ABSTRACT
The psychological, social, and educational consequences of this disease are significant (22,23). As with other chronic conditions, asthma presents a financial burden to the family, restricts the child's physical activities and development, impairs the child's development of social connections and adaptive resources, and contributes to general disruption in the family (24). Asthmatic children are absent from school on more days than other children, and their participation in school-related activities, including sports, is restricted (25). Still, the psychological ramifications of chronic childhood asthma are neither obvious nor universal. Many asthmatic children have no psychosocial difficulties. Two early studies of the psychological adaptation of asthmatic children concluded that psychological disorders were not significantly increased in this population (26,27). More recently, Nassau and Drotar (28) reported a study of childhood social competence in 25 children with insulin-dependent diabetes mellitus, 19 children with asthma, and 24 physically healthy children, matching across groups for economic status, race, gender, and age. Parents, teachers, and the children themselves completed measurements of the children's social adjustment and social skills. Finding no differences between groups on the social competence scales, the authors concluded that the resilience of many chronically ill children may protect them from social debilitation secondary to their illness. Kashini et al. (29) also reported social competence unaffected in asthmatic children. However, research in this arena continues to be equivocal, as suggested by the findings of epidemiological
While these studies suggest that many asthmatic children do not suffer from psychological disturbance, the relationship between illness and psychological adaptation remains complex. Although generally free of marked psychopathology, asthmatic children may experience some impediment to their psychological growth and development. Many studies of psychological functioning in asthmatic children have employed the Child Behavior Checklist (CBCL) (30), a standardized questionnaire regarding behavior problems that is filled out by the parent, usually the mother. Studies using the CBCL have frequently found that asthmatic children were elevated on the composite "internalizing" scale, indicative of anxious, depressed, and overcontrolled behavior, but usually not on the "externalizing" scale (24,31). In most studies that have found more problems among asthmatic than nonasthmatic children, the reported mean differences are small. Although the scores of asthmatic groups are invariably at least slightly higher than those of comparison groups, the mean scores of asthmatic groups are usually within a few points of the comparison group's mean and not in a clinically abnormal range. Observing these small elevations in the problem behavior scores of asthmatic children, Hamlett et al. (24) concluded that these findings indicate problems of adaptation or adjustment but not psychological problems in a clinically significant range.
