Parenting Stress, Difficult Child Behavior, and Use of Routines in Relation to Adherence in Pediatric Asthma

Association of caregiver health beliefs and parenting stress with medication adherence in preschoolers with asthma

“…Contrary to our hypothesis, our findings do not suggest that parenting stress as a function of personal parental characteristics or difficult child behavior was significantly associated with medication adherence in preschool-aged children. Thus, the current study fails to extend to preschool children the findings of DeMore and colleagues [11], which demonstrated that these types of parenting stress significantly predicted ICS adherence as measured by a dose monitor in children aged 8-12 years. Perhaps because school-aged children have more responsibility in taking their ICS, children who exhibit more difficult behavior may also be more rebellious regarding taking their medication.…”

“…Consistent with asthma-related adherence research [9,10,11,13], objectively measured medication adherence was poor in this sample and was subjectively over-reported by caregivers [28,29]. Contrary to our hypothesis, our findings do not suggest that parenting stress as a function of personal parental characteristics or difficult child behavior was significantly associated with medication adherence in preschool-aged children.…”

“…When measured objectively by electronic monitors, McQuaid and colleagues [10] found that adherence to ICS in children with asthma aged 8-16 years was 48%, while DeMore and colleagues [11] found that adherence to ICS in children aged 8-12 years was 67%. Preschool children require parental administration of medication, yet adherence also is poor [12].…”

“…Difficult child behavior may adversely affect parental adjustment and increase parental demands related to following an asthma treatment plan. Parenting stress related to both parental characteristics and difficult child behavior has been significantly and inversely related to adherence to asthma medication in school-aged children [11]. Additionally, increased asthma-related hospitalizations have been associated with high caregiver life stress [18].…”

Family processes in pediatric asthma

“…In another study of a similar population, asthma symptom severity was associated with caregiver anxiety rather than depression or overall distress [14]. In contrast, greater parenting stress was predictive of higher levels of adherence to dry powder inhaler controller medication for a sample of white children from a rural state [15], suggesting that the relationship between caregiver stress and asthma outcomes may depend on factors such as socioeconomic status or neighborhood context.…”