Advancing the science of perceptual accuracy in pediatric asthma and diabetes

Reliability and predictors of resistive load detection in children with persistent asthma: a multivariate approach

OBJECTIVE

Resistive load detection tasks enable analysis of individual differences in psychophysical outcomes. The purpose of this study was to determine both the reliability and predictors of resistive load detection in children with persistent asthma who completed multiple testing sessions.

METHODS

Both University of North Carolina (UNC) Charlotte and Ohio University institutional review boards approved the research protocol. The detection of inspiratory resistive loads was evaluated in 75 children with asthma between 8 and 15 years of age. Each child participated in four experimental sessions that occurred approximately once every 2 weeks. Multivariate analyses were used to delineate predictors of task performance.

RESULTS

Reliability of resistive load detection was determined for each child, and predictors of load detection outcomes were investigated in two groups of children: those who performed reliably in all four sessions (n = 31) and those who performed reliably in three or fewer sessions (n = 44). Three factors (development, symptoms, and compliance) accounted for 66.3% of the variance among variables that predicted 38.7% of the variance in load detection outcomes (Multiple R = 0.62, p = 0.004) and correctly classified performance as reliable or less reliable in 80.6% of the children, χ(2)(12) = 28.88, p = 0.004.

CONCLUSIONS

Cognitive and physical development, appraisal of symptom experiences, and adherence-related behaviors (1) account for a significant proportion of the interrelationships among variables that affect perception of airflow obstruction in children with asthma and (2) differentiate between children who perform more or less reliably in a resistive load detection task.

The role of maternal illness perceptions in perceived asthma symptoms in school-aged children

OBJECTIVE

To examine the unique contribution of perceptions held by mothers about their children's asthma in relation to the symptoms as reported by their children.

METHODS

Families with a child diagnosed with asthma participating in a larger smoking prevention study were invited to participate. For all, 89 children (mean age 10.1 years) and 87 mothers questionnaire and lung function data during home visits were provided. The main outcome of this study involved asthma symptoms as measured by the Pediatric Quality of Life Inventory. Mothers' and children's reports of symptoms, as well as the lung function parameter of percentage of predicted Forced Expiratory Volume in one second (% of predicted FEV1), were analyzed in relation to maternal illness perceptions.

RESULTS

Mothers' perceptions of illness were not associated with % of predicted FEV(1.) However, while controlling for gender and children's baseline asthma symptoms, four out of eight mothers' perceptions of illness (i.e., identity, consequences, concern, and emotional influence) were associated with children's asthma symptoms. Additional analyses controlling for % of predicted FEV(1) in the models with subjective asthma symptoms reports of mother and child did not change the study findings.

CONCLUSIONS

This pilot study provides evidence that, in addition to children's lung function and baseline symptoms, maternal perception of illness contributes to symptom-related quality of life (QoL) of children. More research on underlying mechanisms, which addresses the linking of mothers' perceptions of concern and emotion to the QoL symptoms as reported by children is necessary.

Psychosocial Factors in Pediatric Asthma

This review discusses evidence-based perspectives on psychosocial factors in pediatric asthma. Future directions for inquiry and clinical management also are addressed.

Exploring and explaining low participation in physical activity among children and young people with asthma: a review

Background

Asthma is the most common chronic illness among children and accounts for 1 in 5 of all child GP consultations. This paper reviews and discusses recent literature outlining the growing problem of physical inactivity among young people with asthma and explores the psychosocial dimensions that may explain inactivity levels and potentially relevant interventions and strategies, and the principles that should underpin them.

Methods

A narrative review based on an extensive and documented search of search of CinAHL, Embase, Medline, PsycINFO and the Cochrane Library.

Results & Discussion

Children and young people with asthma are generally less active than their non-asthmatic peers. Reduced participation may be influenced by organisational policies, family illness beliefs and behaviours, health care advice, and inaccurate symptom perception and attribution. Schools can be reluctant to encourage children to take part in physical education or normal play activity due to misunderstanding and a lack of clear corporate guidance. Families may accept a child's low level of activity if it is perceived that breathlessness or the need to take extra inhalers is harmful. Many young people themselves appear to accept sub-optimal control of symptoms and frequently misinterpret healthy shortness of breath on exercising with the symptoms of an impending asthma attack.

Conclusion

A multi-faceted approach is needed to translate the rhetoric of increasing activity levels in young people to the reality of improved fitness. Physical activity leading to improved fitness should become part of a goal orientated management strategy by schools, families, health care professionals and individuals. Exercise induced asthma should be regarded as a marker of poor control and a need to increase fitness rather as an excuse for inactivity. Individuals' perceptual accuracy deserves further research attention.

Detection of hypoglycemia by children with type 1 diabetes 6 to 11 years of age and their parents: a field study

OBJECTIVES

The objectives of this study were to (1) assess accuracy of hypoglycemia detection in children with type 1 diabetes and their parents, using personal digital assistant technology to collect glucose estimates and meter readings, (2) identify demographic, clinical, and psychological predictors of individual differences in accuracy, and (3) test whether poor hypoglycemia detection is a risk factor for severe hypoglycemia in children.

METHODS

Sixty-one children aged 6 to 11 and their parents completed 70 trials, over 1 month, of a survey programmed on a personal digital assistant, which asked them to rate symptoms, estimate current blood glucose level, and then measure blood glucose level. For the subsequent 6 months, parents reported children's severe hypoglycemia episodes bimonthly.

RESULTS

Both parents and children showed poor ability to recognize high or low blood glucose levels, making clinically significant errors as frequently as clinically accurate estimates. Parents failed to recognize >50% of readings <3 mmol/L (<55 mg/dL) and made potentially dangerous errors such as believing the blood glucose level was high when it was low 17% of the time. Children were significantly more accurate at recognizing their hypoglycemia but still failed to detect >40% of episodes. Higher depression scores for children related to lower accuracy. Children who were less accurate at detecting hypoglycemia subsequently experienced more severe hypoglycemia.

CONCLUSIONS

Ability to recognize hypoglycemia is a significant problem for children with type 1 diabetes and their parents. For children, poor ability to detect low blood glucose levels may be a significant and underappreciated risk factor for severe hypoglycemia. More effort is needed to provide education and training designed to improve hypoglycemia detection in this population.