Asthma severity, child security, and child internalizing: Using story stem techniques to assess the meaning children give to family and disease-specific events.

Abstract

Children with persistent asthma are at increased risk for mental health problems. Although mechanisms of effect are not yet known, it may be that children are less trusting of the family as a source of support and security when they have more severe asthma. This study tested whether asthma severity is related to children’s perceptions of insecurity in the family, and whether insecurity is in turn associated with child adjustment. Children (N = 168; mean age = 8 years) completed story stems pertaining to routine family events (e.g., mealtimes) and ambiguous but potentially threatening asthma events such as tightness in the chest. Responses were evaluated for the extent to which appraisals portrayed the family as responding in cohesive, security-provoking ways. Asthma severity was assessed by both objective lung function testing and primary caregiver report. Caregivers reported child symptomatology. Beyond medication adherence, caregiver education, and child age and gender, greater asthma severity predicted more internalizing and externalizing symptoms. Greater asthma severity, assessed using spirometry (but not parent report), was related to less secure child narratives of the family, which in turn related to more child internalizing symptoms. Results suggest that asthma can take a considerable toll on children’s feelings of security and mental health. Furthermore, given the difficulty in assessing young children’s perceptions, this study helps demonstrate the potential of story stem techniques in assessing children’s appraisals of illness threat and management in the family.

Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma

“…Asthma severity has been linked to the emotional responses of children who have asthma (Bender & Zhang, 2008; Blackman & Gurka, 2007; Feldman et al, 2013; Katon et al, 2007; Richardson et al, 2006; Waxmonsky et al, 2006; Winter, Fiese, Spagnola & Anbar, 2011; Wood et al, 2007; Wood et al, 2008; Wood et al, 2006). In general, the literature presents a positive or direct relationship between asthma severity and the increase of internalizing, or anxious and depressive symptoms in children.…”

“…Child self-reported anxiety predicted missed school days due to asthma (a factor often used to identify asthma severity), OR = 1.068, 95% CI [1.004, 1.136], and child self-reported depression predicted missed school days due to asthma OR = 1.065, 95% CI [1.006, 1.127] (Bender & Zhang, 2008). Greater asthma severity was found to be positively and significantly related to greater child internalizing symptoms and positively, though non-significantly related to greater child externalizing symptoms (Winter et al, 2011). Strong associations have been reported between asthma severity, number of asthma symptoms, and asthma symptom days and the emotional responses of children who have asthma (Bender & Zhang, 2008; Blackman & Gurka, 2007; Katon et al, 2007; Richardson et al, 2006; Waxmonsky et al, 2006; Winter et al, 2011; Wood et al, 2008).…”

“…Greater asthma severity was found to be positively and significantly related to greater child internalizing symptoms and positively, though non-significantly related to greater child externalizing symptoms (Winter et al, 2011). Strong associations have been reported between asthma severity, number of asthma symptoms, and asthma symptom days and the emotional responses of children who have asthma (Bender & Zhang, 2008; Blackman & Gurka, 2007; Katon et al, 2007; Richardson et al, 2006; Waxmonsky et al, 2006; Winter et al, 2011; Wood et al, 2008). Findings from these studies align with a systematic literature review of asthma severity and child QOL in pediatric asthma which reported direct correlations between asthma severity and child QOL in 9 out of 14 studies (Everhart & Fiese, 2009).…”

“…Asthma severity has been positively linked with depressive and anxious symptoms in many studies of childhood asthma (Bender & Zhang, 2008; Blackman & Gurka, 2007; Feldman et al, 2013; Katon et al, 2007; Richardson et al, 2006; Waxmonsky et al, 2006; Winter et al, 2011; Wood et al, 2006, 2007, 2008). In a study of 48 children, ages 8–12 ( n = 27 with asthma, n = 21 without asthma; 75% Black non-Hispanic, 23% Hispanic, 2% American Indian), asthma status was defined as either having a physician diagnosis of asthma, or having no chronic illness.…”

Introduction to special section of the Journal of Family Psychology, advances in mixed methods in family psychology: Integrative and applied solutions for family science.

“…The addition of a mixed methods design to program evaluation may save time and money for family researchers conducting large randomized clinical trials. Similarly, Winter, Fiese, Spagnola, and Anbar (2011) had children with asthma complete story stems relating to routine family events in everyday life such as meals. They then coded these for how secure the child felt about the family and its support.…”