Developmental pathways in food allergy: A new theoretical framework

Background: To date, there is no model of psychosocial development based on empirical food allergy (FA) research. This limits the ability of clinicians, researchers and policy-makers to predict and evaluate the real impact of FA on the child, with implications for prevention, treatment, intervention and health policy. Objectives: To provide an integrated conceptual framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour, with particular attention to transition points. Method: Fifteen focus groups meetings were held with 62 children (6-15 years). Developmentally appropriate techniques were designed to stimulate discussion, maintain interest and minimize threat to children's self-esteem. Data were analysed using grounded theory. Results: FA impacts directly on children's normal trajectory of psychological development in both an age- and disease-specific manner. Six key themes emerged from the analysis: 'meanings of food'; 'autonomy, control and self-efficacy'; 'peer relationships'; 'risk and safety'; 'self/identity'; and 'coping strategies'. Conclusions: Coping with FA is more than simply a strategy, it is a cumulative history of interactive processes (age, gender and disease specific) that are embedded in a child's developmental organization. Clinical Implications: The early recognition and incorporation of an FA-specific developmental framework into a treatment plan is essential and sets the stage for an effective medical care and the eventual transition from paediatric to adult care. Capsule Summary: This study represents a first attempt to provide an integrated developmental framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour.