PEDIATRICS Vol. 90 No. 5 November 1992, pp. 808-815
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Behavioral Consequences of Illness: Childhood Asthma as a Model

Thomas L. Creer PhD1, Ruth E.K. Stein MD2, Leonard Rappaport MD3, and Charles Lewis MD, ScD4

1 From the Department of Psychology, Ohio University, Athens
2 From the Department of Pediatrics, Albert Einstein College of Medicine, New York, NY
3 From the The Children's Hospital, Boston, MA
4 From the Division of General Internal Medicine, University of California, Los Angeles

Several areas of research on childhood asthma are discussed within a transactional model of asthma. The model emphasizes the multidirectional influences that affect the severity of asthma and associated behavioral disability. The initial focus is on how the clinical presentation and morbidity of asthma are affected both by somatic predisposition and by interactions with multiple internal and external elements. Specific elements include emotional factors, neuroimmunology, temperament, and medication side effects. Second, the impact of asthma on the child, his or her family, and segments of the community are described, as are consequences of the disorder on quality of life. Third, there is a synopsis of preventative interventions for reducing the medical and behavioral impact of childhood asthma. The motif is that the interaction of medical and behavioral procedures can improve the management of asthma while consequences of the disorder are mollified. Finally, as examples of a transactional model of asthma, selfmanagement programs for teaching children to become partners with their physicians in establishing and maintaining control over the disorder are described. A representative of self-management—the ACT (Asthma Care Training) program—is described, along with the impact such programs have on children, their families, and institutions. The conclusion emphasizes that asthma is a complicated and unpredictable disorder that puzzles physicians, behavioral scientists, and patients. Although new treatments may be over the horizon, controlling childhood asthma and its consequences currently rests on the cooperation and increased interaction of medical and behavioral scientists

Key Words: asthma • behavior • illness

Submitted on July 22, 1991
Accepted on May 15, 1992




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