University of Georgia

Secure parental relationships help kids with asthma

photo of UGA psychologist Katherine Ehrlich
Research led by UGA psychologist Katherine Ehrlich reveals that for children with asthma, having a reliable attachment figure is associated with fewer asthma symptoms, better family asthma management, and a less inflammatory immune response to pathogens. (Photo by Joe Ehrlich)

A secure parental relationship helps children with asthma function better, according to research led by University of Georgia psychologist Katherine Ehrlich.

The study, published in Child Development, revealed that children’s secure base perceptions—their evaluation of a caregiver’s availability and responsiveness during times of need—were associated with fewer asthma symptoms, better family asthma management, and a less inflammatory immune response to pathogens.

“Children’s perceptions of caregivers as a secure base have been linked with socioemotional outcomes, but little is known about connections to physical health,” said Ehrlich, assistant professor in UGA’s Franklin College of Arts and Sciences. “Our results suggest that families, and specifically parents, can do a lot to help their kids manage asthma symptoms.”

Participants in the study included 308 children aged 8–17 who were physician-diagnosed with asthma and accompanied by one parent. Researchers used data from three sources:

  • children’s perceptions of their mothers as a secure base and their self-reports of their asthma symptoms
  • an interview with children and parents that evaluated factors including asthma knowledge, living with asthma and environmental control
  • an in vitro assessment of how children’s immune cells responded to pathogen exposure

They also controlled for a variety of factors, including medication use, children’s depressive symptoms and severity of asthma.

Children who perceived their mothers as a secure base reported fewer asthma symptoms and limitations. In contrast, as children reported more depressive symptoms and parental hostility, they reported experiencing more asthma symptoms and limitations.

The interviewers found that children’s secure base perceptions were generally associated with the family’s knowledge about asthma. In addition, children’s perceptions of their parents were linked to how interviewers rated families’ ability to keep up with the demands of managing children’s disease.

“These findings are telling, because what they suggest is that children who view their mothers as a secure base are living in homes where family members are vigilant about monitoring children’s symptoms, are quick to respond to breathing problems that arise, use medications appropriately, and feel comfortable following up with doctors when needed,” Ehrlich said. “And they do all of this while also juggling the other demands in their lives.”

There was no association between children’s perceptions of their mothers as a secure base and environmental control. This finding was not totally unexpected, according to Ehrlich, because many families are limited in the kinds of actions they can take to reduce children’s exposures to irritants. For instance, families who are renting apartments typically cannot remove carpet from children’s bedrooms, and children might be unavoidably exposed to smoke outside the home.

The in vitro assessment of the children’s immune systems began with a blood draw, after which the researchers isolated the children’s white blood cells, exposed them to various pathogens and examined the extent to which cells mounted an inflammatory response. Results indicated that representations of mothers as a secure base were associated with lower production of Th2 cytokines, signaling molecules that promote excessive mucus production and airway constriction.

“Collectively, these findings suggest that confidence in the availability of a caregiver might promote better behavioral strategies—like taking medication and asking for help—and in turn, these behaviors could reduce the likelihood of exacerbations in inflammatory responses that worsen asthma symptoms,” Ehrlich said.

Overall, the team’s findings suggest that attachment representations may play an important role in health outcomes, including children’s asthma symptoms, management of asthma and inflammatory processes.

“We’re excited to demonstrate the unique role of having a reliable attachment figure within the context of asthma,” Ehrlich said. “There are other asthma studies that show the role of family and parent factors in other domains. Here, we’re extending the literature by showing that when kids feel like they can depend on their parent, they report better quality of life and seem to have immune systems that are less ‘ramped up.’”

Co-authors include Gregory E. Miller, Cynthia Levine, Deanna Williams, Van Le and Edith Chen at Northwestern University, as well as Madeleine Shalowitz and Rachel Story at NorthShore University Health Systems.