Journal of Clinical Psychology in Medical Settings, Vol. 7, No. 1, 2000 Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium Kenneth P. Tercyak, 1,3 Randi Streisand, 2 Beth N. Peshkin, 1 and Caryn Lerman 1 Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications. KEY WORDS: genetic testing; communication; parent–child relations; parents; children; family. Progress in molecular genetics has led to rapid advancements in our understanding of the contribu- tion of heredity to the etiology of many diseases. By the year 2003, 2 years ahead of schedule, efforts from the Human Genome Project are expected to yield the complete DNA sequence of the human genome (Collins, 1999). This seminal knowledge will un- doubtedly add to the existing number of genetic tests that are now available for over 300 diseases (Gene- Tests). These tests may be useful either as diagnos- tic screening tools or as a means of identifying individ- uals who have a predisposition to specific diseases. However, the interpretation of genetic test re- sults is not always straightforward. Although there are some disorders that will almost always occur in individuals who carry a mutated gene (e.g., Hunting- ton disease [HD], a degenerative neurological dis- ease; and familial adenomatous polyposis [FAP], in 1 Lombardi Cancer Center, Georgetown University Medical Cen- ter, Washington, D.C. 20007. 2 Department of Psychology, Children’s National Medical Center, Washington, D.C. 3 To whom correspondence should be addressed. 55 1068-9583/00/0300-0055$18.00/0  2000 Plenum Publishing Corporation which hundreds of colon polyps develop which are likely to become cancerous), other conditions exist where the risk associated with carrying an altered gene is not absolute. In the latter instance, disease onset may be promoted by the interplay of multiple genetic and environmental factors. Examples of these conditions include breast and ovarian cancer, diabe- tes, and certain forms of cardiovascular disease. Though the identification of those at risk introduces the possibility for individuals to engage in risk reduc- tion behaviors, it also highlights the uncertainty sur- rounding the genetic testing process. Predictive testing has several important implica- tions for families, and children in particular. For adult-onset diseases, the motivation for adults to be tested is often for the sake of other family members, such as one’s children (Lerman, Daly, Masny, & Balshem, 1994). Direct testing of children is usually not recommended for these conditions, as the imme- diate medical benefits gleaned from this knowledge are minimal (American Society of Human Genetics Board of Directors and American College of Medical Genetics Board of Directors [ASHG/ACMG], 1995).