Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample

Abstract

OBJECTIVE. Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.METHODS. In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1-4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes. RESULTS.A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, Ͼ20% scored Ͼ1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.CONCLUSIONS. Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma. A STHMA IS THE most common chronic illness of childhood, 1-3 and hospitalization rates are increasing. [4][5][6] In the United States, impoverished children and children from minority ethnic and racial backgrounds suffer disproportionately from asthma. [7][8][9][10][11][12][13] The morbidity associated with asthma is extensive and includes emergency department visits, 6,14,15 hospitalizations, 4,5,16 and cost, 17,18 as well as less traditional factors, including impaired quality of life 19 and absenteeism. 20 In addition, co-existing medical conditions [21][22][23] as well as psychiatric conditions 24,25 now are considered issues that both children and adults with asthma face.Several studies have documented the relationship between asthma and psychosocial problems, with the suggestion that significant comorbidity exists for some children. A recent meta-analysis 26 demonstrated...

The Impact of Asthma and Allergic Diseases on Schoolchildren: Are They at Increased Risk of Absenteeism and Poor School Performance?

“…A good proportion of the parents of asthmatic children compared to parents of non-asthmatic children, indicated that their children had behavioral problems like anxiety (65.3% vs. 42.8%), exam fear (77% vs. 70.1%), shyness (44.1% vs. 29.3%), anger (50.1% vs. 34.7%), violent behaviour (19.3% vs. 9.6%) and fights among peers (32.6% vs. 21.3%). (Table 10) Similar to our study findings on the behavioural problems of school children with asthma, Halterman et al (2006) indicated that those children with persistent asthma scored worse on peer interactions and task orientation and were more likely to exhibit shy and anxious behaviors compared with non-asthmatic children. Mcquaid et al (2001) reported that associations between asthma and reading problems, grade repetition, learning disabilities and behavioral problems were observed in asthmatic children.…”

Pediatric asthma and problems in attention, concentration, and impulsivity: Disruption of the family management system.

“…Children with asthma are at increased risk for internalizing problems such as anxiety and depression (e.g., Goodwin et al, 2004) and, to a lesser degree, externalizing problems (e.g., more disruptive behavioral issues such as oppositional defiant behavior or impulsivity, McQuaid et al, 2001). Furthermore, children with more severe or persistent asthma symptoms are at greater risk for behavioral difficulties, as indexed by global ratings of behavioral and emotional problems (such as oppositional behavior and depressive symptoms; Halterman et al, 2006;McQuaid et al, 2001;Wamboldt, Fritz, Mansell, McQuaid, & Klein, 1998) Psychiatric comorbidity, or even behavioral symptoms that are below threshold for psychiatric diagnosis, may be important factors in disrupting family asthma management. The presence of comorbid behavior problems and/or reported depressive symptoms in children with asthma is associated with more frequent and prolonged hospital admissions (Kaptien, 1982), and more functional impairment due to asthma (Gustadt et al, 1989).…”

Asma, competência social e transtornos comportamentais em crianças e adolescentes

“…Devem, portanto, estar aptos a reconhecer a ansiedade que freqüentemente acompanha a asma, bem como estabelecer um vínculo de confiança com o paciente e com a família, que favoreça o manejo da doença e de todas as dificuldades a ela associadas (Gavin, Wamboldt, Sorokin, Levy & Wamboldt, 1999;Halterman et al, 2006;Katon, Richardson, Lozano & McCauley, 2004).…”