Follow-up study of 35 asthmatic preschool children

Maternal depression related to infant's wheezing

OBJECTIVE

To assess whether maternal psychological status is related to infant's wheezing.

STUDY DESIGN

In a case-control study conducted in Paris in cases aged less than 36 months suffering from wheezing and matched healthy controls, mothers filled a standardized questionnaire on child's health and the State Trait Anxiety Inventory form Y-B and the Beck Depression Inventory short form. Cases underwent also routine clinical and biological assessments. The statistical analysis used the propensity score analysis to control for selection bias.

RESULTS

Hundred and thirty-eight wheezers and hundred and nine controls participated in the study. After adjustment for confounders, maternal depressive symptoms at the period of the survey according to the Beck Inventory were more significantly found in the cases than in others (p < 0.01). A trend was found for maternal depression during pregnancy. Among the cases, 10.6% suffered from severe asthma, 84.8% took inhaled corticosteroids (ICs), 17.4% had positive specific immunoglobulin E (IgE) to allergens and 11.5% hypereosinophilia. The more the mother was depressed according to the Beck Inventory, the more the infant's asthma was severe (OR = 4.25, 95% CI: 1.14, 15.9 between severe infant's wheezing and severe maternal depression). No relationship was observed between mother's depressive symptoms and ICs taken by the infant, allergic sensitization or eosinophilia.

CONCLUSION

Our findings support the hypothesis of a link between maternal depression and infant's wheezing and its severity early in life independent of allergic status. Consequences of our study include the need to assess depressive symptoms in mothers of infants with asthma.

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.

The family of the asthmatic child

The authors report clinical study of 34 asthmatic children between the ages of ten and 15, followed at a specialized outpatient clinic of a large pediatric hospital in Montreal. Evaluation of the children and their families involved the use of clinical scores with inter-rater agreement. The study found strong associations between certain personality traits and an excessive use of medication, and between personality traits and family structure. Regardless of the severity of their asthma, children with high levels of anxiety and dependence were more likely to live with highly cohesive families and to use greater quantities of cortisone than children with better adapted personality structures. Pathological family settings are known to cause more emotional and behaviour problems in children. We suggest there is a reciprocal influence, and we consider the effects on the family of an early childhood disease that is persistent, worrisome, unpredictable, and necessitates repeated hospitalization. Prospective studies of the high-risk subgroups identified in this study could facilitate early intervention for asthmatic children and their families.

Social adjustment and functioning of chronically ill and impaired children and adolescents

A cluster sample of 532 children aged 8 to 19 years with certain impairments were compared to a matched sample of 316 healthy children of the same age. Almost half (46%) of the impaired had a disability, which was mostly in the domain of body disposition ability (in 88%), behaviour (63%) and situational functioning (54%). In the controls, where 12% had some kind of disability, the corresponding figures were 13%, 11% and 15%. The most disabling conditions were CP (67% handicapped), MBD (52%) and epilepsy (42%). The most frequent non-compensated handicaps were those of occupation (44% of impaired), mobility (31%) and social integration (22%). More than one handicap was associated most frequently with CP (76%) and with epilepsy (36%). Neurological impairments are more disabling and handicapping than non-neurological ones, with the exception of mobility and occupation handicaps in asthmatics.

Assisting the parent of a child with asthma

The parents of an asthmatic child are frequently faced with complex decisions that have to take into account the child's asthma as well as more general developmental needs. At times these parents may feel overwhelmed and doubt their ability to make reasonable decisions. If there is discomfort with some aspect of the treatment plan, the parents may remain silent. Denial, minimization, anger, withdrawal and noncompliance may occur. This paper offers suggestions for practicing pediatricians in regard to helping parents cope more effectively with childhood asthma. Specific issues dealt with are discipline, school issues, athletic participation, maintenance of the child's peer relationships, avoiding parental conflict, the use of support systems, behavioral aspects of medical management, and when to refer for psychiatric consultation.

Expressed emotion and airway conductance in children with bronchial asthma

Fourteen asthmatic children (ages 9-11) and their controls were exposed to a stress inducing competitive achievement situation. Facial expression of emotions were systematically analyzed from video-recordings, and peak expiratory flow rate (PEFR) reduction was measured from pre-stress to post-stress. The asthmatic children showed a significantly lower frequency and duration of overall emotional expression than their controls. Specifically, the frequency and duration of expressed anger/rage, enjoyment/joy, and surprise/startle were lower in the asthmatic children. Moreover, duration of overall expressed emotion showed a significant negative correlation with PEFR reduction in the asthmatic group, indicating a relevant relationship between facial expression of emotions and breathing function.

[The "bad mother" to the vulnerability of the parent child relationship]

This paper summarizes the results of a longitudinal study on young asthmatic children and particularly on the mother-child relationship in this illness: At both observation times--14 to 30 months and 4 to 6 years--the majority of the children appeaed to be developing in a very adequate manner, both in the area of autonomy and opposition. Similarly, in most situations, the mothers appeared quite adequate in the face of their child's illness, and mother-child relationships, generally, seemed harmonious. However, a certain vulnerability in the area of opposition was more marked in a few cases, more frequently between 4-6 years than between 14-30 months. The author attempts a brief history of the development of the concept of the "bad mother" who has become a scapegoat not only in childhood asthma but also in many illnesses encountered in child psychiatry. In questioning the role which may have been played by dynamic theories in this evolution, psychoanalytic writings are reviewed (for example, S. Freud, M. Klein, Spitz, Brody) and it is hypothesized that psychoanalytic theory has had more of a catalytic than a causal influence in relation with a strong tendency in our culture to the eclosion of negative attitudes toward the mother in her relationship with her child. The emphasis placed by North American culture on the nuclear family, the hypertrophy of the maternal function coupled with a paternal role much reduced in time, as well as the almost complete disappearance of maternal substitutes, have all probably greatly influenced the development of this concept of the "bad mother". The author notes however, that happily, in recent years some child development theories insist on the concept of mother-child interaction and on the mutual role that mother and child have on one another in their exchanges. A review is made of the work of Sander, Bowlby, Schaffer, Lewis and Rosenblum which demonstrates this new trend. The author also studies the question of vulnerability within parent-child relationships, leading to the appearance of child psychopathology, and discusses the development of methods which could help in its early detection. Recent attempts in this direction are reviewed, particularly those of Broussard, Gray et al., Lézine. The importance of Thomas and Chess' work is particularly underlined, which emphasizes the specific interaction between the temperamental characteristics of the child and the parents' specific responses to them, at all levels of development. More recent studies by Brazelton et al. and by Korner are also reviewed, suggesting a very early interaction between mother and child. The author concludes by briefly developing the preventive implications of these works and stressing the importance of closely following the efforts made at pre- and post-natal levels which may have much influence in the early prevention of psychopathology in parent-child relationships.