Anxiety, Asthma, and Parental Influence: More Complicated Than Researchers Expected

A collaborative study between Psychology and Pediatric Respiratory researchers in Australia uncovered surprising and complex links between children with asthma, parental influence, and anxiety disorders.

According to lead researcher Caroline Hunt, PhD, Associate Head of the University of Sydney's Clinical Psychology Department, past studies have determined that children with asthma are three times more likely than non-asthmatic children to develop anxiety disorders, and those suffering from a combination of asthma and anxiety disorders are more likely to interpret ambiguous scenarios as threatening, but little has been done to analyze the root of that anxiety.

The clinical study by Hunt and colleagues sought to understand how, and to what degree, parental interpretation biases affected children with asthma and anxiety disorders. Insight on the relationship between parents, children, and asthma-related anxiety, could help psychologists create more effective focused treatment for anxiety disorders in this population.

Several studies in the late 1990s attempted to locate the link between anxiety disorders and interpretation bias in children as a whole with mixed results, but determined that interpretation bias and family processes did have a role in "the development and maintenance of child anxiety."

Anxiety disorders are prevalent in many patients with chronic illnesses, which create a pattern of catastrophic thinking and manifest in clear avoidance tactics. In the case of children with asthma, the group predicted that children could be picking up on subtle verbal and behavioral cues from parents, inadvertently adopting their interpretation biases, particularly if the parents suffer from anxiety as well.

Hunt points out that sensitivity to "breathlessness" within normal bounds (for example, a result of active playing) may be misinterpreted or confused by both parents and children as a sign of "imminent physical threat" in patients with asthma. As a result, children with asthma may "overestimate threat in situations in which they experience asthma-like symptoms, triggering a vicious cycle where children engage in avoidance (e.g. missing school) or safety behaviors (e.g. taking medication), which may exacerbate and/or maintain their anxiety and asthma symptoms."

The study focused on 89 parent-child dyads across four groups of children between the ages of 8-13: children with asthma and anxiety, children with anxiety only, children with asthma only, and healthy children. Children with asthma were "monitored by optimal and stable respiratory medications and experienced no recent (i.e. less than one month) exacerbations in their asthma symptoms resulting in hospital admission." Children in the anxiety groups had received a "primary diagnosis of an anxiety disorder."

Participants were asked to complete an "ambiguous scenarios task" with six scenarios: four ambiguous "general threat" scenarios, and two ambiguous "asthma specific" scenarios.

Children responded to "general threat" scenarios such as "you are walking to a friend's house and a big dog comes up," and asthma-specific scenarios such as "you wake up in the morning and notice you have a cough" by answering a series of questions based on interpretation of the situation, possible outcomes, and personal response to the situation.

Parents were asked to predict how their child would interpret and respond to the scenarios. Parents and children were asked to discuss the scenarios before the child decided on an appropriate response, and a researcher blind to the child’s medical diagnoses recorded the responses.

The team discovered that although there seemed to be no significant differences between the interpretations of the "general threat" scenarios across all four groups, children with anxiety tended to offer slightly more avoidant solutions to the scenarios. Children's anxiety status, rather than asthma status, was associated with "higher parental predictions of threat interpretation and avoidance scores in general threat scenarios."

Children with asthma were more likely to interpret ambiguous asthma related scenarios (waking up with a cough, or being out of breath while playing) as immediate threat scenarios. Hunt and fellow researchers were surprised to learn; however, that the "immediate threat" interpretation of asthma related scenarios held true for both the groups of children with asthma regardless of anxiety disorder diagnoses.

Researchers concluded that their study ultimately "appears to provide support for the role that parents play in children's problem-solving strategies" and suggest that avoidance may be "reinforced in families with anxious children" regardless of asthma diagnosis.

Although results did not support the group's prediction that children’s interpretations were influenced by parental anxiety, the results tentatively suggested that increased anxiety in children might be affecting parental anxiety levels.

The final results of the study showed that the relationship between parent and child anxiety levels is more complicated than expected. Hunt suggested that because of the surprising results of the study, treatment programs should strive to include treatment of parents, and "aim to target and modify interpretation biases" in both parent and child to prevent or decrease anxiety in children with asthma. Inclusion of parents in treatment could play a crucial role in overall anxiety treatment for children with asthma, but future studies are needed to determine more about the complex interplay of anxiety and parent-child relationships.

The article, "Threat interpretation and parental influences for children with asthma," was published in the February 2017 issue of Behavior Research and Therapy.

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