Children and Parents: How Do Their Ratings of Asthma Health Compare?

Linda Radecki, Lynn M. Olson, Mary Pat Frintner?Research, American Academy of Pediatrics, Elk Grove Village, IL. Poster presented to the Society for Developmental and Behavioral Pediatrics, 2006.

 

Background: In research and in patient care it is often not clear whom to ask: parent or child? This report compares child and parent reports of asthma health status, examining: a) level of agreement and b) direction of differences. We explore reports by child age and physical versus emotional health.

 

Design/Methods: Parents and children, in separate interviews answered equivalent questions about activities and impact of asthma in the past 2 weeks, including 5-point Likert scale items from Children's Health Survey for Asthma (CHSA). Scales were computed for: a) physical symptoms and b) emotional impact of asthma. Scale scores could range from 0-100; higher scores = better health. Level of agreement examined by % of parents and children who agreed on specific items and weighted kappas. Direction of differences based on paired-sample t-tests comparing parent-child mean scores. Results were examined by child age groups: 7-9, 10-12, and 13-16.

 

Results: 414 parent-child pairs completed the study. 59% of children were male; mean child age = 10.9 years (range = 7-16 years); 46% African American. 42% of families reported annual incomes <$30,000/year. 41% of children had ever been hospitalized overnight for asthma. 53% currently had moderate/severe asthma as rated by parents. Percent agreement between children and parents on individual asthma-related items ranged from 69% to 93%, while kappa scores ranged from .09 to .26. Overall, children rated their asthma physical health (eg, wheezing, sleep disturbance) worse than did their parents (79.2 vs 84.4, p<.001); this pattern was the same in each age group. There were distinct age differences for emotional health, with teenagers (13-16 years) rating their emotional health better than did their parents (79.3 Vs 69.1, p<.001).

 

Conclusions: Child and parent reports differ, with children rating their asthma physical health worse than did their parents. The largest differences between parents and children were found among adolescents, who reported less of an impact of asthma on emotional health than did their parents. The findings underscore the importance of assessing both child and parent reports about symptoms and impact of asthma and other health conditions.