Reciprocal influences in children's and families' adaptation to early childhood wheezing.

OBJECTIVE: The objective of the present study was to demonstrate the reciprocal relationships between family adaptation to illness and children's medication use over time among children who presented with wheezing illness in infancy but have varying illness outcomes by age 4. DESIGN: A longitudinal design and latent growth curve models (LGM) were used to predict change in family and caregiver adaptation to illness and children's medication use over three years among 140 infants with wheezing, among families from low socioeconomic, multi-ethnic backgrounds. MAIN OUTCOME MEASURES: One LGM predicted level and change (slope) of family adaptation to illness from children's baseline medication use. The second LGM predicted level and change (slope) of children's medication use from baseline family adjustment to illness. In both models, illness severity, caregivers' psychological resources, and emergency department use were covaried with the independent variable. RESULTS: Two latent growth models were found to adequately fit the data and demonstrate full reciprocal relations between family adaptation to illness and children's medication use while accounting for baseline variables. Baseline measures of caregiver psychological functioning and illness severity were also significant predictors of family adaptation and children's medication use over time. The two models were not statistically different for children with and without active asthma at 4 years of age. CONCLUSION: Findings support the reciprocal effects model of child and family influences on pediatric illness and underscore the importance of early indicators of individual and family functioning.     

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.     

Validity of the Five Minute Speech Sample in families with infants from low-income backgrounds

Caregivers of 169 infants from low-income and multi-ethnic backgrounds completed the Five Minute Speech Sample (FMSS). Validity of the FMSS was supported by demonstrating significant associations among positive and negative affect dimensions of the FMSS and other indices of the caregiving environment.     

Children's fantasy play and emotional understanding.

Examined the relation between affective and cognitive processes in fantasy play and emotional understanding. Sixty-six children in the 1st and 2nd grades played with puppets (Affect in Play Scale; Russ, 1993), answered questions about their understanding of emotions (Kusche Affective Interview-Revised; Kusche, Greenberg, & Beilke, 1988), and completed a measure of verbal intelligence (Wechsler Intelligence Scale for Children-III; Wechsler, 1991). The major finding of this study was that consistent, yet modest, relations were found between dimensions of fantasy play and emotional understanding. Cognitive dimensions of fantasy play, but not affect expression, were related to facets of emotional understanding. These relations were independent of verbal ability. A composite fantasy play score accounted for a significant amount of variance in a composite emotional understanding score when verbal ability was accounted for. Variations in the pattern of correlations for girls and boys suggest sex differences in the relation between fantasy play and emotional understanding. Implications for clinical research and interventions are discussed.