Cindy Dell Clark's book, In Sickness and in Play: Children Coping with Chronic Illness will be published by the Rutgers University Press in 2003, as part of its series in Childhood Studies. The book reports on an ethnographic study of 5-to-8 year old children suffering from severe asthma or diabetes. In this study, children's own views of illness were given voice, through child-centered interviewing methods. Play and imagination emerged from the research as an important aspect of how children coped with illness.

As Clark described, coping with play and imagination (called "imaginal coping") has been a scant subject in past clinical and experimental research. Based on Clark's ethnographic investigation, it was clear that young illness sufferers used imagination to cope, in day-to-day life. First, children used toys, blankets, or even decorated bed sheets as transitional objects, objects which reassured them about their security and safety amidst illness. Adults were not always aware of the emotional value of transitional objects. A kindergartner recalled that when hospitalized at age three, nurses deprived her of her trusted stuffed tiger, which the nurses mistakenly felt was Intimidating rather than protective. In other cases, parents were sensitive, aware and supportive of children's use of toys as transitional objects, making sure that trusted toys were available.

Another form of imaginal coping concerned rituals practiced along with treatment, such as when administering medication by injection (in diabetes) or by a machine-nebulizer (in asthma). Such rituals included games, which were co-constructed between child and family members. One boy with diabetes sang the refrain from Handel's Hallelujah chorus upon receiving each insulin injection. Rituals were also co-constructed among young illness sufferers who attended summer camp together. At asthma camp, a group of kids playfully made "music" using as instruments the spacers meant to be attached to inhalers - as they waited in line for medications at camp.

Imaginal coping, as a theoretical construct, is defined as the use of imagination to transform and reframe the hardships of illness. Such coping is advantageous to chronically ill children, for whom selfhood does not flow harmoniously in line with the usual norms - due to exceptionalizing experiences such as dietary restrictions or frightening symptoms. Imaginal coping depends on the flexibility to remake meanings, as individuals manipulate cultural symbols and materials in social concert, whether in a family context or at summer camp.

In Clark's presentation, she suggested that imaginal coping may hold further promise as an intervention to promote adherence to treatment in asthma. Clark described a controlled experimental test being conducted in conjunction with Penn State Hershey Medical Center and Crozer Chester Medical Center, of whether popular fantasy characters (Spiderman or Tweety) might be incorporated into asthma treatment to enhance adherence to treatment.

Seminar Pictures First CCCS Regional Childhood Studies Seminar lecture was held on Thursday, Oct 24th, 2002 Dr. Jane Siegel (Criminal Justice) chatting with our guest speaker from Penn State, Dr. Cindy Dell Clark Looks like Drs. Stuart Charme and Bill Whitlow are engaged in a serious conversation Dr. Myra Bluebond-Langner Director, CCCS Center Staff, Amy DeCicco and Lori Mariano always working hard

• back to Center for Children and Childhood Studies Regional Seminar Schedule