Background: The purpose of this study is to compare emotional and behavioural problems between preadolescent children with asthma and healthy children, and to explore if disease factors relate to problem scores. Design: This was a cross-sectional study of 59 children, 34 boys and 25 girls, aged 7-9 years with mild (n = 11), moderate (n = 38) or severe (n = 10) asthma. A normative sample of 306 children in the same age range, 150 boys and 156 girls, was used as a comparison group.Methods: Parents assessed emotional and behavioural problems using the Child Behaviour Checklist. Peak expiratory flow rate and urinary eosinophil protein X were used as measures of lung function and inflammation. Children were interviewed about activity restriction and symptoms during the last week using the Paediatric Asthma Quality of Life Questionnaire. Parents scored day,night and exercise-induced symptoms during the same week. Results: On average, children with asthma were attributed more problems than healthy children of the same age and comparable family socio-economic status. Effect sizes were 0.80 (95% confidence interval 0.52-1.09) for total problems, 0.89 (0.60-1.18) for internalizing problems and 0.67 (0.38-0.95) for externalizing problems. The relative risk for children with asthma exceeding the 95% cut-offpoint for total problems was 4.2 (2.1-8.3) compared to healthy children. Conclusion: Children with parent-reported exercise-induced asthma symptoms were attributed more total problems than asthmatic children without such symptoms. Parent-reported day symptoms and child report of symptoms and restricted activities related with problem scores to a lesser degree. Objective measures of lung function and inflammation were not related to problem scores. Concurrent eczema increased problem scores. It is concluded that asthma in preadolescent children is associated with emotional and behavioural problems. Special attention should be paid to children reported to have exercise-induced symptoms.
1. McQuaid EL , Kopel SJ , Nassau JH . Behavioral adjustment in children with asthma: a meta-analysis . J Dev Behav Pediatr2001; 22: 430-439 .
2.
2. Cohen J . Statistical power for the behavioral sciences, second edition. Hillsdale: L. Erlbaum Associates , 1988.
3.
3. Bender BG , Annett RD , Ikle D , DuHamel TR , Rand C , Strunk RC . Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families.CAMP Research Group . Arch Pediatr Adolesc Med2000; 154: 706-713 .
4.
4. Wennergren G , Strannegard I-L . Asthma hospitalizations continue to decrease in schoolchildren but hospitalization rates for wheezing illnesses remain high in young children . Acta Paediatr2002; 91: 1239-1245 .
6. Juniper EF , Guyatt GH , Feeny DH , Griffith LE , Ferrie PJ . Minimum skills required by children to complete health-related quality of life instruments for asthma: comparison of measurement properties . Eur Respir J1997; 10: 2285-2294 .
7.
7. Solymar L , Aronsson PH , Bake B , Bjure J . Nitrogen single breath test,flow-volume curves and spirometry in healthy children, 7-18 years of age . Eur J Respir Dis1980; 61: 275-286 .
8.
8. Larsson B , Frisk M . Social competence and emotional/behaviour problems in 6-16 year-old Swedish school children .Eur ChildAdolesc Psychiatry1999; 8: 24-33 .
9.
9. Anonymous. Swedish socioeconomic classification. Stockholm: Statistics Sweden , 1995.
10.
10. Bames PJ , Godfrey S . Asthma and wheezing in children. London:Martin Dunitz , 1997.
11.
11. National Heart, Lung and Blood Institute . Global initiative for asthma:guidelines for the diagnosis and management of asthma. NationalInstitute of Health pub no 97-4051. Bethesda, MD , 1997.
12.
12. Lugosi E , Halmerbauer G , Frischer T , Koller DY . Urinary eosinophil protein X in relation to disease activity in childhood asthma . Allergy1997; 52: 584-598 .
13.
13. Juniper EF , Guyatt GH , Feeny DH , Ferrie PJ , Griffith LE , Townsend M . Measuring quality of life in children with asthma . Qual Life Res1996; 5: 35-46 .
14.
14. Reichenberg K , Broberg AG . Quality of life in childhood asthma: use of the Paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7 to 9 years old . Acta Paediatr2000; 89: 989-995 .
15.
15. Reichenberg K . U-EPX and severity of asthma . Allerg2000; 55: 1091-1092 .
16.
16. Achenbach TM . Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry , 1991.
17.
17. Klinnert MD , McQuaid EL , McCormick D , Adinoff AD , Bryant NE . Amultimethod assessment of behavioral and emotional adjustment in children with asthma . J Pediatr Psychol2000; 25: 35-46 .
18.
18. Asher MI , Keil U , Anderson HR et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods . Eur Respir J1995; 8: 483-491 .
19.
19. Fennessy M , Coupland S , Popay J , Naysmith K . The epidemiology and experience of atopic eczema during childhood: a discussion paper on the implications of current knowledge for health care, public health policy and research . J Epidemiol Community Health2000; 54: 581-589 .
20.
20. Wamboldt MZ , Fritz F , Mansell A , McQuaid EL , Klein RB . Relationship of asthma severity and psychological problems in children .J Am Acad Child Adolesc Psychiatry1998; 37: 943-950 .
21.
21. Townsend M , Feeny DH , Guyatt GH , Furlong WJ , Seip AE , Dolovich J . Evaluation of the burden of illness for pediatric asthmatic patients and their parents . Ann Allergy1991; 67: 403-408 .
22.
22. French DJ , Christie MJ , West A . Quality of life in childhood asthma:development of the Childhood Asthma Questionnaires. In Christie M , French D eds. Assessment of quality of life in childhood asthma. Chur:Harwood Academic Publishers , 1994: 157-180.
23.
23. Rietveld S . Symptom perception in chronic asthma: learning for better or worse?Adv Psychosom Med2003; 24: 115-130 .
24.
24. Reichenberg K , Broberg AG . Children with asthma. Few adjustment problems is related to high perceived parental capacity and family cohesion . Nord J Psychiatry2004; 58: in press.
25.
25. Panditi S , Silverman M . Perception of exercise induced asthma by children and their parents . Arch Dis Child2003; 88: 807-811 .
26.
26. Lara M , Duan N , Sherbourne C et al. Differences between child and parent reports of symptoms among Latino children with asthma .Pediatrics1998; 102: E68-E68 .
