Psychological Impact of Asthma in ChildrenKristin 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
Temperament Social support Peer relationships Motivation Problem-solving skills Self-efficacy Parent adjustment Family resources Family cohesion Low family conflict Protective Factors That Promote Adjustment in Childhood Chronic Illness
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