By Dr. Larry Chiaramonte
An article recently came to my attention entitled “Common behavioral problems among children with asthma: Is there a role of asthma treatment?” It looked at the usual suspects:
“A diagnostic and statistical manual disorder–referenced symptom inventory was used to assess attention deficit-hyperactivity disorder (ADHD), attention deficit (AD), hyperactivity and impulsivity (HI), and oppositional defiant disorder (ODD) behavioral problems.”
And it found the medications guilty:
“Rather than asthma itself, adjunctive use of ICS+LA therapy appears to be related with symptoms of common behavioral problems, including hyperactivity, AD, ADHD, and ODD and to increase the risk of ODD.”
As I have written previously on this website, and so has Dr. Ehrlich, people have all kinds of reasons to avoid steroids for themselves and their children. They don’t need one more excuse to worry. As with pregnancy, the disease—asthma—is worse than the “cure”.
Is ADHD or oppositional behavior worse than the weeks of absences from school, poor performance in school, and non-participation in sports that come from uncontrolled asthma? There was a reason to take the kid to the doctor in the first place.
The whole alphabet soup of behavioral disorders is extremely subjective. One kid’s ADHD is another kid’s sleep deprivation. Before parents of non-asthmatic kids reach for the Ritalin, they might try turning off the TV and computer in the evening.
As for the recovering asthmatic, let’s look at it from Junior’s point of view for a moment. He’s spent his whole life worried about coughing and wheezing and worse. He hasn’t been able to lead a normal life. Suddenly, he has some relief. He’s energized. He’s more “normal” than he’s ever been. Isn’t it conceivable that some of the “problem” is from adjustment? And what about the parents’ perceptions of the change? All their lives they’ve been taking care of a sick kid. Now he’s functionally much more healthy. Maybe they are having trouble adjusting. Before they worry about “treating” Junior, perhaps they ought to treat themselves.
The family challenges presented by asthma are no different from those of any chronic, relapsing illness. Parents “hover.” Siblings feel cheated out of parental attention. Half a century ago, a visionary physician, Dr. Murray Peshkin, first at Mt. Sinai in New York and later at National Jewish in Denver, recognized the emotional complexity of asthma families and out of that helped develop the field of family therapy. Yet, few families avail themselves of it either when asthma is active or in remission, or food allergies for that matter. Everyone suffers.