Psychological Impact of Asthma in Children

Kristin A. Kullgren, Ph.D.

Presentation Outline

• Psychological adjustment in children with asthma and their families

• Family correlates of non-adherence

• Time for discussion and questions

Protective Factors That Promote Adjustment in Childhood Chronic Illness

• Temperament• Social support• Peer relationships• Motivation• Problem-solving

skills

• Self-efficacy• Parent adjustment• Family resources• Family cohesion • Low family conflict

Risk Factors for Poor Adjustment in Childhood Chronic Illness

• Low socioeconomic status (SES)

• Major life events

• Poor family functioning

• Longer duration of illness

• Greater functional impairment

• Greater illness severity

Psychological Adjustment in Children With Asthma

• Psychological factors are not initiating causes of asthma

• Asthma is a risk factor for maladjustment

• Maladjustment not more common with asthma vs. other chronic illnesses – 10-35% children with adjustment problems

Psychological Adjustment in Children With Asthma

• Greater risk for internalizing vs. externalizing problems– More symptoms of anxiety than other

chronic illnesses

• 35% with DSM-IV anxiety disorders– Simple phobia– Separation anxiety– Generalized anxiety disorder

Psychological Adjustment in Children With Asthma

• Other issues in kids with asthma & anxiety– Poorer self-esteem– More activity restrictions– Lower social competence

Why Anxiety?

• Similar physiological experience

• When you can’t breathe, its scary!

Psychological Adjustment in Teens With Asthma

• 39% report fearing death from asthma

• 63% report feeling anxious– Social anxiety– Dating anxiety

• Less likely to date

Psychological Adjustment in Teens With Asthma: Importance of Peers

• 39% disclose to friends

• 29% embarrassed to have attack in front of peers

• 38% bring inhaler when leave house– More likely if feel can control asthma– Less likely if embarrassed by asthma

Relationship Between Psychological Adjustment and Asthma Symptoms

• More severe asthma– Higher levels anxiety– More behavior problems

• More behavior problems– More days of wheezing– Poorer functional status

• But it’s a two-way street!

Parenting the Child With Asthma

• Higher levels of criticism with their children• Mothers

– Involved more physically and emotionally

• Fathers – Involved less physically – More critical regarding school absences– More face-to-face contact associated with better

asthma outcomes • 5 hours/day

Psychological Adjustment in Moms of Children With Asthma

• Half report significant depression– Unemployed– Lowest income category– Lower quality of life

• Those w/high depressive symptoms are 40% more likely to take child to ED

Psychological Adjustment in Moms of Children With Asthma

• Caregivers w/clinically significant mental health problems– Children twice as likely to be hospitalized

• Children with greater asthma morbidity – Moms with depressive symptoms– More negative life stressors

• Report >8 undesirable events last year

• Chaotic family life – More hospital admissions asthma

Prevalence of Non-Adherence

• Acute Disease - 30%• Chronic Disease - 50%• Childhood Asthma

– Rates of adherence average around 50%– 28.6% children using meds as prescribed– 41% teens cannot name their medications– Poor adherence related to asthma

exacerbations

Adherence: Patient & Family Correlates

• Demographics

• Knowledge

• Adjustment & coping

• Parental monitoring

• Division of responsibility

• Previous adherence

• Beliefs & expectancies

Adherence: Who’s Doing What?

• Asthma self-management is occurring by ages 4-6

• School or home circumstances vs. developmental readiness – Parent employment status– Independence in other areas

• Children’s inhaler use skills– 60% parents rate child’s skill as excellent– 7% observed to be effective

Adherence: Who’s Doing What?

• Allocation of family responsibilities for asthma– Disagreement between children and

caregivers• Children report more responsibility for

themselves than mothers report • Caregivers overestimate adolescent

responsibility

– Leads to non-adherence and functional morbidity

Adherence: Who’s Doing What?

• Average # of asthma caregivers is > 3– 1/3 with > 4 caregivers

• Responsibility for medication monitoring is often confused– Daycare provider, parent, grandparent,

siblings, child, school

• Need to clarify who does what!

Adherence: Parent Beliefs

• Belief that child is vulnerable– More likely to use regular preventive meds– Take child to doctor– Keep home from school

• Belief that child is not vulnerable– May discontinue medication

Adherence: Parent Beliefs

• Caregivers with negative expectations of their ability to manage asthma– Increased asthma morbidity

• Belief that asthma is episodic vs. chronic

• Negative perceptions of medications

Adherence: Family Functioning

• Poorer asthma adherence – Families with high conflict – High levels of child behavior difficulties

Summary

• Children with asthma are at risk for maladjustment, primarily anxiety

• Parent/family factors can impact asthma morbidity and adherence