The literature suggests that optimal adjustment to relatively uncontrollable stressors may require adjusting oneself to the stressors rather than trying to alter them. This possibility was explored, for low-controllability stressors (e.g., painful medical procedures) associated with leukemia. Children's reports of coping strategies and goals were classified as primary control coping (attempts to alter objective conditions), secondary control coping (attempts to adjust oneself to objective conditions), or relinquished control (no attempt to cope). Secondary control coping was positively associated with (a) general behavioral adjustment assessed by the Child Behavior Checklist and (b) illness-specific adjustment assessed by children's own distress ratings and by behavioral observations during painful procedures. All significant group differences showed better adjustment among secondary control children than among the primary or relinquished groups.

The recent burgeoning of theory and research on how children cope with painful medical stressors warrants close scrutiny. The authors examine the prominent typologies of coping and the research on child adjustment and outcomes stimulated by those typologies. They focus on what researchers know and need to know about moderators (characteristics of the child and the environment that influence coping and outcome) and mediators (mechanisms linking stress, coping, and adjustment). It is argued that important advances can be achieved through efforts to (a) conceptualize and study pain and coping within a multidisciplinary framework; (b) clearly distinguish among coping responses, goals, and outcomes; and (c) replace simplistic conceptualizations with transactional and goodness-of-fit models.

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