WASHINGTON — Inner-city children with persistent asthma appear to have more problems with negative social skills, anxiety, and shyness than children without asthma, according to data presented at the annual meeting of the Pediatric Academic Societies.
“Children with persistent asthma symptoms had significantly more behavior problems across several domains, compared to children with no asthma symptoms,” said Jill S. Halterman, M.D., of the University of Rochester in New York.
Dr. Halterman and her colleagues looked at the relationship between asthma and behavior in all kindergarten children in the city of Rochester school district in 2003. At the beginning of that school year, parents completed a detailed health and development survey assessing the child's background, behavioral functioning, and medical history—with specific questions about asthma symptoms.
Children were included if they were older than 4 years but younger than 6 years at the time of the survey, making a total of 1,619. Black children accounted for 60% of the survey population; Hispanic children accounted for 22%. A majority of the children (59%) received Medicaid insurance.
Asthma status—no asthma, intermittent asthma, or persistent asthma—was determined from parent responses to three questions about asthma symptoms. The criteria for these three categories were based on the National Heart, Lung, and Blood Institute's guidelines for defining asthma severity. Seven percent of the children had intermittent asthma, and 8% had persistent asthma.
Using 12 items on the survey, a child's behavioral functioning was assessed using a 1–4 scale in four areas—positive and negative peer social skills, task orientation, and shyness/anxiety.
There was no difference between the three asthma groups for average positive peer social skills scores, but children with persistent asthma had worse scores for negative peer social skills than children with intermittent asthma or no asthma. Children with persistent asthma also had worse scores than the other two groups for task orientation skills and had higher scores for shyness/anxiety.
More than 20% of children in the persistent asthma group had worse scores (one standard deviation or greater) on two or more behavior measures, compared with 16% of those with intermittent asthma and 10% of those with no symptoms. Children with persistent symptoms were two times more likely than those without symptoms to score more than one standard deviation worse on two or more of the scales.
Multivariate regression analysis was used to evaluate the independent relationships between asthma status and the behaviors. There was no significant association among children with intermittent asthma and negative behaviors. “For children with persistent asthma, a significant association was shown for negative peer and shy/anxious scores,” said Dr. Halterman, speaking at the meeting also sponsored by the American Pediatric Society, the Society for Pediatric Research, the Ambulatory Pediatric Association, and the American Academy of Pediatrics.