Acknowledging Different Perspectives

The different perspectives of the adolescent and their parent(s)/caregiver(s) need to be considered by health professionals involved in the triadic consultations of child-centered health services. Within the generic literature, the most comprehensive study of parents as proxies of adolescents has been conducted by Waters et al. who examined the relationship between 2096 Australian adolescents (aged 12-18 years) and their parents using the Childhood Health Questionnaire (12). This study demonstrated strong overall agreement for physical health. However, adolescents were less optimistic than their parents with respect to their mental health, well-being, general health, and impact of health on family activities. Moreover, these discrepancies increased when the adolescent had an illness.

Within the "chronic illness" literature, only a few studies of child-parent agreement pertain to childhood onset rheumatic diseases (13-20). These have found mixed (and often contradictory) findings including reports of no agreement (17) or poor agreement for pain (14); fair to good agreement for general health (14); fair to excellent agreement for functional disability (14,15,17) and fair agreement for health related quality of life (14,16,19). As such, they generally follow the pattern found in the wider literature, which suggests that parents and children tend to agree about easily observable behaviors compared with less overt phenomena (12). In a study which specifically addressed agreement between adolescents (with juvenile idiopathic arthritis, JIA) and their parents, approximately half did not show agreement in ratings for pain, general health perception, functional ability, and health-related quality-of-life (21). Agreement was associated with better disease-related outcome variables, but not significantly influenced by demographic factors.

Agreement between adolescents and parents was dependent on the level of disease outcome and the health domain under scrutiny and was less for those with moderate disease outcomes (as compared to mild or severe) and for less visible phenomena, e.g., pain, global well-being. These findings are consistent with the considerable changes in family dynamics which occur during adolescence, with young people becoming increasing emotionally autonomous from parents and wanting to spend more time away from home (22,23).

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