Robert B. Klein

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. Childrens asthma severity was rated by experienced pediatric asthma specialists using current guidelines from the National Heart, Lung, and Blood Institute. Children filled out the Childrens Manifest Anxiety Scale and the Weinberger Adjustment Inventory. Parents reported on their childs 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.

Symptom Perception in Pediatric Asthma: Relationship to Functional Morbidity and Psychological Factors

OBJECTIVE Perception of changes in respiratory symptoms is a critical element in the self-management of pediatric asthma. The purpose of this study was to quantify perceptual accuracy in childhood asthma, to investigate links between symptom perception and functional morbidity, and to examine relationships between psychological variables and perceptual accuracy. METHOD Eighty-six children, aged 8 to 15 years, attending an asthma camp made subjective estimates of asthma severity immediately prior to spirometry an average of 31 times at camp. The correlation coefficient between these measures (the childs accuracy index) was analyzed in relation to morbidity data and to scores on instruments that assessed trait anxiety, repressive coping style, intelligence, behavior problems, and parental symptom-reporting patterns. RESULTS A wide range of perceptual ability was found, as childrens subjective-objective r ranged from-.39 to .88. Greater perceptual accuracy was significantly related to fewer days missed from school and fewer emergency medical visits. Of the psychological variables assessed, only intelligence was significantly related to accuracy. CONCLUSIONS Symptom perceptual ability is an important psychosomatic factor affecting the course of asthma for some children. Further study is indicated to understand psychological variables in addition to intelligence that may determine a childs perceptual accuracy.

Medication Adherence Among Latino and Non-Latino White Children With Asthma

OBJECTIVE: Latino children of Caribbean descent remain at high risk for poorly controlled asthma. Controller medications improve asthma control; however, medication adherence remains suboptimal, particularly among minorities. This study assessed socioeconomic, family-based, and parent factors in medication adherence among children with asthma from Rhode Island (RI; Latino and non-Latino white [NLW]) and Puerto Rico. METHODS: Data collection occurred as part of a multicenter study of asthma disparities. Our sample included children (ages 7–16) prescribed objectively monitored controller medications (n = 277; 80 island Puerto Rico, 114 RI Latino, 83 RI NLW). Parents completed questionnaires regarding family background and beliefs about medications. Families participated in an interview regarding asthma management. Multilevel analyses (maximum likelihood estimates) accounting for children being nested within site and ethnic group assessed the contribution of social context, family, and parent variables to medication adherence. RESULTS: Medication adherence differed by ethnic group (F2, 271 = 7.46, P < .01), with NLW families demonstrating the highest levels of adherence. Multilevel models indicated that parental beliefs about medication necessity and family organization regarding medication use were significant predictors of adherence, even for families below the poverty threshold. With family factors in the model, a substantial improvement in model fit occurred (Akaike Information Criterion change of 103.45). CONCLUSIONS: Adherence to controller medications was lower among Latino children in our sample. Targeted interventions that capitalize on existing family resources, emphasize structure, and address parental beliefs about the importance of medications may be of benefit to families from different cultural backgrounds.

The Asthma Responsibility Questionnaire: Patterns of Family Responsibility for Asthma Management

This study provided preliminary validation of the Asthma Responsibility Questionnaire (ARQ), a brief measure that assesses the division of family responsibility for 10 asthma management tasks. Data were collected from 2 samples of children (ages 7 to 15 years) and their mothers, recruited from an asthma camp (Sample 1) and various community sources (Sample 2). The ARQ demonstrated good internal consistency and convergent validity. Child and mother reports of child responsibility were modestly correlated and increased with child age by mother and child report. Four-year longitudinal data demonstrated significant increases in child responsibility for asthma management. Overall, children reported a higher degree of responsibility for themselves than mothers did for them. CHILDREN’S HEALTH CARE, 30(3), 183–199 Copyright

Accuracy of Symptom Perception in Childhood Asthma

Childrens reports of their asthma symptoms are used as important data in the assessment and management of pediatric asthma, but little is known about the accuracy of such reports. Childrens subjective perception of the level of asthma symptoms was correlated with peak expiratory flow rate measures on average of 34 observations for 37 children with asthma. Subjective/objective correlations for a given child varied from 0.86 to −0.16. The childrens perceptual accuracy was not related to age or sex, or to duration or severity of asthma. Implications for clinical practice are discussed.

Cognitive coping strategies of children with chronic illness

Children with chronic illness need to adapt to more stresses than do healthy children. Research highlights the problems of children with chronic illnesses but not how they cope in response to the stress created by these problems. Cognitive appraisal of a stressor and of response options is an important aspect of coping. Our cross-sectional study investigated whether children with chronic illness used cognitive strategies for coping as often as did healthy children. One hundred seventy five children from summer camps with juvenile arthritis, asthma, or diabetes were compared with 145 healthy school children. Spontaneous responses to common painful and stressful events were categorized into coping or catastrophizing ideation. Data on anxiety, disease severity, and other sociodemographic variables were obtained. Coping strategies were reported by 64% of children with chronic illness and 63% of healthy children and varied significantly with age (p < .05) in both groups. Children with different chronic illnesses performed similarly except for a trend among children with severe juvenile rheumatoid arthritis who had higher rates of coping. For the individual stressful events, the rate of coping varied from 46% to 86%. The highest rates of coping responses were found with the childs recent personal stressful event where adolescents with chronic illness were twice as likely to offer more complex coping responses. More children with chronic illness than healthy children offered coping strategies in response to venipuncture (p < .001) but not to dental injection. Children with chronic illness report coping as their predominant strategy for adapting to common painful and stressful events. We need to recognize the role of cognitive strategies and how their use varies as a function of the different stresses faced by children with chronic illness.J Dev Behav Pediatr 14:217–223, 1993. Index terms:chronic illness, coping, arthritis, asthma, diabetes.

Association of psychiatric disorders and different indicators of asthma in island Puerto Rican children

Abstract.Background: We examined the relationship between three different indicators of childhood asthma (asthma diagnosis, ever had an asthma attack, and asthma hospitalization) and having any psychiatric disorder, comorbid disorders, or specific disorders. Three study hypotheses were examined: 1) there will be subject variability in responses to the asthma indicators; 2) there will be different observed associations between the three asthma indicators and psychiatric disorders; and 3) maternal mental health, family income, and maternal education will confound the associations between childhood asthma and psychiatric disorders. Method: Data were drawn from a community-based, random sample of 1,891 island Puerto Rican children aged 4–17 years. Information was collected through direct interview with children and adolescents and their primary caretakers. The Diagnostic Interview Schedule for Children (DISC) was used to determine DSM-IV diagnoses. Results: Thirty-two percent of the children had been diagnosed with asthma but only 22 % had ever experienced an asthma attack. Seventeen percent of the children had been hospitalized for asthma. Having been hospitalized for asthma was not associated with any of the psychiatric disorders, having a diagnosis was associated with some of the disorders, and having experienced an asthma attack was associated with almost all the disorders, after controlling for family income and maternal education and mental health. Conclusions: Determining and measuring asthma may be difficult because of confusion and differing perceptions of what constitutes asthma or an asthma attack. Future studies should consider the problems in capturing perceptions of asthma and severity in Puerto Rican children and should continue to explore the relationship between asthma and mental illness.

Beliefs and Barriers to Medication Use in Parents of Latino Children With Asthma

Disparities in asthma outcomes exist between Latino and non‐Latino white (NLW) children. We examined rates of medication use, medication beliefs, and perceived barriers to obtaining medication in US and island Puerto Rican parents of children with asthma.

Ethnic Differences in Perception of Lung Function: A Factor in Pediatric Asthma Disparities?

RATIONALE Disparities in pediatric asthma exist in that Latino children have higher prevalence and greater morbidity from asthma than non-Latino white children. The factors behind these disparities are poorly understood, but ethnic-related variations in childrens ability to accurately recognize and report their pulmonary functioning may be a contributing process. OBJECTIVES To determine (1) if differences exist between Latino and non-Latino white childrens perceptual accuracy and (2) whether these differences are related to asthma outcomes. METHODS Five hundred and twelve children, aged 7-16 years (290 island Puerto Ricans, 115 Rhode Island Latinos, and 107 Rhode Island non-Latino white children) participated in a 5-week home-based protocol in which twice daily they entered subjective estimates of their peak expiratory flow rate into a hand-held, programmable spirometer and then performed spirometry. Their accuracy was summarized as three perceptual accuracy scores. Demographic data, asthma severity, intelligence, emotional expression, and general symptom-reporting tendencies were assessed and covaried in analyses of the relationship of perceptual accuracy to asthma morbidity and health care use. MEASUREMENTS AND MAIN RESULTS Younger age, female sex, lower intelligence, and poverty were associated with lower pulmonary function perception scores. Island Puerto Rican children had the lowest accuracy and highest magnification scores, followed by Rhode Island Latinos; both differed significantly from non-Latino white children. Perceptual accuracy scores were associated with most indices of asthma morbidity. CONCLUSIONS Controlling for other predictive variables, ethnicity was related to pulmonary function perception ability, as Latino children were less accurate than non-Latino white children. This difference in perceptual ability may contribute to recognized asthma disparities.

Immigration and Acculturation-Related Factors and Asthma Morbidity in Latino Children

OBJECTIVE This article presents a summary of findings from asthma studies focusing on immigration and acculturation-related factors. A study examining associations between these processes, family cohesion and social support networks, and asthma morbidity in a sample of Dominican and Puerto Rican caregivers residing in the mainland U.S., is also described. METHODS Latino children with asthma (n = 232), ages 7-16 (49% female) and their caregivers completed interview-based questionnaires on immigration and acculturation-related processes, family characteristics, and asthma morbidity. RESULTS The frequency of ED use due to asthma may be higher for children of caregivers born in Puerto Rico. Acculturative stress levels were higher for Puerto Rican born caregivers residing in the mainland U.S. CONCLUSION Asthma-related educational and intervention programs for Latino children and families should be tailored to consider the effects that the immigration and acculturation experience can have on asthma management. Specific family-based supports focused on decreasing stress related to the acculturation process, and increasing social and family support around the asthma treatment process may help to reduce asthma morbidity in Latino children.