A study of relationships between family situation, bronchial asthma, and personal adjustment in children

Summary The first phase of a research project on childhood asthma carried out jointly by allergists at the University of Michigan Medical Center and child psychiatrists at Hawthorn Center is described. The focus of the present investigation is the relationship between family psychological situation and the child's asthma situation. Seventy-one children with chronic bronchial asthma and their families were studied to test the following hypothesis: A study of asthmatic children and their families will reveal a positive relationship between the asthma situation (onset, severity, response to treatment) and the family situation (quality of family relationships, identification opportunities, and care and handling). As a control a second hypothesis was tested: A study of the same group of children and their families will reveal a positive relationship between level of disturbance in the child's personality and/or behavior, and level of disturbance in family relationships, and care and handling. The patients were drawn from the regular office and clinic patients of practicing allergists. The asthma situation was studied with emphasis on severity, course, and response to medical management over a period of at least 2 years. Psychiatric study involved individual interviews with each parent and with each patient and systematized recording of findings. Seventy-one variables relating to family situation, the child's adjustment, and asthma situation were recorded for statistical analysis. Three statistical assessments of the data were made: 1. Exploration of relationships between variables. No significant relationships between variables of the family situation and those of the child's asthma are found. In contrast, there is frequent occurrence of significant correlation of variables of the family situation and those of the child's adjustment. Thus the first hypothesis is not supported, while the second hypothesis is strongly supported. 2. Comparison of 2 subgroups representing extremes of family adjustment, including relationships, stability, and child care. The 20 families showing best adjustment and the 20 families showing poorest adjustment are compared on 23 variables including those dealing with severity of asthma and response to treatment. The independent grouping of subjects is confirmed by consistently significant contingencies for all variables concerned with family adjustment. The first hypothesis is not supported; no differences are found between the 2 extreme groups on the asthma variables. The second hypothesis is strongly supported; there is positive relationship between family pattern and child personality and adjustment. 3. Three groups differentiated on the basis of good, moderate, and poor family situation are compared on the changes shown in severity and response to treatment from initial to follow-up status. None of the 3 groups shows significant differences from each other in pattern of changes. All these statistical explorations lead to the conclusion that, in the areas of severity of asthma and response to treatment, no relationships with family situation are demonstrable. On the other hand, close relationships between family situation and child's adjustment are consistently demonstrated by the findings. Child psychiatry is seen to have a selective role in the treatment of the asthmatic child. Routine referral is unnecessary. On the other hand, the disturbed asthmatic child requires psychiatric help, and medical-psychiatric treatment is clearly indicated for a good many of the parents. The deciding factor is not the child's asthma but the emotional status of both child and family, with the recognition that the asthma may add new problems requiring therapeutic intervention through the coordinated efforts of allergists, child psychiatrists, and case workers.