The Excitation-Adaptation Model of Pediatric Chronic Illness

This article examines the value of the psychosomatic family model for the study of chronically ill children. Four conceptual problems arise in the discussion of this model: the unidirectional causality of the model; the function of the sick child for the family system; the pathology of the family characteristics; and the disease type. In the present study, we propose (a) that a distinction be made between uncontrolled and controlled forms of disease, and (b) that the family characteristics of "cohesion" and "adaptation" be examined in relation to the parental capacity for problem solving and the acceptance or rejection of the child by the parents. This is shown by means of empirical research. In this empirical study, 20 families with a child suffering from controlled asthma are compared with 20 families with a child suffering from uncontrolled asthma. Contrary to the assumptions derived from the psychosomatic family model, the results show significantly more cohesion and structure in the group with a child suffering from controlled asthma. The findings from this study are integrated in a new model for the study of chronic childhood illness —"the excitation-adaptation model." In this model, two circular processes are emphasized involving (a) the progress of the illness and the way in which parents and child deal with medication and medical advice (therapy compliance), and (b) the factors influencing the therapy compliance on the part of the parents, the family, and the child. By studying these factors in connection with the management of the illness, it should become clear whether family characteristics are adaptive or pathological.     

Concensus Rorschach interaction patterns of families with an asthmatic child

This paper reports a study of interaction in families with a child suffering from bronchial asthma. Eighteen families, subdivided into two groups according to the severity of the child's illness, were given the Consensus Rorschach following Willi's procedure. Quantitative assessments of family members on cognitive-affective functioning and social interaction were obtained. Factor analysis of quantitative scores revealed diversified interactional strategies among family member groups. Families as wholes varied as to patterns of cross-generational alliances and/or domination of different family members and could be clustered into four interactional pattern groups. There was no correlation between this grouping and the severity of the child's illness. Some measures of cognitive-affective functioning differentiated between family members of asthmatics from the two severity subgroups. The correspondence of these findings to prevailing family theories of psychosomatic illness is discussed.     

Parental Overprotection,Perceived Child Vulnerability,and Parenting Stress: A Cross-Illness Comparison

The current study sought to investigate differences in parenting capacity variables across four disease groups. Parents (N = 425), the majority of whom were mothers, of children with either cancer, asthma, Type 1 diabetes, or cystic fibrosis, completed measures of parental overprotection, perceived child vulnerability, and parenting stress. After controlling for significant demographic variables, parents of children with cystic fibrosis and asthma reported higher perceived child vulnerability than parents of children with either diabetes or cancer, while parents of children with asthma and diabetes reported higher parenting stress than parents of children with cancer or cystic fibrosis. No differences between disease groups were found for parental overprotection. The current study provides support for an illness-specific approach to understanding parenting capacity variables in the context of childhood chronic illnesses.     

Patterns of adaptation in asthma and psoriasis

Patterns of adaptation to a conflict situation were explored by means of the repeated confrontation with the Stroop task (Serial Color-Word Test) in two clinical groups: bronchial asthma (n=40) and psoriasis (n=28). The respective psychosomatic component of each of these syndromes was expected to correspond to peculiar patterns of adaptation. Differences between asthma and psoriasis patients were statistically significant. Asthma was characterized by patterns with high values of nonlinear change, both within each subtest (Primary Types) and across the five subtests (Secondary Types). Psoriatic patients were classified most often as having the C(V) type (high linear increase of nonlinear changes across the subtests) and showed some more ITA+ types, i.e., within the first subtest, longer reading time at the beginning, followed by uniformly faster times.     

Temperamental Differences Between Healthy,Asthmatic, and Allergic Children Before Onset of Illness: A Longitudinal Prospective Study of Asthma Development

The authors investigated the link between children's temperament and the development of asthma and allergies. Prospective longitudinal data on children at the ages of 3-5 months, 3-5 years, and 7-9 years were collected. At age 7-9 years, analyses were performed on data for 3 groups of children (n = 42): those with asthma (no allergies), those with allergies (no asthma), and those with neither asthma nor allergies (the control group). Data for children who developed asthma or allergies prior to age 7-9 years were not analyzed. Differences were found in the premorbid period between the control group and the children who later developed asthma or allergies as well as between the asthma and allergy groups. After onset of illness, no temperamental differences were observed between the 3 groups. The study shows the importance of longitudinal design for asthma research.     

Factor specific differences in locus of control for emotionally disturbed and normal children.

The Nowicki-Strickland Locus of Control Scale for Children was given to 20 normal and 20 emotionally disturbed children to investigate the differences between the two groups on self-reported locus of control. The locus of control score and scores for each separate factor were calculated. Separate analyses of variance indicated that emotionally disturbed children did not differ from normals on overall locus of control nor on four of the five factors. However, one factor, Helplessness, differentiated the two groups with emotionally disturbed children endorsing more Helplessness items. The results are discussed in terms of factor specific methodology and in regards to the clinical relevance of Helplessness as a key factor.     

Negative Thoughts in Children with Symptoms of Anxiety and Depression

This study examined whether negative thoughts are different in anxious, depressed, and chronically ill children. Screening of 1,316 children on anxiety, depression, and asthma resulted in the selection of 118 children. Four groups were formed: (1) a high anxiety group, (2) a high anxiety/depression group, (3) an asthma group, and (4) a low anxiety, low depression, and no chronic disease (control) group. The data yielded no pure depression group. Subsequently, the Negative Affectivity Self-Statement Questionnaire (NASSQ) and a Worry scale were administered. Results showed that cognitive scores were different in all groups. Highest scores were obtained from the high anxiety/depression group, and lowest from the control group. Children with asthma scored high on anxiety, not on depression. High correlations between scores on negative thoughts and conventional measures of negative emotions suggested that negative thoughts provided no unique information about the problems underlying emotional states in different groups of children. Implications for cognitive assessment in emotionally disturbed children are discussed.     

The Discriminative Power of Szondi's Quotient of Tendency Tension

The Nowicki-Strickland Locus of Control Scale for Children was given to 20 normal and 20 emotionally disturbed children to investigate the differences between the two groups on self-reported locus of control. The locus of control score and scores for each separate factor were calculated. Separate analyses of variance indicated that emotionally disturbed children did not differ from normals on overall locus of control nor on four of the five factors. However, one factor. Helplessness, differentiated the two groups with emotionally disturbed children endorsing more Helplessness items. The results are discussed in terms of factor specific methodology and in regards to the clinical relevance of Helplessness as a key factor.     

Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

Perception de la maladie et adhérence thérapeutique chez des enfants asthmatiques

This study had two objectives. The first one was to adapt and validate the Revised-Illness Perception Questionnaire (IPQ-R) for children and their parents. The second one was to assess the influence of parent's and children's asthma perception and parent's involvement in treatment on adherence among children suffering asthma. One hundred and forty-six asthmatic children (8–12 years old) and ninety-two parents completed the Revised-Illness Perception Questionnaire and a therapeutic adherence scale. Children who have a good understanding of their illness and who think that their treatment control their asthma, have a better therapeutic adherence. The originality of this research lies in the use of the Illness Perception Questionnaire among children; this could be used in other chronic pediatric diseases.     

Change in the moving bodymind: Quantitative results from a pilot study on the use of the BodyMind approach (BMA) to psychotherapeutic group work with patients with medically unexplained symptoms (MUSs)

Background: This article reports quantitative results from a pilot study in primary care (PC) undertaken from 2004–2007. The intervention programme, derived from movement psychotherapy, was termed ‘Learning groups: the BodyMind approach (BMA),’ and emphasised a verbal and non-verbal integrated model, awareness of the inter-relationship between body and mind and a self-managing framework. Aim: To evaluate systematically the outcomes of a 12-week group BMA intervention programme with patients suffering from anxiety/depression with at least one chronic (over two years) medically unexplained symptom (MUS), another term for a psychosomatic condition or somatoform disorder. Method: A mixed method was applied to a single-case design. Outcome measures completed at baseline, mid-, post- intervention and three-month follow-up were the Measure Yourself Medical Outcome Profile (MYMOP) and the Counselling Outcome Routine Evaluation (CORE). Results: Increased activity levels and well-being; more effective coping/functioning strategies; reduction in anxiety/depression, GP-consultation and medication usage, and symptom distress. All changes were maintained at three-month follow-up.     

Coping Strategies and Locus of Control as Mediating Variables in the Relation Between Exposure to Political Life Events and Psychological Adjustment in Israeli Children

The relation between political life events and distress was examined with particular emphasis on coping strategies and locus of control as two possible mediators. Subjects were 88 Israeli children. Results partially supported a linear relation between reported impact of exposure and distress. Findings for coping strategies as a mediator suggested, counterintuitively, that greater use of coping strategies is related to more experienced distress. Findings for locus of control as a mediator suggested that subjects with external locus of control experience greater distress, other than in the case of depressive symptomatology. These results indicate that coping strategies and locus of control play a complex role in the stress-outcome relation, the precise nature of which remains to be resolved. Theoretical, clinical and political implications of the findings are discussed.     

Psychopathology in Children with Thalassemia Major

The present work investigated the prevalence and spectrum of psychopathology in children with thalassemia. Childhood psychopathology measurement schedule (CPMS), adapted from Child Behavior Checklist was administered on children with thalassemia major receiving regular blood transfusion. Age and sex matched children with other chronic illness (bronchial asthma) served as controls. 46.7% of children with thalassemia had a CPMS score of > 10 as against 17.1% in the control group. Children with thalassemia had higher scores in factors of conduct problems, special symptoms and somatization. This study highlights the significantly higher psychopathology in children with thalassemia major and emphasizes the need for psychosocial support during treatment.     

Objectifying the effect of autogenic training on disordered ventilation in bronchial asthma]

Forty-one persons suffering from asthma (aged 20 to 55; duration of disease: greater than or equal 2 years) were divided into 2 groups and participated in courses of instruction in autogenic training. The control group was comprised of 14 patients. The effects of autogenic training on the maximum rate of expiration as well as the limiting respiratory value were recorded. The control group showed a seasonal decrease in the maximum rate of expiration and the limiting respiratory value by 10 to 20% in the period extending from April through November. The autogenic-training patients showed a temporally similar increase in the maximum rate of expiration of 27 and 22%, respectively (the difference to the control group being 47 and 42%, respectively). In 35 patients the increase in the limiting respiratory value was equal to or greater than the effect produced by novodrine. Catamnesis after one year (n = 40): Absence from work in a twelve-month period was 663 days prior to autogenic training and 77 days (11.6%) subsequent to autogenic training. Accordingly, autogenic training may be considered to be an objectively effective component of a combination of therapeutical methods used in the treatment of bronchial asthma.     

Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.     

The "psychosomatic family" model: an empirical and theoretical analysis

Evolution of the Family Systems Paradigm has been constrained by the dichotomy between theory building and empirical research. This article integrates these two domains by presenting a theoretical analysis of the "psychosomatic family" model as it informs and is informed by an empirical research project. Forty families of children with Crohn's disease (CD), ulcerative colitis (UC), and functional recurrent abdominal pain syndrome (RAP) were rated during standard, videotaped family interaction tasks, lunch, and interview. Laboratory scores of disease activity were associated with triangulation, marital dysfunction, and total "psychosomatic family" scores. Disease activity was not significantly correlated with enmeshment, overprotection, rigidity, conflict avoidance, or poor conflict resolution. Thus, the marital/triangulation and enmeshment/overprotection/conflict clusters may be subcomplexes of the "psychosomatic family" complex. CD, UC, and RAP groups differed in the relations among particular family patterns and disease activity. A heuristic family-psycho-somatic model is presented to facilitate future research.     

Asthma in children of Caribbean descent living in the inner-city: comparing Puerto Rican and Afro-Caribbean children

Ethnic minority children bear a disproportionate amount of the US asthma burden. We compared asthma morbidity and pulmonary function (%FEV₁) in two Caribbean groups living in the Bronx, NY: Puerto Rican and Afro-Caribbean children. Caregiver-child dyads (Puerto Rican: n = 113, M age = 9.89 ± 2.05; Afro-Caribbean: n = 47, Mage = 10.35 ± 2.08) responded to sociodemographic and asthma-related questions, and children’s %FEV₁ was measured. Puerto Rican children had significantly greater (past year) asthma morbidity, yet there were no significant differences in %FEV₁. This discrepancy between objective pulmonary function and asthma morbidity suggests the importance of considering sociocultural factors in pediatric asthma care.     

Temperamental differences between healthy,asthmatic, and allergic children before onset of illness: a longitudinal prospective study of asthma development

The authors investigated the link between children's temperament and the development of asthma and allergies. Prospective longitudinal data on children at the ages of 3-5 months, 3-5 years, and 7-9 years were collected. At age 7-9 years, analyses were performed on data for 3 groups of children (n = 42): those with asthma (no allergies), those with allergies (no asthma), and those with neither asthma nor allergies (the control group). Data for children who developed asthma or allergies prior to age 7-9 years were not analyzed. Differences were found in the premorbid period between the control group and the children who later developed asthma or allergies as well as between the asthma and allergy groups. After onset of illness, no temperamental differences were observed between the 3 groups. The study shows the importance of longitudinal design for asthma research.     

Emotional competence and quality of life of children with asthma: The mediating effect of coping strategies

This study explored the mediating effect of coping strategies on the relationship between emotional competence (EC) and quality of life (QOL) among children with asthma. Participants were 87 children (M age?=?11.72, SD?=?2.58) with controlled and partially controlled asthma, undergoing everyday treatment. They filled in questionnaires assessing EC, coping strategies and QOL. Results showed that the association between some ECs and the QOL of children with asthma was fully mediated by two maladaptive cognitive coping strategies. Among children with asthma, a greater ability to differentiate their emotions, a reduced attention to bodily signals of emotions and a reduced analysis of their current emotional state were related to decreased engagement in two coping strategies (‘Ignoring Asthma’ and ‘Worrying about Asthma’), which in turn increased their QOL. These findings show that EC has an indirect effect on QOL through very specific coping strategies. They also emphasise the importance of screening EC in children with asthma and the importance of developing and using multidisciplinary interventions for them.     

小儿支气管哮喘和胃食管返流关系的哲学思考

支气管哮喘是当今世界上最常见的气道慢性炎症性疾病,运用哲学的观点认识小儿支气管哮喘与胃食管返流之间的关系,对于支气管哮喘合并胃食管返流的临床治疗非常重要.