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      Hospitalized Children: Anxiety, Coping Strategies, and Pretend Play

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          Abstract

          The aim of this paper was to assess strengths and fragilities in children aged 6 to 10 who suffered one or more hospitalizations. State and trait anxiety, coping abilities, and cognitive and affective functioning through play were assessed using a triangulation approach. Fifty hospitalized children aged 6–10 were compared to 50 non-hospitalized children, and children at first admission were compared with children with more than one hospitalization experience. The State-Trait Anxiety Scales Inventory for Children was administered for assessing trait and state anxiety, and the Children's Coping Strategies Checklist (Revision 1) was administered to assess coping dimensions. The Affect in Play Scale - Preschool - Brief (Extended version) was used to assess cognitive and affective dimensions of play. No significant differences were found for trait anxiety between hospitalized vs. non-hospitalized children. Instead, as expected, state anxiety was significantly higher in hospitalized childen than in the non-hospitalized children. Hospitalized children reported higher scores than non-hospitalized children in support-seeking strategies. As for pretend play, hospitalized children showed significantly higher cognitive scores than non-hospitalized children. However, hospitalized children appeared significantly more restricted in their affect expressions. No significant differences were found for play and anxiety scores between children admitted for the first time in the hospital ward and children with more than one admission. However, children at first admission scored higher in coping and positive cognitive restructuring and in avoidance-coping strategies than children with more than one admission. The initial assessment of the interplay of key variables such as anxiety, coping and play can inform healthcare professionals by serving as a guide in order to determine a child's risk for negative psychological outcomes due to hospitalization, to plan appropriate interventions and to provide substantial assistance to hospitalized children in the future.

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          Most cited references52

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          Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research.

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            Searching for the structure of coping: a review and critique of category systems for classifying ways of coping.

            From analyzing 100 assessments of coping, the authors critiqued strategies and identified best practices for constructing category systems. From current systems, a list of 400 ways of coping was compiled. For constructing lower order categories, the authors concluded that confirmatory factor analysis should replace the 2 most common strategies (exploratory factor analysis and rational sorting). For higher order categories, they recommend that the 3 most common distinctions (problem- vs. emotion-focused, approach vs. avoidance, and cognitive vs. behavioral) no longer be used. Instead, the authors recommend hierarchical systems of action types (e.g., proximity seeking, accommodation). From analysis of 6 such systems, 13 potential core families of coping were identified. Future steps involve deciding how to organize these families, using their functional homogeneity and distinctiveness, and especially their links to adaptive processes.
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              Responses to stress in adolescence: measurement of coping and involuntary stress responses.

              The development of a measure of coping and involuntary stress responses in adolescence is described. The Responses to Stress Questionnaire (RSQ) reflects a conceptual model that includes volitional coping efforts and involuntary responses to specific stressful events or specified domains of stress. The psychometric characteristics of the RSQ were examined across 4 domains of stress in 3 samples of adolescents and parent reports obtained in 2 samples. The factor structure of the RSQ was tested and replicated with an adequate degree of fit using confirmatory factor analysis across 3 stressors in 2 samples. Internal consistency and retest reliability for the 5 factors were adequate to excellent. Concurrent validity was established through correlations with another measure of coping, heart rate reactivity, and correlations of self- and parent-reports. Significant correlations with both adolescents' and parents' reports of internalizing and externalizing symptoms were consistent with hypotheses.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                06 September 2019
                2019
                : 7
                : 250
                Affiliations
                [1] 1Dipartimento di Filosofia, Scienze Sociali, Umane e della Formazione, Università di Perugia , Perugia, Italy
                [2] 2DPSS – Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova , Padova, Italy
                Author notes

                Edited by: Marie Leiner, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, United States

                Reviewed by: Prashanth GP, Oman Medical College, Oman; Bert Johansson, Texas Tech University Health Sciences Center, United States

                *Correspondence: Daniela Di Riso daniela.diriso@ 123456unipd.it

                This article was submitted to Children and Health, a section of the journal Frontiers in Public Health

                Article
                10.3389/fpubh.2019.00250
                6743064
                31555632
                01acd457-981d-4740-95dd-d7bbea65f005
                Copyright © 2019 Delvecchio, Salcuni, Lis, Germani and Di Riso.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 February 2019
                : 20 August 2019
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 70, Pages: 8, Words: 6400
                Categories
                Public Health
                Original Research

                anxiety,coping,symbolic play,hospitalized child,assessment
                anxiety, coping, symbolic play, hospitalized child, assessment

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