Hemophiliac Adolescents - Spencer and Behar

U Mattsson and Gross have discussed the “coping mechanisms” which are used in successful adjustment to hemophilia in boys and young men2. In their study of 35 hemophiliac boys and young adults, 27 were considered to have adapted well at school, in the home, and with their peers, with few limitations except for those realistically imposed by the disease. In those instances of failure, difficulties seem to fall into the category of behavioral disturbance with either excessive risk-taking behavior or inappropriate passivity. However, an investigation of the social and psychological adjustment of 26 hemophiliacs at this center3 revealed a high incidence (46%) of gross sexual and marital maladjustment, in spite of a low frequency (23%) of frank psychiatric problems. The ten adolescent patients in this group were studied more closely to identify precursors of the sexual and marital maladaptations, and a variety of problems were found which make us consider the adaptation of virtually all these adolescents to be sub-optimal. Although the overall educational achievement was impressively high in the younger group, several instances were found of inhibition of school performance going beyond the interference of bleeding episodes. In some cases adjustment at school, in the family, and with peers was superficially good, but closer examination revealed areas of considerable conflict and impairment. These difficulties can be loosely categorized into the following areas: 1. Problems in vocational and scholastic achievement, involving the child’s refusal or reluctance to attend school, learning difficulties, or a seeming lack of goals and ambitions.