Asthma

Asthma is the most common childhood chronic illness. The Centers for Disease Control and Prevention reported in 1998 that 3.8 million children had at least one asthma attack per year. Asthma is an inflammation of the cells in the bronchial passages, which causes the airways to be hypersensitive to respiratory irritants, such as allergens, exercise, viral infections, and emotional responses (e.g., laughing and crying). When exposed to these irritants, an exaggerated airway response, or “asthma attack,” occurs, resulting in the passages narrowing or becoming obstructed from mucus buildup. During this physiological response, the child has rapid shallow breathing, tightness in the chest, and wheezing or coughing. Although physiologically based, asthma is exacerbated by environmental factors (e.g., air pollution and second-hand smoke) and psychological factors (e.g., stress). Sensitivity to [Page 28]these triggers varies as does the frequency and severity of attacks. Therefore, the child's doctor should be consulted before restricting activities and exercise. Asthma medications increase lung capacity and decrease sensitivity to allergens. These treatments include long-term medications to reduce the reactivity and sensitivity of the airways and quick relief medications to control acute attacks.

Compared to their healthy peers, children with asthma at times have problems with decreased adherence to the medication regimen that can further impact the severity of their asthma. Therefore, good control of asthma often requires psychological as well as medical interventions. Psychological interventions for children with asthma typically include disease and treatment education, increasing medication compliance, stress management, and improvement of family interactions. The education component focuses on increasing the child's self-efficacy for controlling the disease and learning how to avoid triggers of attacks. Improved adherence can be achieved by reducing barriers to treatment, clarifying expectations and roles, and behavioral strategies of contracting and reinforcement. Stress management including relaxation therapy can improve the child's physiological response to the symptoms.

Asthma can adversely affect academic functioning directly (e.g., side effects of the medication and increased school absenteeism) and, for some, increase the risk for behavior problems and peer interaction difficulties. Medication side effects should be monitored to balance health benefits with possible negative academic impact. School attendance for children with chronic illnesses is linked to the attitude of the teachers and to the resources provided by the school administration. In response, some schools provide asthma education and training programs for teachers and other school personnel. Additionally, having classmates who are well educated about a peer's condition provides what may be the most effective support and incentive for attending school.

School psychologists may become involved in evaluating academic performance and medication side effects; assisting the child's adjustment or adherence to treatment regimens; and consulting with teachers, staff, and parents. Additionally, they can monitor for the possible development of asthma-related behavior disorders.