Association of Hypothalamic-Pituitary-Adrenal Axis Function with Neuropsychological Performance in Children with Mild/Moderate Asthma

The present study examines the relationship between hypothalamic-pituitary-adrenal (HPA) axis function and child psychological/neuropsychological function in a group of children with mild to moderate asthma. The goal of the study was to determine whether child neuropsychological functioning and psychological functioning were associated with cortisol production in response to adrenocorticotropic hormone(ACTH) stimulation when assessed as area under the curve. Data for this study were gathered from 63 children who participated in an ancillary study within the Childhood Asthma Management Program (CAMP) during the pre-randomization phase of the CAMP trial. At 2 of the 8 CAMP clinical centers participants completed an ACTH stimulation test after an overnight stay in the General Clinical Research Center. Gender differences on baseline cortisol and change in cortisol 30 minutes after infusion of ACTH were present. Results further indicated significant associations between cortisol production and measures of child neuropsychological function. Stepwise multiple regression analysis revealed that cortisol change could be predicted by measures of gender, working memory, and arousal maintenance, providing support for the hypothesis that cortisol plays a modest role in the neuropsychological function of children with mild and moderate asthma. In contrast, cortisol production was not associated with child reports of psychological functioning. Limitations to the methods employed in this study are discussed.     

The Value of Research Methods in Psychotherapy Research: A Reply to the Commentary of Dr Norton

Norton's commentary on our article has prompted us to think further about the purpose of psychotherapy research. We agree with his suggestion that researchers have much work to do to understand when and for whom interventions are most efficacious. We hope that our field will make progress in this regard. In this reply, we further describe why we believe careful attention to research methods, such as those highlighted in our article, is key to making progress in psychotherapy research.     

Predictors of repeat hospitalizations in children with asthma: the role of psychosocial and socioenvironmental factors.

This study examined relationships between psychosocial factors and asthma rehospitalization patterns in 115 children (ages 4-15) who had > or = 1 hospitalization during the study period. Lifetime history of hospitalizations and new hospitalizations during a 1-year follow-up period were measured, controlling for baseline asthma symptoms and medications. Prospectively, caretaker characteristics (lower sense of mastery, being less emotionally bothered by asthma) predicted greater likelihood of future asthma hospitalizations. Lifetime history of hospitalizations was associated with family impacts (greater family strain and family conflict greater financial strain) as well as caretaker characteristics (greater personal strain, beliefs about not being able to manage one's child's asthma). These findings could help guide future interventions targeted at the subgroup of children who represent a high proportion of asthma hospitalizations.