Developmental pathways in food allergy: a new theoretical framework

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. 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. 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. 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'. 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. 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. 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.