Intellectual, cognitive, and academic performance among sons of alcoholics, during the early school years: differences related to subtypes of familial alcoholism

BACKGROUND: Research on intellectual and cognitive functioning of children of alcoholics has been marked by inconsistency, with some studies unable to document deficits. This discrepancy may reflect the substantial heterogeneity found in the alcoholic population and among families of alcoholics. The current study sought to examine the effects of familial alcoholism subtypes on intellectual, cognitive, and academic performance in early school-aged sons of alcoholics. METHODS: Subjects for the present study were 198 elementary-age boys who were participants in the larger MSU-UM Longitudinal Study. Familial alcoholism subtypes were determined based on fathers' alcoholism and antisocial personality disorder diagnoses. Intellectual functioning was measured with the Wechsler Intelligence Scale for Children-Revised (WISC-R); academic achievement was measured with the Wide Range Achievement Test-Revised. In addition, Mazes and Freedom from Distractability factor scores of the WISC-R were used to assess abstract planning and attention abilities. RESULTS: Children of antisocial alcoholics (AALs) displayed the worst IQ and academic achievement compared with children of nonantisocial alcoholics (NAALs) and controls. In addition, children of AALs displayed relatively poorer abstract planning and attention abilities compared with children from control families. Regression analyses revealed that familial alcoholism subtype continued to account for variance in child intellectual ability even when other factors were excluded. CONCLUSIONS: Findings indicate that children from AAL families are most susceptible to relative intellectual, cognitive, and academic deficits. The study further supports the proposition that familial risk characteristics (i.e., paternal alcoholism and antisociality) may serve as effective indicators of family risk for poor intellectual outcome among offspring as early as the elementary school years.     

Overt Behavior Problems and Serotonergic Function in Middle Childhood Among Male and Female Offspring of Alcoholic Fathers

A large body of literature indicates that the serotonergic system is involved in behavioral regulation, as evidenced by the inverse relationship between impulsive aggression and serotonergic function found in adult alcoholics and nonalcoholics. However, studies of this relationship among child and adolescent offspring of alcoholics (COAs) have not previously been done. This study examines the potentially parallel relationship between behavioral dysregulation and low serotonergic function in young COAs. The relationship is of potential interest as a phenotypic marker of biological vulnerability to aggressiveness, which itself has been hypothesized to be a risk factor for later antisocial alcoholism. The present work is part of an ongoing prospective study of the development of risk for alcohol abuse/dependence and other problematic outcomes in a sample of families subtyped by the fathers' alcoholism classification. We examined the relationship between overt behavior problems in middle childhood (mean age = 10.5 ± 1.7 years) and whole blood serotonin (5-HT) in a subsample of the offspring ( N = 32 boys and 12 girls). Using a Child Behavior Checklist (CBCL) index of behavioral under-control, we obtained results indicating that high total behavior problem (TBP) children had lower levels of whole blood 5-HT than did low-TBP children ( p < 0.01). These results support the hypothesis that there is an inverse relationship between whole blood serotonin levels and behavior problems in young male and female COAs. A father's alcoholism status was not significantly related to his child's 5-HT level, i.e., the child's phenotypic expression of behavioral dysregulation was more reliably connected to serotonergic function than was paternal alcoholism.     

Alcohol Schema Acquisition in Preschoolers: Differences Between Children of Alcoholics and Children of Nonalcoholics

Cognitive schemas provide the structure within which children organize their knowledge and beliefs about the use of alcohol. The development of schemas about alcohol should be affected both by age and parental patterns of alcohol use. We examined differences in alcohol schema development among 139 male children of alcoholics (COAs) and 82 controls [children of nonalcoholics (NCOAs)] utilizing the Appropriate Beverage Task as an indicator of these processes. Overall, the vast majority of the sample identified at least one alcoholic beverage from photographs, even at age 3. COAs were more likely to identify at least one alcoholic beverage. With age controlled, COAs were better able to identify specific alcoholic beverages and correctly identified a larger number of alcoholic beverages. There was a trend for these children of alcoholic men to attribute more alcoholic beverage use to male adults than NCOAs. Moreover, differences in these children's attributions of alcoholic consummatory behavior were predicted by their parents' current consumption levels. Results provide evidence that alcohol schemas are detectable in early childhood and are more common in children from alcoholic homes. Discussion focuses on the potential relevance of these risk attributes to the development of more fully formed alcohol expectancies and to the later emergence of alcohol-related difficulty.     

Pathways into Risk: Temperament and Behavior Problems in Three- to Five-Year-Old Sons of Alcoholics

Evidence suggests that a child with a difficult temperament, reared in an alcoholic family, is at high risk for the development of behavior problems that antedate the emergence of antisocial behavior, alcoholism, and coactive psychopathology. However, the causal linkage between difficult temperament and problem behavior in childhood, and antisociality and alcohol abuse in adulthood is far from certain, in part because few studies assess emergent behavior patterns in young children of alcoholics. In this study, we investigated the temperament-behavior problem relationship in 191 3- to 5-year-old boys, 149 of whom were being reared in high-risk alcoholic, low socioeconomic environments. Boys were classified as high in problem behavior or not based on standardized clinical cut-off scores for Total Behavior Problems from the Child Behavior Checklist. Results indicated that boys rated in the clinical range for total behavior problems exhibited more characteristics of difficult temperament than boys who were not rated in the clinical range. Parents of the boys in the clinical group had significantly more alcohol-related problems, higher levels of antisociality, and significantly lower levels of socioeconomic status, income, and education. Results are consistent with the supposition that the difficult temperament-behavior problem relationship flourishes in the context of an antisocial, alcoholic family environment.     

Family Interactions of Alcoholics as Related to Alcoholism Type and Drinking Condition

BACKGROUND: Several studies have reported that the marital interactions of antisocial and aggressive, versus nonantisocial and nonaggressive, alcoholics exhibit higher rates of aversive-defensive communications and higher levels of negative reciprocity. To extend these findings, we examined the effect of alcoholism type (high- versus low-antisocial alcoholics: HAS, LAS) and drinking condition on family communication patterns. METHODS: Marital and parent-child dyads from 100 alcoholic families were videotaped while they discussed personally relevant issues during drinking and no-drinking sessions (no children were offered any alcohol). All interactions were coded with the Marital Interaction Coding System, and the data were assessed for differences in rate of positive, negative, and problem-solving behaviors, as well as sequential structures. RESULTS: HAS couples were more negative during the drink versus no-drink condition, whereas drinking did not affect negativity for LAS couples. In addition, the negative communications of HAS versus LAS alcoholics were more likely to increase spouse negativity during the drink versus no-drink condition. Group differences for parent-child interactions were few. CONCLUSIONS: The nature of family interactions was related to both alcoholism type and alcohol consumption, and the marital interactions of alcoholism types could be differentiated on the basis of the frequency and sequential structure of negative exchanges. It is most important to note that it is the interactions of the HAS alcoholic that undergo the most change as a function of drinking condition, with little support for the "adaptive consequences" hypothesis that alcohol consumption leads to more effective problem-solving for couples in which the alcoholic exhibits fewer antisocial and more internalizing characteristics. Study limitations and directions for future research are discussed.     

Parenting behavior of adolescent children of alcoholics

We compared the parenting behavior of children of alcoholics (COAs) and non-COAs within a sample of adolescent mothers. COAs and their children showed dyadic behaviors that were less problematic than those of their peers on mother-child teaching interactions at 1 year of age, mother-child interactions during structured play at pre-school age and child attachment behavior at pre-school age. COAs reported feeling relatively more rejection as compared to love from the alcoholic parent, but this was not related to their own parenting scores. Similar to other research, COAs reported more historical life stress, more family disruption and more drug use compared to non-COAs, but these measures also were not related to parenting scores. These results suggest that, although adolescent mothers are at risk for parenting difficulties compared to adult mothers, adolescent COAs do not necessarily encounter more problems in parenting their own children compared to other adolescent mothers.     

The Prevalence of Type A Personality in the Children of Alcoholics

Three studies are reported which investigate the prevalency of an excess risk of type A personality in the children of alcoholics (COAs). Reports in the clinical literature suggest there is an excess risk of type A in COAs, but this has never been empirically demonstrated. The Matthews Youth Test for Health (MYTH) was administered to nonalcoholic mothers of 46 COAs and 65 matched controls to measure children's type A competitiveness and impatience-aggression. Results were significant only for greater impatience-aggression in COAs. In a second study, 104 COAs and controls matched for age, sex, race, and father's occupational status were rated by military fathers of intact families using MYTH. The results of the first study were not replicated for COAs, and there was no correlation between a father's Jenkins Activity Scale (JAS) score and his child's type A personality. A third study of 70 matched COAs and controls used the Hunter-Wolf A-B Rating scale, a self-rating scale for children and found no significant differences in children's type A personalities based on membership in an alcoholic family, sex, or birth order. It was concluded that the discrepancy between clinical reports and the present data may have been due to misperceptions about successful, hardworking COAs who, particularly in contrast to their more notorious siblings, may be viewed as "workaholics" and improperly labeled as type A personalities.     

Conscious and unconscious perceptions of self in children of alcoholics.

The conscious and unconscious self-concept was examined in three groups of children: 23 children of alcoholics (COA), 19 children from nonalcoholic but dysfunctional families, and 23 children from normal families without alcoholism or family dysfunction. Self-concept was assessed both objectively, using the Piers-Harris Children's Self Concept Scale, and subjectively, using the Draw-A-Person Test and the Thematic Apperception Test from rating systems designed to tap unconscious dimensions of self. The COAs and normal controls were also compared for behavioral problems with the Achenbach Child Behavior Checklist. We found that COAs made more positive self-statements on objective measures of self-concept than children from families without alcoholism, whether or not the families were dysfunctional. Subjective analyses of projective test responses revealed unconscious differences in self-concept among the COAs, though this was not corroborated with objective scores, probably due to the crudeness of the rating instrument in failing to tap these dimensions. Also COAs had significantly more behavior problems, based on parental reports, which contrasts with their objective reports of self. Implications of these findings were discussed.     

Spatial Learning Deficits in Preschool Children of Alcoholics

When compared with nonalcoholics, chronic alcoholics and their children show significant deficits in the processing of visuospatial information. The literature supports two possible explanations of a visuospatial processing deficit in the child of an alcoholic (COA) when compared with the child of a nonalcoholic (NCOA). Ether the COA may suffer cognitive disruptions produced by personal and social development within an alcoholic family, or the COA may inherit or very early develop alterations in central nervous system substrates of neurocognitive operations. The present study was designed to continue our examinations of visuospatial information processing differences and the source of these differences in COAs. An evaluation of very young subjects not only assisted in providing a more complete view of visuospatial processing across the COA's life span, but also helped explain why the deficit occurs. Thirty matched male and female preschool children, aged 35.8–51.6 months, served as participants. Fifteen children were COAs from families in which the biological father and two other relatives had an alcoholism history. The other group of 15 children were NCOAs. Each child performed a visuospatial learning task similar to the task used in previous studies of older COAs. The visuospatial learning performance of the preschool COAs was inferior to that displayed by preschool NCOAs. The patterns of correct, error, and nonresponses emitted by the preschool COAs and the interrelationships of these data closely resembled the data from our previous studies of older children, adolescent, and adult COAs. The consistency of the deficit and its underlying processes in COAs sampled across the life span from different family environments support a model of visuospatial deficit that is more neurocognitive inheritance than personal/developmental.     

A Comparison of Family of Origin Factors between Children of Alcoholics and Children of Non-alcoholics in a Longitudinal Panel

Secondary analysis of longitudinal panel data reveals minimal differences in family of origin factors between children of alcoholics (COAs) and children of non-alcoholics (non-COAs). From 220 subjects, 37 parents were identified as alcoholic. The COA subjects′ retrospective reports about family of origin factors were compared to those of non-COAs. Contrary to the assertions of the COA clinical literature, few differences were found between the two groups. However, these differences are congruent with the findings of other panel studies which have investigated family of origin factors and adult outcome among COAs.     

The Influence of Both Drinking and Familial Risk Statuses on Cognitive Functioning of Social Drinkers

Problem and nonproblem drinking, college student sons of alcoholics were compared to problem and nonproblem drinking college student sons of nonalcoholic fathers with respect to cognitive functioning. Problem drinkers performed more poorly on two of the four cognitive tasks, Group Embedded Figures and Symbol-Digit Paired Associates Learning Task, thus supporting earlier findings of cognitive deficits in problem drinking nonalcoholics. Additionally, sons of alcoholics tended to perform more poorly than sons of nonalcoholics on the Group Embedded Figures Test. Cognitive performance was not predicted by any of four measures of impulsive/antisocial personality and behavior-preadult antisocial behavior, childhood behavior problems, sensation seeking, and the MacAndrew Alcoholism Scale. The findings of the research pointed to the importance of considering both drinking and familial alcoholism risk statuses in studies of the cognitive performance of nonalcoholics. Further implications and limitations of the findings are discussed.     

Affective circuitry and risk for alcoholism in late adolescence: differences in frontostriatal responses between vulnerable and resilient children of alcoholic parents

Background: Children of alcoholics (COAs) are at elevated risk for alcohol use disorders (AUD), yet not all COAs will develop AUD. The 2 primary aims of this study were to identify neural activation mechanisms that may mark protection or vulnerability to AUD in COAs and to map the same activation patterns in relation to risk behavior (externalizing or internalizing behavior). Methods: Twenty‐two adolescent COAs were recruited from an ongoing community longitudinal study of alcoholic and matched control families. They were categorized as either vulnerable (n = 11) or resilient (n = 11) based on the level of problem drinking over the course of adolescence. Six other adolescents with no parental history of alcoholism, and no evidence of their own problem drinking were recruited from the same study and labeled as low‐risk controls. Valenced words were presented to the participants in a passive viewing task during functional magnetic resonance imaging. Activation to negative versus neutral words and positive versus neutral words were compared between groups. Behavior problems were assessed with the Youth Self‐Report (YSR). Results: The resilient COA group had more activation of the orbital frontal gyrus (OFG), bilaterally, and left insula/putamen than the control and vulnerable groups, in response to emotional stimuli. In contrast, the vulnerable group had more activation of the dorsomedial prefrontal cortex and less activation of the ventral striatum and extended amygdala, bilaterally, to emotional stimuli than the control and resilient groups. The vulnerable group had more externalizing behaviors which correlated with increased dorsomedial prefrontal activation and decreased ventral striatal and extended amygdala activation. Conclusions: These results are consistent with dissociable patterns of neural activation underlying risk and resiliency in COAs. We propose that the pattern observed in the resilient COAs represents an active emotional monitoring function, which may be a protective factor in this group. On the other hand, the vulnerable group displayed a pattern consistent with active suppression of affective responses, perhaps resulting in the inability to engage adaptively with emotional stimuli.     

Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population

Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a) < 20 years; b) 20-25 years, and c) > 25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20-25-year onset group usually had intermediate scores. The < 20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the < 20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogeneous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments.     

PARENTAL ALCOHOLISM AS A RISK FACTOR FOR DSM-IV-DEFINED ALCOHOL ABUSE AND DEPENDENCE IN AMERICAN WOMEN: THE PROTECTIVE BENEFITS OF DYADIC COHESION IN MARITAL COMMUNICATION

Important trends in research over the past decade indicate that women are as greatly affected by familial alcoholism as are men. Although it is increasingly recognized that the adverse drinking outcomes predicted for adult children of alcoholics (COAs) are not inevitable, and only a small percentage develop alcohol dependence or grow up to be alcoholic, relatively little knowledge exists regarding moderating factors that reduce their vulnerability. This study identifies a multiple mediator latent structural model of the intergenerational transmission of risk for DSM-IV-assessed alcohol abuse and dependence among women COAs in adulthood. The effects of both parental alcoholism and family environment are estimated at three time points spanning 10 years across 5-year intervals (1984, 1989, and 1994) using data from a subsample of 4449 women in the National Longitudinal Survey of Youth (NLSY). Dyadic cohesion in marital communication (greater marital cohesion, harmony, and less verbal disagreement, discord, and conflict) is a proposed moderating factor that may operate in adulthood to lower the risk of female COAs developing alcohol abuse and dependence. Maximum likelihood standardized estimates of the effects of alcohol mediators measured over time indicate that direct parental effects for adverse outcomes decline when COAs are in their late 20s and early 30s. Indirect parental effects through environmental influences dramatically increase the risk of abuse and dependence among COAs at this time if they have one or more alcoholic siblings, especially an alcoholic sister. Dyadic cohesion and positive interpersonal communication patterns were found to moderate effectively the relationship that existed among parental alcoholism, environmental influences, and adverse alcohol consequences. COAs with satisfactory marital communication also evidenced higher levels of intimacy with their partners, perceived the division of housework to be fairer, shared more responsibilities and burdens of the household, and had less conflict over critical domestic issues than other women COAs. The protective benefits of a good marriage against the risks of alcoholism remained when applied to younger and older subjects, across diverse backgrounds, and after adjusting for other factors such as employment status.     

Parental alcoholism as a risk factor for DSM-IV-defined alcohol abuse and dependence in American women: the protective benefits of dyadic cohesion in marital communication.

Important trends in research over the past decade indicate that women are as greatly affected by familial alcoholism as are men. Although it is increasingly recognized that the adverse drinking outcomes predicted for adult children of alcoholics (COAs) are not inevitable, and only a small percentage develop alcohol dependence or grow up to be alcoholic, relatively little knowledge exists regarding moderating factors that reduce their vulnerability. This study identifies a multiple mediator latent structural model of the intergenerational transmission of risk for DSM-IV-assessed alcohol abuse and dependence among women COAs in adulthood. The effects of both parental alcoholism and family environment are estimated at three time points spanning 10 years across 5-year intervals (1984, 1989, and 1994) using data from a subsample of 4,449 women in the National Longitudinal Survey of Youth (NLSY). Dyadic cohesion in marital communication (greater marital cohesion, harmony, and less verbal disagreement, discord, and conflict) is a proposed moderating factor that may operate in adulthood to lower the risk of female COAs developing alcohol abuse and dependence. Maximum likelihood standardized estimates of the effects of alcohol mediators measured over time indicate that direct parental effects for adverse outcomes decline when COAs are in their late 20s and early 30s. Indirect parental effects through environmental influences dramatically increase the risk of abuse and dependence among COAs at this time if they have one or more alcoholic siblings, especially an alcoholic sister. Dyadic cohesion and positive interpersonal communication patterns were found to moderate effectively the relationship that existed among parental alcoholism, environmental influences, and adverse alcohol consequences. COAs with satisfactory marital communication also evidenced higher levels of intimacy with their partners, perceived the division of housework to be fairer, shared more responsibilities and burdens of the household, and had less conflict over critical domestic issues than other women COAs. The protective benefits of a good marriage against the risks of alcoholism remained when applied to younger and older subjects, across diverse backgrounds, and after adjusting for other factors such as employment status.     

Children of alcoholics exhibit attenuated cognitive impairment during an ethanol challenge

In an attempt to identify markers potentially related to the development of problem drinking, we examined cognitive functioning in children of alcoholics (COAs) and children of nonalcoholics, both while sober and after consuming 0.85 ml/kg of ethanol. Consonant with previous research indicating that COAs exhibit less intense responses to alcohol, we predicted that COAs would experience attenuated cognitive deficits while intoxicated. Male (n = 71) and female (n = 29) college students completed tests of contextual and rote memory recall in a repeated-measures design. Findings indicated that intoxication impaired both memory and attentional capacities, and that COAs exhibited attenuated cognitive deficits relative to children of nonalcoholics. Results were consistent with previous research demonstrating attenuated responses to alcohol in COAs. Potential mechanisms for the pathogenesis of problem drinking are discussed.     

Is having an alcoholic father hazardous for children's physical health?

Five hundred and ninety-time French-Canadian pre-adolescent children for whom the alcoholic status of the parents was known were subdivided into eight groups, according to family structure (intact, non-intact), alcoholic status of the father (alcoholic, non-alcoholic) and gender of the target child (girl, boy). ANCOVAs were conducted (controlling for income, a factor which contributes to illness) for health-related variables in order to test the hypothesis that children of alcoholic fathers have more physical health problems compared to children without alcoholic fathers. Data pertaining to use of medical services, serious and minor illnesses and pregnancy-related events were analysed. It was found that overall, pre-adolescent children of alcoholics were not more ill than children of non-alcoholics. There were, however, some differences worthy of note. Children of alcoholics had significantly lower birthweights than the children of non-alcoholics. Boys in non-intact alcoholic families were of shorter stature than the other children. A three-way interaction showed that daughters of alcoholics and sons of non-alcoholics living in non-intact families were more likely to have used psychologists' services, as were sons of alcoholics in intact families. The results were discussed in terms of the heterogeneity of alcoholic families as well as the need to identify subgroups of children of alcoholics who are at risk.     

The influence of comorbid asthma on the severity of symptoms in children with attention-deficit hyperactivity disorder

Objective: The current study examined the association between asthma and attention-deficit hyperactivity disorder (ADHD) symptoms in a clinical pediatric sample. Methods: Demographic and neuropsychological data for children with a billing diagnosis of ADHD were extracted from a clinical database. Families completed standard rating scales. Seventy-one patients with a co-morbid asthma diagnosis were identified and matched by age to a group of 71 patients with only ADHD. Results: Children with asthma and ADHD were more likely to display clinically elevated levels of hyperactivity, externalizing behaviors, anxiety, and hyperactive/impulsive behaviors compared to children with ADHD alone. Boys with asthma and ADHD had more symptoms than boys with only ADHD of somatization and emotional internalizing, while girls with asthma and ADHD had more symptoms of hyperactivity/impulsivity, conduct problems, anxiety, and emotional internalizing compared to girls with only ADHD. Conclusions: Findings suggest that in children with ADHD, co-morbid asthma is associated with increased behavioral and internalizing symptoms, with distinct gender differences present. Increased behavioral and internalizing symptoms seen in children with both asthma and ADHD may be due to the burden of their medical condition. No difference was found on cognitive variables, suggesting chronic hypoxia may be less influential in explaining these differences. Future research should determine the specific mechanisms of these differences.     

Antisocial alcoholic patients show as much improvement at 14-month follow-up as non-antisocial alcoholic patients

The authors investigated the impact of DSM-III-R adult criteria for antisocial personality disorder (and co-occurrence of childhood conduct or mood disorder) on one-year changes of multi-domain problem severity in 309 alcoholic patients. Adult antisocial traits were associated with more drug, legal, and psychiatric problems at baseline and with more drug problems at follow-up. However, patients with antisocial traits showed at least as much improvement from baseline through follow-up as their non-antisocial counterparts. Furthermore, the co-occurrence of childhood conduct disorder or mood disorder among the antisocial alcoholics did not define prognostically relevant subgroups. These findings suggest that antisocial alcoholics benefit from treatment at least as much as non-antisocial alcoholics.     

Psychological, social and school implications of asthma: a comparison of Belgian French-speaking children having asthma with healthy children

The present study aimed to explore the psychosocial implications of asthma among Belgian French-speaking children. Ninety-nine parents of children having asthma (Mage=11.40, SD=2.35) and 102 parents of children without asthma (Mage=11.25, SD=.81) participated in the study. Parents filled in the Child Behaviour Checklist and a demographic questionnaire. Results showed that children having asthma were assessed by their parents as having more internalizing, social and attention problems and as having less competence in doing activities (e.g., sports, hobbies, jobs) than their healthy peers. Significant differences also appeared between genders for attention problems, anxiety/depression, activities, social and school competences, indicating that boys were more vulnerable to psychological and social difficulties than girls but they had better school competences than girls. Finally, results showed no difference for psychological, social, and school adjustment between children who controlled and partly controlled their asthma. These findings emphasize the importance of screening children who would be at risk for having psychosocial problems and developing multidisciplinary interventions for children with asthma and for their families.