title: Systematic review of character development and childhood chronic illness.
abstract: OBJECTIVE
  To review empirical evidence on character development among youth with chronic illnesses.
  
  
  METHODS
  A systematic literature review was conducted using PubMed and PSYCHINFO from inception until November 2013 to find quantitative studies that measured character strengths among youth with chronic illnesses. Inclusion criteria were limited to English language studies examining constructs of character development among adolescents or young adults aged 13-24 years with a childhood-onset chronic medical condition. A librarian at Duke University Medical Center Library assisted with the development of the mesh search term. Two researchers independently reviewed relevant titles (n = 549), then abstracts (n = 45), and finally manuscripts (n = 3).
  
  
  RESULTS
  There is a lack of empirical research on character development and childhood-onset chronic medical conditions. Three studies were identified that used different measures of character based on moral themes. One study examined moral reasoning among deaf adolescents using Kohlberg's Moral Judgement Instrument; another, investigated moral values of adolescent cancer survivors with the Values In Action Classification of Strengths. A third study evaluated moral behavior among young adult survivors of burn injury utilizing the Tennessee Self-Concept, 2(nd) edition. The studies observed that youth with chronic conditions reasoned at less advanced stages and had a lower moral self-concept compared to referent populations, but that they did differ on character virtues and strengths when matched with healthy peers for age, sex, and race/ethnicity. Yet, generalizations could not be drawn regarding character development of youth with chronic medical conditions because the studies were too divergent from each other and biased from study design limitations.
  
  
  CONCLUSIONS
  Future empirical studies should learn from the strengths and weaknesses of the existing literature on character development among youth with chronic medical conditions.
authors.affiliation: Gary R Maslow, Departments of Pediatrics, Duke University School of Medicine, Durham, NC 27710, United States.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Maslow
authors.affiliation: Gary R Maslow, Departments of Pediatrics, Duke University School of Medicine, Durham, NC 27710, United States.
authors.forename: Sherika N
authors.initials: SN
authors.lastname: Hill
keywords: Adolescents; Character development; Childhood; Chronic illness; Positive youth development