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Psychosocial functioning and quality of life are of increasing emphasis in consideration of outcome for people with chronic health conditions. The World Health Organization's assessment of quality of life has six domains, three of which refer to psychosocial outcomes (WHOQOL group, 1995). While few will experience clinically significant psychopathology, children with chronic illness are more likely to have psychosocial problems and a child's illness can impact on the whole family (Drotar and Crawford 1985; Eiser, 1990; Wallander et al., 1989).
Healthcare services for children and adolescents with disorders of sexual differentiation and determination (DSDD) are in part aimed at the prevention of psychopathological responses to diagnosis and treatment. Medical and nursing staff aim to provide healthcare that is designed to be sensitive to patients' psychological needs, but it is acknowledged that specialist psychosocial care should also be available and integrated with the medical care. A clinical psychologist or other applied psychologist in a health setting with experience of DSDD generally provides this service.
The psychologist has a dual role of supporting the family and working with the wider team to ensure that individual child or family needs are incorporated into treatment from the outset. Recognition of the psychological components of healthcare does not represent a presumption of psychological disorder, rather an acknowledgement of the possible impact on the child's psychological development and the wider family adaptation.
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