Behavioral adjustment in children with asthma: a meta-analysis

This study is a meta-analytic review of the behavioral adjustment of children and adolescents with asthma. Of 78 studies initially reviewed, 26 studies (encompassing 28 data sets), reflecting data on nearly 5,000 children with asthma (mean age = 8.4 years; 40% female), met criteria for inclusion. Effect size estimates were calculated across studies using standard methods. Separate effect sizes were calculated for internalizing and externalizing behavioral problems, degrees of asthma severity, and differences in control group used (i.e., sample controls or normative data). Results indicate that children with asthma have more behavioral difficulties than do healthy children, with the effect for internalizing behaviors being greater than that for externalizing behaviors (d(mn) = .73 vs .40). Increased asthma severity was associated with greater behavioral difficulties. Results did not differ by comparison group (healthy controls vs normative data). The findings suggest that patients with asthma, particularly children with severe asthma, should be considered at higher risk for behavioral difficulties that may necessitate psychosocial intervention.

Stress and airway resistance in children with asthma

OBJECTIVE

The present study implements an experimental paradigm to examine airway reactivity to stress in children with asthma and controls.

METHOD

114 children with asthma and 30 controls (ages 9-15) participated. The protocol involved 5 min of baseline physiological measurements followed by a 5-min stressful task. Skin conductance (EDG), skin temperature, and heart rate were measured continuously. Airway resistance was measured at baseline and after the task.

RESULTS

110 children (76% of the sample) were significantly "stressed" as shown by physiological changes. Asthmatics and controls differed on overall airway resistance, F(1, 108)=12.3, P<.001. The entire sample demonstrated a trend toward increased airway resistance in response to stress, F(1,108)=3.1, P<. 08. A portion of asthmatics (22%) had increases of greater than 20% of baseline airway resistance. Changes in airway resistance in response to stress were unrelated to asthma severity, F(2,78)=2.0, ns.

CONCLUSION

Children with asthma and controls demonstrate variation in airway function in response to stress, although increases are likely more meaningful for children with asthma. Further research is needed to examine the mechanisms underlying this response.

Repressive-defensive style and physiological reactivity among children and adolescents with asthma

OBJECTIVE

This study evaluates the concordance of two self-report methods of operationalizing repressive-defensive style in children with asthma. It was hypothesized that, compared with low-anxious children, repressive-defensive children would exhibit increased physiological reactivity during a stressful laboratory task, despite comparable self-reports of state anxiety.

METHODS

Ninety-one children and adolescents (mean age = 11.5 years) with asthma participated in the study. Repressive-defensiveness was operationalized as self-reported low distress coupled with high defensiveness or restraint. Self-report data reflecting trait anxiety, defensiveness, and personality style were used to classify children as repressive-defensive by two independent methods. Physiological reactivity was operationalized as standardized changes in peripheral temperature, heart rate, and/or skin conductance from baseline to a stressful task. For the stressful task, children spoke into a tape recorder about a stressful or embarrassing event.

RESULTS

Each method classified 20% of children as repressive-defensive. However, of the children classified as repressive-defensive by either method (n = 26), only 38% (n = 10) were classified as repressive-defensive by both methods. In addition, regardless of the classification method, repressive-defensive children did not consistently differ from low-anxious children with respect to physiological reactivity under stress, one of the hallmarks of repressive-defensiveness in adults.

CONCLUSION

These results cast doubt on our ability to measure repressive-defensiveness reliably using self-report measures. Future research should determine whether children and adolescents can be reliably classified as repressive-defensive, whether this classification is related to physiological reactivity as in adults, and whether repressive-defensiveness plays a role in emotionally triggered asthma symptoms.

Thresholds of resistive load detection in children with asthma

Threshold detection of added resistive loads was studied in asthmatic children and compared to data previously obtained in a group of healthy children. The relationships between possible psychological predictors of perceptual ability, the perceptual threshold, and functional morbidity variables were also investigated. Our subjects were 103 children (mean age, 10.9 years) with asthma who completed two laboratory protocols in which they were asked to distinguish breaths with varying degrees of added resistance from unloaded breaths. Using two different computer-driven protocols, resistances were presented as percentages of each child's intrinsic respiratory system resistance (R(rs)). Cognitive ability was assessed through subtests of the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III), and functional morbidity was quantified through a combination of school absences, emergency medical visits, and days hospitalized. Detection thresholds for both protocols were highly correlated with intrinsic resistance (r = 0.49 and 0.66; P < 0.001). Weber fraction thresholds were significantly lower for asthmatic children than healthy controls. Thresholds were not significantly related to either intelligence or pulmonary functional abnormalities due to asthma. Methodologic limitations require cautious interpretation of the results, but we conclude that psychophysical approaches may be useful in the study of symptom perception in pediatric asthma.

Empirically supported treatments of disease-related symptoms in pediatric psychology: asthma, diabetes, and cancer

OBJECTIVE

To review empirical studies of psychological treatments for (1) reducing physical symptoms in children and adolescents with asthma, (2) improving glycemic control in children and adolescents with diabetes, and (3) reducing chemotherapy side effects in children and adolescents with cancer.

METHODS

We identified peer-reviewed studies of effects of psychological treatments for asthma symptoms, diabetes symptoms, and side effects of cancer chemotherapy through computerized databases (i.e., PSYCHLIT and MEDLINE). Treatment approaches are evaluated with respect to meeting criteria for being "promising," "probably efficacious," or "well-established" based on the Chambless criteria (Chambless et al., 1996).

RESULTS

Two well-established treatments (EMG biofeedback for children with emotionally triggered asthma and imagery with suggestion for children undergoing chemotherapy) and two probably efficacious treatments (relaxation for children with emotionally triggered asthma and distraction with relaxation for children undergoing chemotherapy) were identified. Additional research is needed to evaluate the efficacy of treatments for diabetes-related symptoms.

CONCLUSIONS

Future research would be enhanced by identifying characteristics of children who are likely to respond to psychological treatment as an adjunctive strategy for symptom management and by clearly elucidating mechanisms of effect of various interventions.

Social competence among children with central nervous system-related chronic health conditions: a review

Reviewed empirical studies of social competence among children with central nervous system (CNS)-related chronic health conditions published since 1975. The overwhelming majority of studies evaluated social competence at the level of social adjustment; the domains of children's social performance and social skills were relatively neglected (Cavell, 1990). Findings are critiqued with respect to conceptualization of social competence among children with CNS conditions and methodological considerations. Directions for future research include expanding the conceptualization of social competence in this population to include social demands and competencies specific to children with CNS conditions and utilizing explicit theoretical frameworks that allow for competing hypotheses to be tested.

Social competence in children with IDDM and asthma: child, teacher, and parent reports of children's social adjustment, social performance, and social skills

Used Cavell's (1990) model of childhood social competence to compare the social competence in peer relations of 25 children (ages 8-10 years) with insulin-dependent diabetes mellitus (IDDM), 19 children with asthma, and 24 physically healthy children. Children were individually matched for economic status, race, gender, and age. Children, their parents, and their teachers completed measures of children's social adjustment, social performance, and social skills in peer relations. Contrary to hypotheses, no differences between the groups of children were noted on any of the measures of social competence. Results are discussed in terms of the resiliency of children's social competence to these chronic conditions.

AIDS education: the Rhode Island experience

AIDS prevention, by public school education, is designed to change knowledge, attitudes, and future behavior. This study evaluated the impact of a state-mandated educational program on a sample of 2709 adolescents. Changes from pre to posttest were evaluated using standardized change scores and comparisons between the experimental and a delayed education control group were made. The experimental group, but not the control group, changed to a statistically significant degree (p less than .001). They became more knowledgeable, endorsed slightly more tolerant attitudes, and reported an increased intention to avoid intercourse as a means of AIDS prevention. The extent of change was substantially greater for knowledge than for attitudes. Age, gender, and AIDS-related anxiety were found to be significant variables in the AIDS education process. The modest changes observed emphasize that the dissemination of AIDS information by public schools is only the first step in changing adolescent behavior as a means to AIDS prevention and that other, additional approaches are needed.