This study examines the long-term adjustment of pediatric burn survivors as they undergo the transition from adolescence and burn induced dependency to the independence and autonomy of adulthood. Previous studies indicate that approximately 33% of pediatric burn survivors less than 18 years of age have more psychosocial problems than normal children, and these problems are not attributable to burn size or age of burn. However, once these children leave the home environment, little is known about their emotional lives. This is particularly true of those with large burns, since only recently have these children regularly survived. First, we hypothesize that individuals burned as children have increased difficulty with the transition from home to independent living. Second, we expect that for these individuals the psychosocial difficulties with the transition to adulthood increase with increasing burn size. To measure the success of transition to adulthood, the study completes a baseline assessment of 150 individuals ages 18 to 26, burn size 30% or greater, and at least 2 years post burn, who have been treated at the Shriners Burns Hospital as children. This assessment includes a physical (AMA disability milestones) handicaps determination, intelligence testing as well as interviews focusing on psychiatric disorder, psychosocial adjustment, living arrangement, and family relationships. The data will be analyzed against age, with special attention to gender, burn size and visibility, age of burn, physical handicaps, intelligence and initial family environment. From the baseline data a cohort will be identified for an intervention. The individuals ages 18 to 22 who are not well adjusted will be randomized into two groups: one will be a control and the other will receive a psychoeducational intervention consisting of social skills training and group therapy. Both groups will be reassessed a year later to determine the efficacy of such an intervention. Change within subjects and between groups will be examined through regression models, controlling initial status on the dependent measures and other appropriate background variables. The above studies should assist in planning long term care of pediatric burn survivors and in understanding the effects of such extreme trauma on the transition of adolescence into adulthood. In addition, the intervention may provide a model for improving the outcome of that transition.
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