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.
Objectives Examine 1) the extent to which changes in objectively measured asthma-related lung function (FEV1 % predicted) within a sleep period are associated with sleep quality and sleep duration during that sleep period, in a group of urban children with persistent asthma; and 2) associations between morning and evening asthma-related lung function and sleep quality and duration on the adjacent night, and 3) whether these associations differ by ethnic group. Design Cross-sectional, multi-method approach. Children completed a clinic assessment of asthma and allergy status and used home-based objective measurements of asthma-related lung function and sleep. Setting Children and their caregivers participated in a clinic assessment at an asthma and allergy clinic and completed additional assessments at home. Participants Two hundred and sixteen African American, Latino, and non-Latino white urban children, ages 7–9 years, and their primary caregivers. Measurements Participants took part in a clinic assessment of asthma and allergy status, completed interview-based questionnaires including a diary to track asthma symptoms and sleep patterns, and used actigraphy and home-based spirometry daily across a 4-week period to assess sleep and lung function. Results and Conclusions Results from analyses using structural equation modeling revealed an association between worsening FEV1 and poor sleep quality in the full sample, as well as better asthma-related lung function at night and more optimal sleep efficiency that night. Ethnic group differences emerged in the association with morning or nighttime lung function measurements and sleep quality. Urban minority children with asthma may be at heightened risk for poorer quality sleep. Timing of lung function worsening may be important when considering when and how to improve both asthma health outcomes and sleep quality within specific groups.
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