Children with leukemia at different ages presented different social adaptation states, and the existing social adaptation problems were not completely the same. As children with leukemia grow older, various social adaptation problems may occur. Analyzing the social adaptation problems and their causes at various ages is of great significance for the targeted improvement of the current status of maladjustment of children with leukemia and the improvement of their level of social adaptation. The social adaptation problems of children with leukemia at different ages summarized in this study are shown in Fig 1.
Psychological maladaptation in children with leukemia aged 2 to 7 years
This study found that with the increase in hospitalization time and the number of hospitalizations, the level of social adaptation of children aged 2 to 7 years had an increasing tendency. Children with outgoing personality and good family support adapted better, but most children showed obvious psychological maladjustment in the initial stage of hospitalization, which was summarized as follows:
Fear was the adverse emotional reaction of a child after a long period of hospitalization and a series of operations required for diagnosis and treatment. It was also a manifestation of the child's psychological maladjustment. The child cried because he was afraid of injections and waist puncture, and his low coordination affected the treatment of the disease.
N1: "The child cried when she saw the medical staff."
N8: "The child was afraid of injections, and would cry. We worry that the child will shrink and become timid in the future."
N9: "The child was feared and was afraid of the injection at first. When hearing the injection, he started crying and was afraid of waist piercing and taking medicine. He didn't cooperate at the beginning. He was still a bit uncooperative after two months."
N11: "Child was afraid of injections. She was afraid when she arrived at the hospital and saw the nurse uniform."
(2) Excessive attachment
Early childhood is an important stage for the formation of the sense of security and optimism. During hospitalization, children had to experience changes in their living environment and were forced to undergo various treatments. They were prone to insecurities. In addition, with the caregivers’ love and compassion for the children, many children had strong attachment emotions, and more of them manifested separation anxiety. It was difficult for children to produce joyful emotions, which also affected learning and development in other fields.
N1: "The child was very dependent on me (his mother) and could not leave without me (his mother)."
N16: "After the child was sick, his attachment emotion was stronger and depended on us (parents) more."
N20: "She was very dependent on me (mother) after she was sick, I (mother) had always taken care of her."
Psychological maladaptation in children with leukemia aged 8 to 18 years
This study found that there were differences in the psychological adaptation problems faced by children with leukemia at different ages. As the children grow older, their cognitive level continues to improve, and their understanding of disease knowledge increases. Children aged 8 to 18 years had more psychological activities than children aged 2 to 7.Generally speaking, children with outgoing personality, wide-ranging hobbies and positive family education had a good social adjustment, however, some children aged 8 to 18 faced the following psychological adjustment problems:
(1) Impatience and irritability
The side effects of drugs and long-term hospitalization had changed the children's temperament, and they were prone to irritability and tantrums. In addition, adolescents are in a psychological transition period, and their independence and self-awareness are increasing. Some children have rebellious psychology and often conflict with caregivers, which would not only affect the development of the parent-child relationship, but also is not conducive to the recovery of children's diseases.
N5: " After I got sick, I got a bad temper. I became a little irritable and lost my temper with my mother."
N17: " After I got sick, I was very upset. If they (parents) talked too much, I would be very impatient and quarrel. Sometimes it was annoying after hearing them talk too much, and I wanted to give up."
Most children were afraid of bone puncture, waist puncture, chemotherapy, etc. These treatments brought them a series of discomfort. Before each operation, the children would feel nervous and anxious but with a good cooperation, which is significantly different from the fear of young children. In addition, with the improvement of children’s cognitive abilities, older children were not satisfied with their learning, interpersonal communication needs due to hospitalization, and they were more worried about the adverse effects of treatment and physical appearance Change.
N12: "The waist piercing was too painful and the bone piercing hurt more. I was afraid, but there was no other choices. I was worried that the indwelling needle could not be pierced so that I needed many times because my blood vessels were not good for piercing."
N17: "I was afraid of bone piercing and chemotherapy. I suffered from stomach pain during chemotherapy, but I cooperated with the doctor."
N7: "I also checked the information and learned about the disease. I was worried about recurrence. I could only take one step at a time. I had a bad interpersonal relationship in junior high school. I worried about changes in appearance so that people who were familiar with me would have strange eyes on me."
Behavioral maladaptation in children with leukemia aged 2 to 7 years
The age of 2 to 7 years is a critical period for the development of children's social behavior, which includes social communication and life ability. This study found that children aged 2 to 7 years with leukemia were prone to behavior changes due to the influence of their own diseases and surrounding environment during hospitalization, which hindered the positive development of their social behavior. Summarize their behavior maladjustment as follows:
(1) Decrease in independent behavior
The children had a decline in physical function due to the disease and treatment. Coupled with a strong psychological attachment, they gradually lost the existing self-care ability in behavior and reduced their independent behavior. The infant stage is a period of extremely rapid physical and functional development of children. The formation of the bad habit of over-dependence would affect the development of their initiative and independence.
N2: "The child couldn't take care of himself well. He was very dependent on me (his mother), and I had to feed him for meals."
N16: "The child was more dependent after being sick and he could take care of himself before."
(2) Dependence on electronic products
Children with leukemia between 2 and 7 years old were limited in their range of activities during the hospitalization. Communication between peers was reduced, and the frequency of using electronic products was higher. Many caregivers also used mobile phones as a placebo for children when they cry. The children relied on electronic products, and most of them liked watching cartoons or browsing Tik Tok on mobile phones.
N11: "The child prefer to spend time on mobile phone after she was sick, and she would cry if we didn't give it to her, so we (parents) usually gave it to her."
N16: "The child was very addicted to electronic products, and he would be angry if he was not allowed to play."
N20: " The child liked spending time on mobile phones after he was sick, and he often looked at his mobile phone in the ward."
Behavioral maladaptation in children with leukemia aged 8 to 18 years
Children with leukemia in their adolescence have a rapid development of intelligence and cognitive ability. Compared with their early childhood, they have more social needs and thirst for learning. Long-term and repeated hospitalization had caused the children to face many challenges of role conversion and environmental changes. Some children had insufficient self-regulation ability, and it was inevitable that bad behavior changes would occur. The summary was as follows:
(1) Learning was blocked
The experience of repeated hospitalization made the children with leukemia aged 8 to 18 years had to take time off or leave school, and be unable to go to school for a normal study life. Their study time was reduced and academic performance declined. What’s more, communication and interaction with teachers and classmates were also relatively reduced, for which the children felt distressed and worried about profound impact on the future study life.
N10: "After I got sick, I only worried about the decline in grades."
N11: "I couldn't go to school in hospital and I felt very uncomfortable."
N15: "I was worried about delaying my studies and repeating the grade. I was taking a leave of absence to be hospitalized."
N19: "For going to school, I wanted to hang out with my classmates. I also felt that illness had delayed a lot."
(2) Addicted to electronic products
During the hospitalization, due to environmental changes and limitations, the children with leukemia aged 8 to 18 years had been separated from their peers for a long time, and their hobbies and social needs could not be met. Mobile games became the main entertainment of the children. Long-term use of electronic products and indulging in mobile games had further reduced the interaction between the child and others, which is not conducive to the development of children's social skills, and also affects their return to normal learning and life.
N5: "Because I was hospitalized, I played more games, and I would be very upset if my rank dropped."
N13: "I can talk with you while playing games, I usually play games almost all day."
N17: " I liked playing games during my hospital stay as it was too boring."
N19: "I like playing games with friends, and I used to play games during hospitalization."