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Developmental and Behavioral Comorbidities of Asthma in Children

Blackman, James A. MD, MPH*; Gurka, Matthew J. PhD

Journal of Developmental & Behavioral Pediatrics: April 2007 - Volume 28 - Issue 2 - p 92-99
doi: 10.1097/01.DBP.0000267557.80834.e5
Original Article

Objective: Asthma is the most common chronic childhood illness. Treatment is typically focused on disease management rather than developmental and behavioral comorbidities that may affect quality of life or contribute to poor disease control. The purpose of this study was to explore the prevalence of developmental and behavioral comorbidities of asthma and the role of confounding socioeconomic factors.

Methods: The first National Survey of Children’s Health was the data source for this study. Interviews with parents or guardians were conducted during 2003–2004 to ascertain the physical, emotional, and behavioral health of 102,353 randomly selected children ages 0–17 years. Associations were examined between asthma and rates of developmental and behavioral problems. Logistic regression was used to adjust for potential confounding effects of age, gender, race, income, and parent education on outcomes.

Results: Children with asthma have higher rates of attention-deficit/hyperactivity disorder; diagnoses of depression, behavioral disorders, learning disabilities; and missed school days (all p < .0001). The more severe the asthma is, the higher the rates are of these problems. Children with asthma are bullied more commonly and are more likely to abuse drugs. When socioeconomic factors are controlled for, asthma significantly increases the odds of having developmental, emotional, and behavioral problems.

Conclusions: Children with asthma, especially severe asthma, are at high risk of developmental, emotional, and behavioral problems. Asthma is independently associated with these problems, although socioeconomic disadvantage adds additional risk. Asthma treatment programs must acknowledge and address these comorbidities to achieve the best overall outcomes for children with this common chronic disease.

From the *Department of Pediatrics, Division of Developmental Pediatrics, School of Medicine and †Department of Public Health Sciences, Division of Biostatistics and Epidemiology, School of Medicine; University of Virginia, Charlottesville, VA.

Received July 2006; accepted January 2007.

The research was funded in part by NIH/NICHD/NCMRR grant R24HD39631.

Address for reprints: James A. Blackman, M.D., M.P.H., Kluge Children’s Rehabilitation Center and Research Institute, University of Virginia, 2270 Ivy Road, Charlottesville, VA 22903; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.