Relationship of asthma severity and psychological problems in children

OBJECTIVE: To determine whether physiological severity of asthma is associated with increased psychological symptoms in children. METHOD: Participants were 337 children, aged 7 to 19 years (mean 11.9, SE 0.13), and a parent of each child. Children's asthma severity was rated by experienced pediatric asthma specialists using current guidelines from the National Heart, Lung, and Blood Institute. Children filled out the Children's Manifest Anxiety Scale and the Weinberger Adjustment Inventory. Parents reported on their child's medical history, completed the Child Behavior Checklist (CBCL) about their child, and completed the Pennebaker Inventory of Linguid Languidness as a measure of their own physical symptoms. RESULTS: Child-rated anxiety symptoms were unrelated to asthma severity or to markers of asthma functional morbidity. Parental ratings of internalizing symptoms in their children were related to severity. Parent physical symptoms explained 10.2% of the variance in CBCL Internalizing symptoms, and asthma severity added an additional 6.7% to the variance. CONCLUSIONS: Asthma severity may be a more salient stressor to parents, who in turn report higher levels of child internalizing symptoms for children with severe asthma, than to children themselves. Contrary to prior hypotheses, children with severe asthma did not rate themselves as having higher levels of anxiety than those with mild or moderate asthma or than standardized norms.     

Illness-specific catastrophic thinking and overperception in asthma.

Objective: This study investigated the role of illness-specific catastrophic thinking in symptom perception in asthma. Design and Main Outcome Measures: A total sample of 72 patients with intermittent to moderate persistent asthma completed the Catastrophizing about Asthma Scale and completed the Asthma Symptom Checklist to measure retrospective symptom reporting. In addition, symptoms were concurrently assessed during different respiratory challenges eliciting mild and ambiguous versus salient and pronounced symptoms. Results: Catastrophic thinking in general, when patients are not having an exacerbation, is related to an increase in emotional symptoms, especially in ambiguous situations where respiratory difficulties could occur. Catastrophic thinking during exacerbations is related to an increase in emotional symptoms as well as in respiratory symptoms during respiratory challenges. Conclusion: These strong relationships between catastrophic thinking and increased perception of asthma symptoms suggest a link between illness-specific catastrophic thinking and overperception. Consequently, catastrophic thoughts are an important target for psychological interventions in support of drug treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological aspects of asthma.

Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity.

This study tested a hypothesized model of the relationship between maternal depression and child psychological and physical dysfunction mediated by parenting and medication adherence. A sample of 242 children with asthma, aged 7 to 17, participated with their mothers. Maternal depression was assessed by self-report, and parenting was observed during family interaction tasks. Internalizing symptoms were assessed by self- and clinician reports. Asthma disease activity was assessed according to National Heart Lung and Blood Institute guidelines, and medication adherence was evaluated with a 24-hr recall method. Structural equation modeling indicated that negative parenting partially mediated the relationship between maternal depression and child internalizing symptoms. Child internalizing symptoms, in turn, mediated the associations between both maternal depression and negative parenting and asthma disease activity. Medication adherence did not mediate the link from maternal depression to disease activity. Thus, maternal depression was linked to child psychological dysfunction both directly and indirectly via negative parenting but linked to physical dysfunction only indirectly through psychological dysfunction. These findings suggest that diagnosing and treating depression in mothers of children with asthma would enhance child well-being both psychologically and physically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study

OBJECTIVE: To describe factors related to underdiagnosis of asthma in adolescence. DESIGN: Subgroup analysis in a population based cohort study. SETTING: Odense municipality, Denmark. SUBJECTS: 495 schoolchildren aged 12 to 15 years were selected from a cohort of 1369 children investigated 3 years earlier. Selection was done by randomisation (n = 292) and by a history indicating allergy or asthma-like symptoms in subject or family (n = 203). MAIN OUTCOME MEASURES: Undiagnosed asthma defined as coexistence of asthma-like symptoms and one or more obstructive airway abnormalities (low ratio of forced expiratory volume in 1 second to forced vital capacity, hyperresponsiveness to methacholine or exercise, or peak flow hypervariability) in the absence of physician diagnosed asthma. Risk factors (odds ratios) for underdiagnosis. RESULTS: Undiagnosed asthma comprised about one third of all asthma identified. Underdiagnosis was independently associated with low physical activity, high body mass, serious family problems, passive smoking, and the absence of rhinitis. Girls were overrepresented among undiagnosed patients with asthma (69%) and underrepresented among diagnosed patients (33%). Among the risk factors identified, low physical activity and problems in the family were independently associated with female sex. The major symptom among those undiagnosed was cough (58%), whereas wheezing (35%) or breathing trouble (50%) was reported less frequently than among those diagnosed. Less than one third of those undiagnosed had reported their symptoms to a doctor. CONCLUSIONS: Asthma, as defined by combined symptoms and test criteria, was seriously underdiagnosed among adolescents. Underdiagnosis was most prevalent among girls and was associated with a low tendency to report symptoms and with several independent risk factors that may help identification of previously undiagnosed asthmatic patients.     

Are cognitive errors of underestimation predictive or reflective of depressive symptoms in children: a longitudinal study

Children in Grades 3-8 participated in a longitudinal study of the relation between negative self-evaluation errors and symptoms of depression. Children's self-perceived competence in 5 domains (academic, social, athletic, appearance, and conduct) was compared with teachers' and peers' perceptions. Children's tendency to underestimate their competencies predicted increases in depression scores in only 1 of 6 grade levels. Children's depression scores predicted increases in the underestimation of self-competence over time in all grade levels. Gender differences and developmental differences in the cognitive errors associated with depression scores also emerged. Contrary to A. T. Beck's (1963, 1972) model, negative self-distortions appear to be more reflective than predictive of depression in children.     

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.     

Symptom perception in childhood asthma: The role of anxiety and asthma severity.

This study tested the relationship of anxiety and asthma severity to symptom perception. Eighty-six children diagnosed with mild or moderate asthma had symptom perception and pulmonary function measured throughout methacholine challenge (to induce bronchoconstriction). Higher trait anxiety was associated with heightened symptom perception (controlling for pulmonary function) at baseline. Greater asthma severity was associated with blunted symptom perception (controlling for pulmonary function) at the end of methacholine challenge and with a slower rate of increase in symptom perception across methacholine challenge. These results suggest that anxiety plays a role when children's symptoms are mild, whereas medical variables such as severity play a role in perception of changes in asthma symptomatology as bronchoconstriction worsens. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: Mediation by interparental negativity and parenting.

This study tested a hypothesized model of the relationships among parental depressive symptoms, family process (interparental negativity and negative parenting behavior), child internalizing symptoms, and asthma disease activity. A total of 106 children with asthma, aged 7 to 17, participated with their fathers and mothers. Parental depressive symptoms were assessed by self-report. Interparental and parenting behaviors were observed and rated during family discussion tasks. Child internalizing symptoms were assessed by self-report and by clinician interview and rating. Asthma disease activity was assessed according to National Heart, Lung and Blood Institute guidelines. Results of structural equation modeling generally supported interparental negativity and negative parenting behavior as mediators linking parental depressive symptoms and child emotional and physical dysfunction. However, paternal and maternal depressive symptoms play their role through different pathways of negative family process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Emotionally triggered asthma: a review of research literature and some hypotheses for self-regulation therapies

Asthma is a common disease whose morbidity and mortality are rapidly increasing. Panic disorder is common in asthma. Panic, other negative emotions, and a passive coping orientation may affect asthma by producing hyperventilation, increased general autonomic lability, a specific pattern of autonomic arousal that may cause bronchoconstriction, and/or detrimental effects on health care behaviors. Generalized panic is a risk factor for increased asthma morbidity. A repressive coping style also appears to be a risk factor for asthma morbidity because it is accompanied by an impaired ability to perceive symptoms, a necessary prerequisite for taking appropriate remediation. Several self-regulation strategies are hypothesized to be useful adjuncts to asthma treatment. Preliminary research has been done on relaxation therapy, EMG biofeedback, biofeedback for improved sensitivity in perceiving respiratory sensations, and biofeedback training for increasing respiratory sinus arrhythmia. It is hypothesized that finger temperature biofeedback also may be a promising treatment method, and that relaxation-oriented methods will have their greatest effect among asthmatics who experience panic symptoms, while improved perceptual sensitivity will be helpful both for patients who panic and those with repressive coping styles.     

Successful salvage using mismatched umbilical cord blood transplant in an adult with recurrent acute myelogenous leukemia failing autologous peripheral blood progenitor cell transplant: a case history and review

OBJECTIVE: To investigate the relationship between asthma and obesity in children and adolescents. DESIGN: Medical record review. SETTING: Urban community health center. PARTICIPANTS: One hundred seventy-one children aged 4 to 16 years, 85 with asthma and 86 nonasthmatic controls. MAIN OUTCOME MEASURES: Diagnosis of asthma, age, and sex-adjusted body mass index (weight in kilograms divided by the square of the height in meters). RESULTS: Seventy-eight percent of the sample was Hispanic, 17% was African American, 2% were white, and 3% were other minorities. There were significantly more children with asthma (30.6%) who were very obese (> or =95th body mass index percentile) compared with controls (11.6%) (P=.004). Children with asthma were also significantly more overweight than controls (mean+/-SD, 22.5%+/-28.3% vs 12.0%+/-19.6% overweight; P=.004). The difference in obesity between children with asthma and controls was significant for both sexes and across the 4.5 to 10.9 years and 11 to 16 years age groups. Asthma severity was not related to obesity. CONCLUSION: Asthma is a risk factor for obesity in children and adolescents.     

Developmental sex differences in global-local perceptual bias.

Previous developmental studies have indicated that boys tend to perform better than girls on tasks associated with the right hemisphere (e.g., spatial tasks), whereas girls perform better on tasks associated with the left hemisphere (e.g., verbal tasks). Extending this body of literature to what is known about hemispheric specialization of visuospatial processing, we predicted that boys would be more global than girls in their perception of visual hierarchical stimuli. Forty girls and 39 boys between the ages of 4 and 12 years were administered a perceptual judgment task previously used by Kimchi and Palmer (see record 1983-02534-001). Boys were significantly more global in their perceptual judgments than girls at all ages. Younger children of both sexes were less global than older children. Results were consistent with developmental models that suggest an early left-hemisphere advantage for girls and a right-hemisphere advantage for boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of verbal fluency abilities and strategies in elementary-school-age children.

This study of two experiments designed to examine children's abilities and strategies for completing tests of verbal fluency. In Experiment 1, 64 third graders and 71 sixth graders completed four fluency tasks constructed for the study as well as several tests of other verbal abilities. Subjects received two sets of scores for the fluency tasks: a fluency score and scores for strategies expected to distinguish more verbally fluent children from less fluent children. The results demonstrated that the two sets of scores were positively correlated. In Experiment 2, 40 third graders and 38 sixth graders completed expanded versions of two of the fluency tasks used in Experiment 1. The results revealed grade and gender differences in strategy use as well as in level of task performance. In addition, the results indicated that the children's scores for one of the two strategies were strong predictors of their performance on the verbal fluency tasks. The effects of strategy selection and implementation, grade, and gender (as well as their combined influence on children's verbal fluency skills) are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations among self-reported depressive symptoms in clinic-referred children versus adolescents.

Although there is consensus regarding the existence of childhood depression, disagreement remains as to whether symptoms are developmentally isomorphic. Previous studies focused on developmental differences in symptom levels; analyses of relations among symptoms may be more appropriate, however. Here both approaches were used to compare the Children's Depression Inventory responses from 1,030 clinic-referred children and adolescents. Four of 9 symptom categories showed significant developmental differences in their correlations with total score. Externalizing behavior and guilt were more strongly related to depression in children than adolescents; affective symptoms and concerns about the future showed the reverse pattern. Results illustrate the importance of considering relations among symptoms as well as differences in symptom levels when evaluating theoretical claims about developmental differences in the nature of clinical syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maltreated children's memory: Accuracy, suggestibility, and psychopathology.

Memory, suggestibility, stress arousal, and trauma-related psychopathology were examined in 328 3- to 16-year-olds involved in forensic investigations of abuse and neglect. Children's memory and suggestibility were assessed for a medical examination and venipuncture. Being older and scoring higher in cognitive functioning were related to fewer inaccuracies. In addition, cortisol level and trauma symptoms in children who reported more dissociative tendencies were associated with increased memory error, whereas cortisol level and trauma symptoms were not associated with increased error for children who reported fewer dissociative tendencies. Sexual and/or physical abuse predicted greater accuracy. The study contributes important new information to scientific understanding of maltreatment, psychopathology, and eyewitness memory in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperament and parenting antecedents of individual differences in three-year-old boys' pride and shame reactions

To examine individual differences in pride and shame reactions of 3-year-olds and their temperamental and parenting antecedents, 110 boys were studied at ages 36 and 37 months in a "rigged" achievement situation. After being trained to complete explicitly stipulated "easy" and "difficult" tasks before a buzzer sounded, success and failure were manipulated by artificially "rigging" how much time the child had to work on these tasks. Children's facial, verbal, and postural reactions to success and failure were composited to create pride scores following success and shame scores following failure. As expected, pride reactions were greater following success on the difficult than on the easy task, and shame reactions were greater following failure on the easy than on the difficult task. Early temperament (at 12/13 months) proved unrelated to pride and shame. With respect to parenting, measurements composited across 15, 21, 27, and 33 months showed that mothers and fathers who were more positive in their parenting had children who displayed less pride, and that children whose parents (especially mothers) were more negative in their parenting evinced less shame. These counterintuitive findings are discussed in terms of differences between assessments of parenting obtained in this investigation of parenting antecedents and those obtained in other studies of parental responses in the achievement situation itself. Directions for future research are outlined.     

Risk perception in smokers with children with asthma.

Objective: No studies have examined the relationship between caregiver beliefs about the risks of smoking to their own health and caregiver beliefs about the effect of their smoking on their child's health. In the current study, we investigated our proposed risk congruence hypothesis among caregivers who smoke. Specifically, we investigated whether caregivers' self-perceived risk of smoking is directly associated with their perception of the risks of smoking to their child. Method: The sample consisted of 271 regular smokers (≥3 cigarettes per day; Mage = 32.9 years; 214 women) who were caregivers of children with asthma (Mage = 4.9 years) who had a recent visit to the emergency room for their asthma. Three constructs of perceived risk were measured via self-report questionnaires assessing both caregiver perception of smoking risk to self and to child: Precaution Effectiveness, Optimistic Bias, and Perceived Vulnerability. Child asthma-related functional morbidity and home and child secondhand smoke exposure were also assessed. Results: Consistent with our risk congruence hypothesis, self-perceived risk of smoking was significantly associated with perceived risk to child, over and above the child's secondhand smoke exposure and caregiver report of child's asthma symptoms (i.e., asthma-related functional morbidity). Conclusions: These findings should be considered in the design of clinical interventions seeking to influence risk of caregiver behavior on child health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of approval motivation and social reinforcement in children's discrimination learning.

144 3rd- and 4th-grade children were given a 2-choice discrimination learning task. The 2 major factors were (a) the 3 levels of social desirability (high, moderate, and low) on the Children's Social Desirability scale; and (b) the 2 types of treatment conditions (monetary-social reinforcement and monetary-no social reinforcement). In opposition to D. P. Crowne and D. Marlowe's (1961) model of the approval-motivated individual, the high-social-desirability group made significantly fewer errors than both the moderate and low groups. It is suggested that for young children, social desirability scores may require a different interpretation than scores for older children and adults. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation Between Naming and Literacy in Children With Word-Finding Difficulties.

Difficulties with picture naming tasks are associated with literacy problems. When given naming tasks, children with dyslexia are slower to produce words and have a higher proportion of errors (M. Wolf & P. G. Bowers, 1999). However, little is known about the relation between literacy and naming in other populations. This study investigated this relation in 20 children (age 6 years 6 months to 7 years 11 months) with word-finding difficulties. The children in the sample performed very poorly on assessments of naming, but unlike children with dyslexia, they were found to have decoding and spelling abilities within the normal range. In addition, their abilities on phonological awareness tasks were at a similar level to their decoding abilities. In contrast, their performance on reading comprehension and language comprehension measures was significantly worse than their performance on decoding, spelling, and rhyme awareness measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)