Anxiety in Youth with Asthma

The aim of this thesis was to undertake a comprehensive investigation into the comorbidity of childhood asthma and anxiety. The research comprised of four studies, and used multiple methods to answer the research questions, including two meta-analyses and two empirical studies, one qualitative and the other quantitative. The first empirical chapter was a meta-analytic review aimed to provide an up to date comprehensive analysis of the literature investigating the prevalence of anxiety disorders in children and adolescents with asthma, and comparing anxiety disorders and symptomatology in young people with asthma, compared to those without (Submitted, Pediatric Pulmonology). Results showed that there is strong, quantified, support for the presence of anxiety in children with asthma and, for the first time, support for the presence of specific anxiety disorders. Despite the high anxiety prevalence rates reported in Study 1, little is known about why some children with asthma develop anxiety. The second study was a qualitative inquiry aimed at developing a model to aid understanding of the impact asthma has on a child and their parents, specifically as it may relate to the development or maintenance of anxiety (Submitted, Patient Education and Counseling). Results showed that the way in which parents and children with asthma adjust is determined in part by the circumstances around diagnosis, the availability of knowledge and skills and the severity of the condition. Where there was difficulty adjusting to the illness, hypervigilance and associated parental behaviours, similar to those seen in people with anxiety, were reported. The extent to which these behaviours were adaptive or maladaptive related to the level of their child’s asthma control. Experimentally, hypervigilance to threat is measured through paradigms such as attentional bias tasks. The purpose of Study 3 (Clinical Psychology Review, 2015, 40, 66- 75) was to provide a meta-analytic review of attentional bias research to examine whether children with anxiety demonstrate an attentional bias to threat-related information, compared to children without anxiety. Results showed that, overall, children with anxiety displayed significantly greater attentional biases to threat-related stimuli, compared to controls and that biases were moderated by participant and experimental factors. Finally, the fourth study (Submitted, Journal of Abnormal Child Psychology) sought to determine whether children with comorbid asthma and anxiety demonstrate attentional biases to threat-related or asthma-related stimuli. Results showed that attentional biases did not differ between the groups investigated, thus there was no evidence that anxiety in children with asthma was associated with threat- or asthma-related attentional biases. However, a significant association was found between poor asthma control and attentional bias towards asthma stimuli. This result is important as it suggests that attentional biases may be adaptive in children with asthma if their asthma is poorly controlled. Taken together, this research has expanded our understanding of anxiety in children with asthma. There is strong, quantified, support for presence of anxiety in children with asthma and, for the first time, support for the presence of specific anxiety disorders. Additional important contributions include the development of a model to understand how asthma impacts the child and parents, preliminary evidence to suggest that the attentional mechanisms involved in maintaining anxiety in children with comorbid asthma may be different to those in a healthy child population and evidence of adaptive biases to health- related information. Future researchers should continue to investigate this comorbidity further by using the model to guide psychosocial interventions, by understanding the role of asthma control in anxiety and also determining what the mechanisms are that underlie anxiety in youth with asthma, with the ultimate aim of providing effective preventative and treatment programs for these children