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In Childhood Asthma, Dr. Bruce G. Bender demonstrates his approach to counseling children with asthma so as to reduce the behavior that exacerbates this respiratory condition. Dr. Bender uses a family-management approach to treat young clients with asthma. Because a child lives within a family system, it is important to involve parents and other family members in assessment and treatment.
In the session on this video, Dr. Bender works with an 18-year-old girl named Kate who has had asthma since she was 8. As a young child, she also had problems with ear infections and her hearing. Kate is inconsistent with her medication: She takes it when she feels in poor health but stops taking it as soon as her health improves.
He meets with the client and her mother and performs a thorough assessment of the client's living situation, family life, medical history, and interactions with doctors. He then helps her determine ways to live with asthma and provides advice on making better use of available services.
An integrated and comprehensive approach to psychological treatment for children with poorly controlled asthma must focus on (a) the entire family system and (b) the entire range of behaviors required for effective asthma management. Adherence in asthma involves not only taking medications on time and using good technique but also working in partnership with a physician, having good environmental controls of asthma triggers, and recognizing and treating asthma symptoms when they occur. Because the required behaviors are complex and because families are so varied, individualized assessments of barriers that impede effective asthma management must precede the design of a treatment tailored to overcome those barriers.
Central to a family asthma management approach is a behaviorally focused assessment conducted with the parents together with the asthmatic child. This assessment includes an analysis of the family system and, in particular, the problem areas that serve as barriers to good asthma management. The assessment focuses on all aspects of the child's asthma, such as symptom patterns, triggers, monitoring of symptoms, medications prescribed, decision-making processes regarding administering medications, the relationship with the physician, and the distribution within the family of asthma-related tasks. The family's knowledge of asthma and management behaviors, their capacity to follow through with illness management procedures, and deficiencies undermining asthma control are determined.
An exploration of the family's existing asthma management system often uncovers impediments to more effective management. The family's current behavior deficits may be related to a lack of knowledge about asthma, counterproductive health beliefs or attitudes, organizational problems that prevent adherence, or interpersonal or relational difficulties. It is also not uncommon to discover more systemic problems, such as parent–child interaction problems, spousal conflict, limited intellectual abilities, or financial limitations.
Bruce G. Bender, PhD, is head of the Division of Pediatric Behavioral Health at the National Jewish Medical and Research Center in Denver, Colorado, where he oversees the delivery of mental health services in the Department of Pediatrics and runs the pediatric neuropsychology testing service.
Dr. Bender is the recipient of the 2002 Outstanding Scientific Achievement Award from the National Jewish Medical and Research Center and is a member of the American Thoracic Society and the American Academy of Allergy, Asthma, and Immunology. He is also a professor of psychiatry at the University of Colorado School of Medicine.
Dr. Bender's research program includes investigations into the neuropsychological side effects of medications used to treat allergies and asthma, treatment adherence, health care behaviors that moderate asthma treatment effect, and the impact of chronic illness on psychological functioning.
- Apter, A. J., Reisine, S. T., Affleck, G., Barrows, E., & ZuWallack, R. L. (1998). Adherence with twice-daily dosing of inhaled steroids: Socioeconomic and health-belief differences. American Journal of Respiratory and Critical Care Medicine, 157, 1810–1817.
- Bender, B., Milgrom, H., & Rand, C. (1997). Nonadherence in asthmatic patients: Is there a solution to the problem? Annals of Allergy, Asthma, and Immunology, 79, 177–86.
- Klinnert, M. D., McQuaid, E. L., & Gavin, L. A. (1997). Assessing the family asthma management system. Journal of Asthma, 34 (1), 77–88.
- Kotses, H., & Harver, A. (Eds.). (1998). Self-management of asthma. New York: Marcel Dekker.
- Wilson, S. R., Mitchell, J. H., Rolnick, S., & Fish, L. (1993). Effective and ineffective management behaviors of parents of infants and young children with asthma. Journal of Pediatric Psychology, 18, 63–81.
- Wright, R. J., Roidriguez, M., & Cohen, S. (1998). Review of psychosocial stress and asthma: An integrated biopsychosocial approach. Thorax, 53, 1066–1074.
- Zimmerman, B. J., Bonner, S., Evans, D., & Mellins, R. B. (1999). Self-regulating childhood asthma: A developmental model of family change. Health Education and Behavior, 26, 55–71.
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