Recent advances in physical treatments have changed the implications of receiving a diagnosis of chronic physical illness in childhood. Individuals with disorders such as diabetes, cystic fibrosis, renal failure, and cancer, who may previously have had a limited life expectancy are now surviving into adulthood.

During childhood, chronic physical illness confers an increased risk of emotional and behavioural disorders,1 although the majority of children and families successfully adapt to the diagnosis. The increased likelihood of psychiatric disorder during childhood does not seem to be specific to the diagnostic category beyond those involving brain dysfunction,2 ,3 but reflects the difficulties inherent in living with a chronic illness.

Children at greater risk are those with more severe physical disorder,4 and perhaps those with illnesses carrying a greater degree of life threat.5 The risk also varies with the stage of the illness. Adjustment disorders (emotional and/or behavioural symptoms clearly linked in onset to a stressful event and time limited in manifestation) are probably the most frequent psychiatric sequelae and are particularly common at the time of initial diagnosis and after changes in treatment have occurred. For example, psychological problems were reported in almost 60% of children at the time of starting dialysis. One year later, after stabilisation of their physical condition, the prevalence of disturbance was reduced to 21%.6 Similarly, 36% of 8–13 year olds with newly diagnosed insulin dependent diabetes mellitus developed an adjustment disorder (most commonly dominated by depressive symptoms) within the first three months of diagnosis; 50% had recovered within two months.7

While interest is frequently focused on thephysical outcome of this group of children as they progress through adolescence into adult life, much less attention has been given to psychosocialoutcome. How are they functioning emotionally and socially after their discharge …