Original studyFrontiers in Psychology, 2026Read the paper →
Living with a long-term physical illness can shrink a child’s world. Pain, hospital stays, and limits on play or school leave less room for ordinary childhood, and the emotional cost is easy to miss when the medical chart takes centre stage. A new review of screening scores suggests that young people with chronic physical health conditions show clearly higher levels of mood and body-related distress than peers without those conditions.
Researchers at Marburg University pooled 115 studies covering 12,958 children and adolescents with chronic physical health conditions and 24,638 comparison children. The study appears in Frontiers in Psychology. All of the included papers used the six DSM-oriented scales from the Achenbach System of Empirically Based Assessment, a widely used set of checklists filled in by parents, teachers, or the young people themselves.
The average age across samples was about 10 years, and just under half the children were girls. Epilepsy, atopic conditions such as eczema, heart disease, cancer, HIV, obesity, traumatic brain injury, and chronic pain were among the most commonly studied conditions. Most scores came from parent reports on the Child Behavior Checklist.
The six scales map checklist items onto familiar diagnostic themes. Affective problems cover low mood and related complaints. Anxiety problems track worry and fear. Somatic problems cover physical complaints such as aches and nausea. The remaining scales cover attention deficit hyperactivity problems, oppositional defiant problems, and conduct problems.
Scores were higher on every scale among children with chronic illness. The largest gaps were for somatic problems and affective problems, with moderate effect sizes of about 0.66 and 0.61 standard deviation units. Anxiety problems sat at a moderate 0.50. Elevations for attention, oppositional, and conduct problems were smaller, though still statistically clear. Between about 9% and 14% of children with chronic illness scored in the clinical range on these scales, compared with roughly 2% in the general population.
Gaps were larger when parents rated the child than when adolescents rated themselves, especially for mood and anxiety. Conditions that directly involve the nervous system showed stronger elevations on most scales. Shorter illness duration and older age were also linked to larger gaps on several measures. Visibility of the condition and the child’s gender made little difference.
The authors stress that a high screening score is not the same as a clinical diagnosis. Somatic scores in particular can overlap with symptoms of the illness or its treatment. The evidence base for these DSM-oriented scales is still much smaller than for the older empirically derived Achenbach scales, and few of the included studies used probability samples or carefully matched comparison groups.
Earlier work with related checklists has already shown moderate rises in internalising problems and smaller rises in externalising problems among children with chronic physical illness. The new synthesis points in the same direction and argues for routine psychosocial screening in paediatric care, with particular attention to children whose conditions involve the brain or nervous system.
