cover domains not ap- plicable to children (e.g., economic indepen- dence, infertility) or base the psychometrics on adult responses. Thus, there is little information regarding the validity or reliability of these measures for use with children. When assessing a child’s QOL, age and development should be considered. In addition, there is a lack of con- sensus in the literature regarding who is the best informant of a child’s health-related QOL. Early measures did not take into account a child’s perceptions, for example. Instead, par- ents, teachers, nurses, and doctors provided sub- jective information to define children’s QOL. While some studies have suggested that proxy informants are similar to a child’s own percep- tions of his or her QOL, the majority of the research provides limited evidence for concor- dance between respondents (Vogels et al., 1998). Additionally, considerable difference in ob- server ratings provided by parents and teachers and the children’s own self-ratings of health at- titudes and behaviors has been reported (Pantell & Lewis, 1987). Using parents to rate QOL is a widely imple- mented strategy in the literature, yet parents may not report all important aspects of their children’s well-being. For example, parents of adolescents might underestimate the important role of peers. Health personnel also may serve as reporters for a child’s QOL. One advantage of hospital staff is that these individuals can use other patients as points of reference. However, they may have limited knowledge regarding the child’s functioning in other arenas of life, such as at home, in school, or with peers. In addition, they may overemphasize the importance of pos- itive health outcomes versus social, psycholog- ical, or spiritual outcomes. Guyatt and colleagues (1997) suggested that information should be obtained regarding per- ceived QOL from the children themselves. Al- though age-appropriate modifications are nec- essary, self-report QOL information can be reliably obtained from children as young as 7 (Feeny, Juniper, Ferry, Griffith, & Guyatt, 1998). Guyatt et al. noted that younger children have difficulty recalling events that occurred more than a week earlier. In addition, they found that the feeling thermometer, a measure often used to assess children’s QOL, seemed more difficult for children to understand than interview-administered questionnaires. They suggested that feeling thermometers should only be used with children at a reading level of age 8 or grade 3. One frequently used measure assesses both child and parent perceptions of health-related QOL. The Pediatric Cancer Quality of Life In- ventory (PCQL) contains two parallel forms de- signed to define health-related QOL in terms of the impact of the disease and treatment on the child’s physical, social, psychological, and cog- nitive functioning and disease or treatment- related symptoms as perceived by parent and child patient (Varni et al., 1998). In addition to issues of who is the best informant, a clinician must decide between general and disease- specific QOL measures. General measures of QOL can be used in many other instances as well, such as for children with low-incidence 670 PART IX. SPECIAL POPULATIONS AND SETTINGS childhood diseases. Additionally, these general measures allow for cross-condition compari- sons. These measures include the Child Health and Illness Profile—Adolescent Edition (Star- field et al., 1995); Child Health Questionnaire (Landgraf, Abetz, & Ware, 1996); Functional Status II-R (Stein & Jessop, 1990); and Play Performance Scale for Children (Mulhern, Fair- cough, Friedman, & Leigh, 1990). Disease-specific measures of QOL may be more sensitive in determining the differential effects of treatments within one illness domain. Consequently, different QOL measures have been developed for use with various childhood conditions including pediatric cancer (Varni et al., 1998), diabetes (Diabetes Control and Com- plications Trial Research Group, 1988), asthma (Mishoe et al., 1998; Townsend et al., 1991), and children born with limb deficiencies (Pruitt, Seid, Varni, & Setoguchi, 1999). These mea- sures demonstrate some utility in detecting changes in patients whose health status has changed due to fluctuations of their disease or as a result of treatment. In the case of children’s asthma, a multidisciplinary team assesses QOL in the domains of symptomatology, activity limitations, and emotional functioning (Town- send et al., 1991). The QOL measure for dia- betes assesses disease impact as well as school life and relationships with peers (Ingersoll & Marrero, 1991). Most of the better measures ap- pear to use this multidimensional approach to assess not only physical symptoms but also health status, psychological and adaptive func- tioning, and family functioning. Interventions One purpose of studies examining QOL is to add clinical relevance to the results of outcome studies following medical or psychological in- terventions. Drotar and colleagues (1998) sug- gested that the use of health-related QOL mea- sures could aid in the identification of children with chronic illness who may need additional psychological assessment and intervention. The use of these measures early in the initial iden- tification of an illness may help improve par- ents’ ability to report information regarding their child’s mental and physical health earlier and more thoroughly. For example, for children diagnosed with cancer, Boggs and Durning (1998) reported using the Pediatric Oncology Quality of Life Scale as a screening measure to determine which children would be most likely to benefit from psychological services. Another purpose of QOL studies is to identify the chil- dren who are experiencing health problems who are less likely to adhere to a treatment protocol (Drotar et al., 1998). For some children, the side effects of a treatment regimen may be seen as very aversive and may affect QOL. Information collected through the use of QOL measures may lead to additional support or intervention for the child. Psychosocial interventions de- signed to improve the adjustment and function- ing of children undergoing medical treatment may also impact reported QOL. Related Concepts of Positive Psychology There are several psychological concepts related to positive psychology in children in addition to the concepts reviewed here. The movement in pediatric psychology away from an exclusive fo- cus on children’s deficits or pathology to a more affirming and strength-building approach ex- emplifies a positive psychology orientation (whether acknowledged or not). Clinicians and researchers are increasingly focused on enhanc- ing and facilitating children’s development whatever the setting or circumstances. In the psychosocial care of children with cancer, Noll and Kazak (1997) emphasized that while diag- nosis and treatment “can be overwhelming, they can be managed in positive ways that en- courage families to continue to function in the best possible fashion and facilitate personal growth” (p. 263). They recommended that in order to promote positive adaptations, certain psychologically directed actions can be taken by professionals, parents, and children themselves. Other aspects related to enhancing the psycho- social growth of children in medical settings in- volve making changes in the hospital architec- ture that welcome and support children and families, training staff to recognize and facilitate children’s needs and development at all times, and following medical procedures that allow children appropriate input and control regarding what is done to them (Johnson, Jeppson, & Red- burn, 1992). Similarly, schools can be envisioned as set- tings where children can experience empower- ment and enhanced development rather than places where the focus is on stresses and chal- lenges (Donnelly, 1997; Schorr, 1997). For ex- ample, Spivack and Shure have developed and CHAPTER 48. POSITIVE PSYCHOLOGY FOR CHILDREN 671 tested a model of teaching children and teachers to use interpersonal cognitive problem-solving skills in interactions (Shure, 1996). These skills enhance positive growth and development with- out focusing on any of a child’s deficiencies. Social support is also viewed as a potential element of positive psychology for children fac- ing the challenges of stressful events as well as coping and adjusting in everyday living. Quitt- ner (1992) noted that the accepted definition of social support includes several aspects such as “provision of direct assistance, information, emotional concern, and affirmation” (p. 87). So- cial support has not been fully conceptualized within a positive psychology framework but re- lates to it very well. Faith is another aspect of positive psychology that has not been given significant attention. As noted by health researchers, “Spiritual factors promote good health and contribute to the state of wellness that characterizes health” (In- stitute for the Future, 2000, p. 190). Additional consideration of faith and religion in the lives of children and adolescents may be an important aspect of positive psychology research. Developmental Perspective Because positive psychology is a newly devel- oping field of research and application, there re- main a large number of issues for children and adolescents that deserve greater attention. Al- though it is encouraging to have any research, the relative lack of empirical studies to review in this chapter indicates that there is much to be done. We strongly urge that positive psy- chology theorists and researchers consider a de- velopmental perspective rather than focusing only on adults (and children as “smaller hu- mans”) or give minimal attention to develop- ment by considering childhood only as a period preceding adulthood. Maddux et al. (1986) sug- gested that two elements are important to a de- velopmental approach. The first is a future ori- entation in which any effort at intervention or change is considered important because of its relationship to improving future health status (i.e., in adulthood). The second, and perhaps most neglected, element in a developmental per- spective requires that “each period of life receive attention to the particular problems evident in that period” (p. 25). Thus, there should be a fo- cus on the health status of children while they are children rather than recognizing children’s importance only because the children will be- come adults in the future. We think both ele- ments are important in the positive psychology movement, but we want to emphasize the latter point. The uniqueness of children’s develop- ment needs to be recognized in all theories, measurements, and application of positive psy- chology concepts. Prevention and Promotion Interlinked with the developmental perspective is a view that childhood may be the optimal time to promote healthy attitudes, behavior, ad- justment, and prevention of problems (Roberts & Peterson, 1984). Roberts (1991) stated, “Pre- vention is basically taking action to avoid de- velopment of a problem and/or identify prob- lems early enough in their development to minimize potential negative outcomes. Health promotion refers to increasing individuals’ abil- ities to adopt health-enhancing life styles” (p. 95). Prevention and promotion efforts in childhood attempt to improve the quality of life for the child during childhood and for that child’s later adulthood. As noted by Peterson and Roberts (1986), prevention efforts often take a developmental perspective and focus on competency enhancement that “is likely to be most effective when applied during the time of greatest competency acquisition, which is dur- ing childhood for many skills such as language, social abilities, or self-efficacy beliefs” (p. 623). Such enhancement of positive psychology thinking, such as encouraging hope, would sim- ilarly be most effective at these early stages of human development. Future Research Directions Studies of the positive psychology topics of hope and optimism, as examples, have typically util- ized cross-sectional designs. Longitudinal mod- els would elucidate the sequence of development and what influences change over time. Interven- tions and evaluations of programs to promote hope or optimism are also prime areas for fur- ther work. Interventions may enhance the posi- tive frames for all children or for those with special stresses. In the latter case, applications may be necessary with children who have a chronic illness or with those experiencing psy- chological problems or disruptive life events, [...]... Williamson, 199 9; Williamson, 199 8, 2000; Williamson & Schulz, 199 2, 199 5; Williamson et al., 199 8) In their acclaimed book, Successful Aging, Rowe and Kahn ( 199 8) propose that there are three components of successful aging: (a) avoiding disease, (b) engagement with life, and (c) maintaining high cognitive and physical function They further propose that each of these factors is “to some extent independent of. .. unipolar depression Journal of Personality and Social Psychology, 46, 877– 891 Binstock, R H ( 199 9) Challenges to United States policies on aging in the new millennium Hallym International Journal of Aging, 1, 3–13 Birren, J E., & Birren, B A ( 199 0) The concepts, models, and history in the psychology of aging In J E Birren & K W Schaie (Eds.), Handbook of the psychology of aging (3rd ed., pp 3–20) San... change in activities of daily living: A longitudinal study of the oldest old in Sweden Journal of Gerontology, 52, 294 –302 Foley, K M ( 198 5) The treatment of cancer pain New England Journal of Medicine, 313, 84 95 Gatz, M., & Smyer, M A ( 199 2) The mental health system and older adults in the 199 0s American Psychologist, 47, 741–751 Hendricks, J., Hatch, L R., & Cutler, S J ( 199 9) Entitlements, social... Journal of Consulting and Clinical Psychology, 49, 517–525 Manton, K G., Stallard, E., & Corder, L ( 199 5) Changes in morbidity and chronic disability in the U.S elderly population: Evidence from the 198 2, 198 4, and 198 9 National Long Term Care Surveys Journal of Gerontology, 50, 194 –204 CHAPTER 49 AGING WELL Mathew, R., Weinman, M., & Mirabi, M ( 198 1) Physical symptoms of depression British Journal of. .. Williams, H A ( 199 3) A comparison of social support and social networks of black parents and white parents with chronically ill children Social Science Medicine, 37, 15 09 1520 Williamson, G M ( 199 5) Restriction of normal activities among older adult amputees: The role of public self-consciousness Journal of Clinical Geropsychology, 1, 2 29 242 Williamson, G M ( 199 8) The central role of restricted normal... 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Elliott, J L ( 199 8) Negotiating the reality of visual impairment: Hope, coping, and functional ability Journal of Clinical Psychology in Medical Settings, 5, 173–185 *Keany, C M.-H., & Glueckauf, R L ( 199 3) Disability and value change: An overview and reanalysis of acceptance of loss theory Rehabilitation Psychology, 38, 199 –210 Kemp, B J., & Vash, C L ( 197 1) Productivity after injury in a sample of spinal... Journal of Psychiatry, 1 39, 293 – 296 McCrae, R R ( 198 9) Age differences and changes in the use of coping mechanisms Journal of Gerontology, 44, 161–164 McCrae, R R., & Costa, P T., Jr ( 198 6) Personality, coping, and coping effectiveness in an adult sample Journal of Personality, 54, 385– 405 McGinnis, J M., & Foege, W H ( 199 3) Actual causes of death in the United States Journal of the American Medical... adjustment of children with chronic health conditions: What have we learned? What do we need to know? Journal of Pediatric Psychology, 22, 1 49 165 *Dunn, D S ( 199 4) Positive meaning and illusions following disability: Reality negotiation, normative interpretation, and value change Journal of Social Behavior and Personality, 9, 123–138 Dunn, D S ( 199 6) Well-being following amputation: Salutary effects of positive . & Williamson, 199 9; Wil- liamson, 199 8, 2000; Williamson & Schulz, 199 2, 199 5; Williamson et al., 199 8). In their acclaimed book, Successful Aging, Rowe and Kahn ( 199 8) propose that there. in terms of predicting those who will restrict their activities in the wake of stressful events (Wal- ters & Williamson, 199 9; Williamson & Schulz, 199 5; Williamson et al., 199 8). In other. Rubin- stein, H., & Stahl, K. J. ( 199 7). The develop- ment and validation of the Children’s Hope Scale. Journal of Pediatric Psychology, 22, 399 – 421. CHAPTER 48. POSITIVE PSYCHOLOGY FOR CHILDREN 675 Snyder,