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Behavior Problems Antecede the Development of Wheeze in Childhood: a Birth Cohort Study.
Calam R, Gregg L, Simpson A, Simpson B, Woodcock AA, Custovic A
Am J Respir Crit Care Med. 2005;171(4):323-7.
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Abstract
Rationale: It is not clear to what extent behavior problems observed in children with asthma antecede asthma development, or are a consequence of the disease.Objectives: We investigated psychological factors at age 3 years andsubsequent development of wheeze by age 5 in an unselected birth cohortstudy. Children were recruited prenatally, followed prospectively andreviewed at age 3 and 5 years. Measurements and Main Results: The rate ofsignificant behavior problems at age 3 years (above clinically relevantcut-off on Eyberg Child Behavior Inventory) was compared between childrenwho had never wheezed (n=397) and those developing late-onset wheezing(after age 3 years; n=39). Late-onset wheezers were more likely to beabove cut-offs for behavior problems at 3 years (before wheeze onset)compared to children who never wheezed, on Intensity (23.1% vs. 6.0%,p<0.001) and Problem scores (10.8% vs. 1.3%, p<0.001). Families oflate-onset wheezers had poorer scores on family functioning variables, butwe found no evidence of increased anxiety or depression scores in parents.In the multivariate analysis, significant and independent associates oflate-onset wheeze were: maternal asthma (odds ratio 5.4, 95% confidenceintervals 2.1-13.8, p<0.001), maternal smoking when child was aged 3years (3.3, 1.2-8.7, p=0.02), expressiveness (0.71, 0.55-0.9, p=0.005) andsignificant behavior problems at age 3 years (3.5, 1.2-9.9, p=0.02).Conclusions: Behavior problems in early life are associated with increasedrisk of subsequent development of wheeze.