Studies on Resilience

Research on resilience usually focuses on social competence despite bad conditions. The latter are most often described as major negative life events. Apart from methodological limitations in assessing life events (60) it should be kept in mind, that there may also be a profound (cumulative or even exponential) interactive effect if more than one bad condition is present (58,57). Also, life stress not only results from major life events; the chronic influence of so-called "daily hassles" may represent bad, stressful conditions, too. Daily hassles are irritating, frustrating experiences that occur in everyday transactions with the environment. The idea that daily hassles can be stressors seems particularly important with respect to JIA since the presence of the disease often leads to lots of small, daily reminders of

Table 6 Key Elements of Resilience

Dispositional attributes of the child

Constitution (positive temperament, robust neurobiology) Sociability (responsiveness to others, pro-social attitude to others) Intelligence (academic achievement, planning and decision making) Communication skills (developed language)

Personal attributes (tolerance for negative affect, self-efficacy, self-esteem, internal locus of control) Family level

Atmosphere and support (parental warmth, cohesion and care, belief in the child, non-blaming) Income and status (material resourced) Community level

School experiences (supportive peers, positive teacher influence) Supportive communities (provisions and resources to assist, nonpunitive)

Source: Adapted from Ref. 58.

misery that may well be categorized as daily hassles and sources of stress. Surprisingly, most studies on stress in children and young people with JIA did not assess stressors specific to the lives of children with arthritis (61).

What are the "ingredients" of resilience? Garmezy's distinction is still valid which identifies three categories of resilience enabling factors: (1) dispositional attributes of the child, (2) family cohesion and warmth, (3) the availability and use of external support systems by parents and children [(62), according to (60)]. Olsson et al. (58) further differentiate the most influential processes and factors, all of which are empirically substantiated (Table 6).

Even though dispositional attributes of the child are certainly of great importance, it must be kept in mind that resilience is not an attribute born into the child (59). As Rutter noted, resilience is the concerted effect of a certain way of responding to external stressors (active coping instead of mere reacting), feelings of self-efficacy and of self-esteem (both of which are prerequisites of active coping), and a secure attachment to family members and significant others [(63), according to (64)].

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