Indian Pediatrics 2001; 38: 1328-1330  

Reply

We thank Dr. Gupta for the comments made on our recently published article(1) and have the following response to offer:

1. Several studies in the literature have indicated that illness related variables do not predict psychosocial functioning in children with asthma (2-5). For example, Perrin et al.(4) found no relationship between an objective measure of asthma severity and psychosocial problems but they did find that parental perceptions of mild or severe asthma were associated with higher rates of child behavior problems. In a recent study, Wamboldt et al.(5) found ashthma severity, as rated by two pediatric asthma specialists, had no relationship with child’s report of symptoms of anxiety. It has been suggested in the literature that any chronic illness places strain on the family and this strain is the key factor which determines whether the ill child suffers from psychosocial problems in addition to medical problems(5). In the present study also illness related variables such as duration of illness, age at onset were not significantly correlated with any of the three psychological measures. However, number of wheezing/coughing episodes was negatively correlated only with child’s adjustment score and not with either child’s self concept or psycho-pathology score. Therefore, poor control of symptoms was not related to poor psychosocial functioning across the board. Further, it remains to be seen whether control of disease would emerge as a significant predictor of psychosocial adjustment in children with asthma when family related variable such as family functioning and maternal stress are added in the predictive equation.

2. Regarding the point that medications used to treat asthma may have had an adverse behavioral affect, it is important to keep in mind that research on impact of medica-tion used to treat asthma on behavioral and/or cognitive changes in children with asthma has been inconclusive. While some studies have reported that theophylline negatively affects behavior and cognition(6,7) others have reported no relationship(8,9). It is possible that only a small sub group of children with asthma may be particularly susceptible to behavioral side effects linked to drugs (10) and, therefore, to suggest that behavioral difficulties reported by mother’s of children with asthma is attributable only to drug intake, may not be completely warranted. However, we do agree that more details regarding the medical management of children with asthma would have provided useful additional information.

3. Psychosocial adjustment in children with asthma was operationalized by three measures. Two child reported measures were Self Concept and Adjustment while the parent’s reported on child’s behavioral and emotional functioning. All these three are dependent variables and none of these qualify for potentially modifiable protect-ive measures. Therefore, computing intercorrelations among these measures, as suggested by Dr. Gupta, would not shed light on the variables that would promote better overall adjustment in children with asthma. Some of the protective factors which have been found to predict significant amount of variance in childs’ psychosocial adjustment include family functioning and social support variables(11,12).

4. The main emotional and behavioral problems reported by parents, in order of importance are mentioned in the paper on page 526, column 2 last paragraph. These include both internalizing and external-izing symptoms. Finally, our findings suggest that attention simply to the medical control of the disease will not address the full range of problems of children with asthma. Interventions aimed at alleviating the emotional and behavioral problems will go a long way in improving the overall quality of life of children and adolescents with asthma.

Prahbhjot Malhi,
Lata Kumar,
Meenu Singh,
Department of Pediatrics,
Advanced Pediatric Center, Postgraduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.

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9. Lindgren S, Lokshin B, Stromquist A, Weinberger M, Nassif K, Mc Cubbin M, et al. Does asthma or treatment with theophylline limit children’s academic performance. N Engl J Med 1992; 327: 926-930.

10. Creer TL, Stean REK, Rappaport L, Lewis C. Behavioral consequences of illness: Childhood asthma as a model. Pediatrics 1992, 90: 808-815.

11. Levigne J, Faier-Routman J. Correlates of psychological adjustment to pediatric physical disorders: A meta-analytic review and comparison with existing models. J Dev Behav Pediatr 1993; 14: 117-123.

12. Malhi P, Kumar L, Singh M. Effects of family functioning and temperament on psychosocial adaption of children with asthma. Ann Allergy Asthma Immunol 1998; 82: 124.