Preschoolers with Asthma: Narratives of Family Functioning Predict Behavior Problems

Abstract

This study tested a model predicting behavior symptoms in preschoolers with asthma. Specifically, it examined the role that asthma severity and children's representations of family functioning may play in the development of child behavior problems in a sample of 53 low-income preschoolers. The study included parent report of asthma severity and a narrative story-stem method to assess children's representations of both general and disease-specific family processes. A regression model tested the inclusion of both types of family processes in predicting child internalizing and externalizing behavior. Disease severity and children's family narratives independently predicted children's behavior over and above the combined effects of demographic variables including child age, socioeconomic status, and family structure. Although children's narratives about general family functioning predicted children's behavior, narratives about family response to asthma symptoms did not. Findings support that both disease severity and family functioning are important considerations in understanding children's behavior problems in the context of asthma. Clinical applications of findings may include: (1) Informing family based-assessments to incorporate children's narratives, and (2) A focus on reducing asthma symptoms and strengthening family functioning to prevent or address child behavior problems.

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

“…Specifically, greater asthma physiological threat was associated with more negative appraisals, which in turn were associated with more internalizing symptoms. These paths are in agreement with previous research showing that child appraisals of threat mediate paths between adversity (e.g., interparental conflict) and child internalizing symptoms (Davies & Cummings, 1998; Grych, Harold, & Miles, 2003) and that children’s positive depictions of family functioning in the face of routine family events relate to fewer parent-reported behavior problems (Spagnola & Fiese, 2010). …”

Psychosocial Factors in Pediatric Asthma

“…Or, negative emotions may heighten asthma vulnerability by precipitating physiological derangements (eg, inflammatory processes) and disrupting asthma selfcare routines. 4,9,10,11,28,29 As a more complex alternative, some other intervening variables, such as health-detrimental lifestyle behaviors (eg, smoking and other substance use, physical inactivity, imprudent diets, obesity), may mediate the connection. From this perspective, comorbid psychological problems may increase the odds of unhealthy behaviors, which, in turn, heighten asthma risk.…”

“…Consistent with anecdotal observations, empirical evidence has documented a covariation between parental well-being, family functioning, and pediatric asthma morbidity, especially as disease burden increases. 7,8,11,27,30 In particular, parental emotional distress and dysfunction have been associated with reduced adherence to pediatric asthma regimens, suboptimal symptom control, and greater health care utilization, including emergency room and hospital admissions. || Interestingly, there are tantalizing empirical hints 30 that certain types of parental psychopathology may increase child susceptibility to respiratory (vs other) illness.…”

“…In addition to becoming one of the most common chronic conditions afflicting children, asthma's severity and consequences also have worsened, leading to a concomitant upsurge in the utilization of acute care, emergency room, and inpatient hospital services. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Beyond their significant proximal impact on child health, persisting asthma symptoms hinder regular school attendance and constrain age-appropriate social interactions (eg, participation in sports and other peer activities) with potentially adverse repercussions on developmental processes and outcomes. Indeed, these illness-imposed departures from normative childhood experiences heighten risks for delayed mastery of age-relevant tasks and downstream psychosocial maladaption.…”

“…3,8,12,17,18 As an illustrative case in point, asthma health disparities have been well documented, with the socioeconomically and culturally disenfranchised being disproportionately affected. [3][4][5]11,13,19,20 However, as complex umbrella variables, designations such as social class and minority status subsume myriad influences, including health literacy, beliefs and behaviors, access to resources, and other contextual contributors. 3,7,[21][22][23] Accordingly, evidence-based consideration of these psychosocial factors is a necessary prerequisite to comprehensive asthma management.…”