PSYCHOLOGICAL MANAGEMENT OF CHILDHOOD ASTHMA.

Over-emphasis on physical factors in asthma probably has come about because psychological factors have seemed elusive, difficult to define and often misleading. Several concepts of classic causes of emotional disturbances that abet asthmatic attacks in children may be helpful in management of the patient and his environs. The first concept has to do with feelings of inadequacy in the mother which lead her to place the burden of decision-making upon the child. She is thus able to give the child very little support and communicates to him her anxiety. Often encouragement to the mother, through the physician's pointing out her very real capacities and achievements can be helpful to the child. The second concept has to do with the asthmatic child's character structure and his assumption of a pseudo-mature position. Among the things the physician can do is to advise the parents as to what is age-appropriate behavior for the child and instruct them in ways to make the child recognize his position of dependence. The third concept concerns threat of separation as a precipitant to the asthma attack. To deal with such a situation the physician may make a number of recommendations of methods for alleviating such a threat. In some families, the degree of disturbance is so great that the parents cannot respond to the physician's advice and may need psychiatric referral. Clues for recognizing such a situation are given along with recommendations on how to make a successful referral.