Halterman Jill S, Conn Kelly M, Forbes-Jones Emma, Fagnano Maria, Hightower A Dirk, Szilagyi Peter G
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital at Strong, Rochester, New York, USA.
Pediatrics. 2006 Feb;117(2):e192-9. doi: 10.1542/peds.2005-1140.
Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.
In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1-4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes.
A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.
Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.
以往研究提示儿童哮喘与行为问题之间存在关联。然而，很少有研究使用基于社区的样本评估有哮喘症状的城市儿童中行为问题的患病率。本研究的目的是评估内城区儿童人群中哮喘症状与行为之间的关系，并确定有哮喘症状儿童中行为共病的患病率。
2003年，罗切斯特市即将进入幼儿园的儿童的家长完成了一项关于孩子背景、病史（有关于哮喘症状的具体问题）和行为的详细调查。我们比较了无哮喘症状、间歇性症状和持续性症状的儿童在积极的同伴社交技能（如容易交朋友）、消极的同伴社交技能（如与其他孩子打架）、任务导向（如注意力集中）和害羞/焦虑行为（如孤僻）方面的情况（经过验证的量表；范围：1 - 4）。我们使用多变量回归来确定症状严重程度与行为结果之间独立的关联。
共纳入1619名儿童（应答率：80%；平均年龄：5.1岁），15%有哮喘症状（8%为持续性，7%为间歇性）。与有间歇性症状和无症状的儿童相比，有持续性哮喘症状的儿童的平均消极同伴得分更差（平均得分：1.88、1.70和1.65）。在任务导向评估（2.85对3.03）和害羞/焦虑行为评估（2.11对1.89）方面，有持续性症状的儿童得分也比无症状的儿童差。在有持续性哮喘症状的儿童中，超过20%在2个或更多量表上得分低于平均水平1个标准差以上，相比之下，有间歇性症状的儿童为16%，无症状的儿童为10%。
与无症状儿童相比，有持续性哮喘症状的城市儿童在多个领域表现出更多行为问题。这些发现表明，对于易患哮喘的儿童，迫切需要一种早期的生物心理社会护理方法。
