Investigating and Comparing Child Attachment, Mother's Emotion Regulation and Mother-child Relationships in Children with Asthma and Children with Eczema: A Cross-sectional Study
,
Abstract
Childhood asthma and eczema are common chronic diseases that significantly affect the health of children and parents. These children experience physical and psychosocial problems, including behavioral and emotional disturbances. This study was conducted to identify the psychological issues such as children's attachment, maternal emotion regulation, and child-parent relationship in children with autoimmune disorders, especially asthma and eczema.
This cross-sectional study included80 mother-child pairs (40 with asthma and 40 with eczema) recruited from Yazd autoimmune clinics between 2022 and 2023. Exclusion criteria included additional physical or psychiatric illnesses in parents and parental drug addiction. Participants completed a demographic questionnaire and three validated questionnaires: Children's Attachment Questionnaire, Gross Emotion Regulation Strategies Questionnaire, and Pianta Mother-Child Relationship Questionnaire.
Results analysis and comparison showed that both the asthma and eczema groups have moderate levels of secure attachment with a 25% achieving favorable score. Emotion regulation showed very low desirability (up to 25% for its subscales). Geographical location had a slight but significant effect on attachment and emotion regulation. Scores of the Pianta mother-child relationship scale were generally positive. No significant effects were observed in relation to the child's gender, occupation, and educational status of the mothers.
This study found moderate levels of children's secure attachment and maternal emotion regulation in both groups and favorable mother-child relationships in children aged 5 to 12 years with asthma and eczema. Only a small percentage of children demonstrated secure attachment, reflecting existing research linking childhood illness to parental distress and impaired child development.
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2. Bereda G. Bronchial asthma: etiology, pathophysiology, diagnosis and management. Austin J Pulm Respir Med. 2022;9(1):1085.
3. González-Freire B, Vázquez I, Pértega-Díaz S. The relationship of psychological factors and asthma control to health-related quality of life. J Allergy Clin Immunol Pract. 2020;8(1):197-207.
4. Stanescu S, Kirby SE, Thomas M, Yardley L, Ainsworth B. A systematic review of psychological, physical health factors, and quality of life in adult asthma. NPJ Prim Care Respir Med. 2019;29(1):37.
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9. Yamamoto N, Nagano J. Parental stress and the onset and course of childhood asthma. Biopsychosoc Med. 2015;9:7.
10. Langan SM, Mulick AR, Rutter CE, Silverwood RJ, Asher I, García‐Marcos L, et al. Trends in eczema prevalence in children and adolescents: a Global Asthma Network Phase I study. Clin Exp Allergy. 2023;53(3):337-52.
11. Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, et al. Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies. Br J Dermatol. 2021;184(4):627-37.
12. Teasdale E, Sivyer K, Muller I, Ghio D, Roberts A, Lawton S, et al. Children’s views and experiences of treatment adherence and parent/child co-management in eczema: a qualitative study. Children (Basel). 2021;8(2).
13. Lee HJ, Lee GN, Lee JH, Han JH, Han K, Park YM. Psychological stress in parents of children with atopic dermatitis: a cross-sectional study from the Korea National Health and Nutrition Examination Survey. Acta Derm Venereol. 2023;103:adv00844.
14. Chong YY, Kwan JY, Yau PT, Cheng HY, Chien WT. Roles of parental psychological flexibility, self-compassion, and self-efficacy in affecting mental health and quality of life in parents of children with eczema. Healthcare (Basel). 2023;11(20).
15. Cooke JE, Kochendorfer LB, Stuart-Parrigon KL, Koehn AJ, Kerns KA. Parent–child attachment and children’s experience and regulation of emotion: a meta-analytic review. Emotion. 2019;19(6):1103.
16. Steinhausen HC, Schindler HP, Stephan H. Correlates of psychopathology in sick children: an empirical model. J Am Acad Child Psychiatry. 1983;22(6):559-64.
17. Juffer F, Bakermans-Kranenburg MJ, Van Ijzendoorn MH. Promoting positive parenting: an attachment-based intervention. London: Taylor & Francis; 2023.
18. Cassibba R, van Ijzendoorn MH, Bruno S, Coppola G. Attachment of mothers and children with recurrent asthmatic bronchitis. J Asthma. 2004;41(4):419-31.
19. Ehrlich KB, Miller GE, Shalowitz M, Story R, Levine C, Williams D, et al. Secure base representations in children with asthma: links with symptoms, family asthma management, and cytokine regulation. Child Dev. 2019;90(6):e718-28.
20. Bilge Y, Sezgin E. Anne ve çocuk duygu düzenleme arasındaki ilişkide annenin kişilik özelliklerinin ve bağlanma stillerinin aracı rolü. Anatolian J Psychiatry. 2020;21(3):310-8.
21. Posada GE, Trumbell JM, Lu T, Kaloustian G. The organization of attachment behavior in early childhood: links with maternal sensitivity and child attachment representations. Monogr Soc Res Child Dev. 2018;83(4):35-59.
22. Bailey HN, Bernier A, Bouvette-Turcot AA, Tarabulsy GM, Pederson DR, Becker-Stoll F. Deconstructing maternal sensitivity: predictive relations to mother-child attachment in home and laboratory settings. Soc Dev. 2017;26(4):679-93.
23. Wijirahayu A, Krisnatuti D, Muflikhati I. Kelekatan ibu-anak, pertumbuhan anak, dan perkembangan sosial emosi anak usia prasekolah. J Ilmu Keluarga Konsumen. 2016;9(3):171-82.
24. Soleimani H, Bashash L, Latifiyan M. Psychometric properties of the kinship center attachment questionnaire (KCAQ) of latency-aged for children. Iran J Psychiatry. 2014;9(2):112-20.
25. Mashhadi A, Hasani J, Mirdoraghi F. Factor structure, reliability and validity of Persian version of the cognitive emotion regulation questionnaire-children form (CERQ-KP). J Fundam Ment Health. 2012;14(55):59-246.
26. Ashori M, Afrooz GHA, Arjmandnia AA, Pormohammadreza-Tajrishi M, Ghobari-Bonab B. The effectiveness of positive parenting program (triple-P) on parental self-efficacy and mother-child interaction in children with intellectual disability. SSU J. 2015;23(5):489-500.
27. Hui VK, Chan CH, Fung YL, Chan CL, Luk MS. Efficacy of the integrative body–mind–spirit group intervention for improving quality of life in parent–child dyads adjusting to atopic dermatitis: protocol for a randomised controlled trial. BMJ Open. 2022;12(3):e059150.
28. Kilic N, Kilic M. Investigation of quality of life of patients with atopic dermatitis and quality of life, psychiatric symptomatology, and caregiver burden of their mothers. Children (Basel). 2023;10(9):1487.
29. Absolon CM, Cottrell D, Eldridge SM, Glover MT. Psychological disturbance in atopic eczema: the extent of the problem in school-aged children. Br J Dermatol. 1997;137(2):241-5.
30. Arshadi M, Valizadeh S, Babapour J, Shameli R. Comparison of the attachment situation of kindergarten and non-kindergarten preschools in Tabriz, 2011. J Nurs Educ. 2013;1(1):10-8.
31. Mellblom AV, Korsvold L, Ruud E, Lie HC, Loge JH, Finset A. Sequences of talk about emotional concerns in follow-up consultations with adolescent childhood cancer survivors. Patient Educ Couns. 2016;99(1):77-84.
32. Fearon R, Roisman GI. Attachment theory: progress and future directions. Curr Opin Psychol. 2017;15:131-6.
33. Firoozi M. Distress tolerance in mothers of children with cancer for predicting her parenting style and child’s attachment behaviors: a cross-sectional study. Int J Cancer Manag. 2020;13(3):e102345.
34. Saeedi F, Aghdasi A. The relationship of three attachment styles with depression and anxiety in seventh and eighth grade female students. Women Fam Stud. 2018;10(40):165-89.
35. Bovenschen I, Lang K, Zimmermann J, Förthner J, Nowacki K, Roland I, et al. Foster children’s attachment behavior and representation: influence of children’s pre-placement experiences and foster caregiver’s sensitivity. Child Abuse Negl. 2016;51:323-35.
36. Khodabakhsh M, Hashemi-Razini H, Nouri Ghasemabadi R. Structural model of social skills in children with learning disabilities based on attachment styles with the mediating role of academic self-efficacy. Child Ment Health J. 2021;8(1):1-13.
37. Mrazek DA, Casey B, Anderson I. Insecure attachment in severely asthmatic preschool children: is it a risk factor? J Am Acad Child Adolesc Psychiatry. 1987;26(4):516-20.
38. Simbar S, Hosseinkhanzadeh AA, Abolghasemi A. Hope for the future, attachment relationships, and emotional-behavioral problems in child labor. Q J Child Ment Health. 2019;6(3):51-65.
39. Salehi Shahrabi M, Shahrabi M, Heidari A, Ghaderi H. Role of attachment style in prediction of behavior of 3- to 6-year-old children. Eur Arch Paediatr Dent. 2020;21:647-56.
40. Sicouri G, Sharpe L, Hudson JL, Dudeney J, Jaffe A, Selvadurai H, et al. Parent-child interactions in children with asthma and anxiety. Behav Res Ther. 2017;97:242-51.
41. Schöbinger R, Florin I, Reichbauer M, Lindemann H, Zimmer C. Childhood asthma: mothers’ affective attitude, mother-child interaction and children’s compliance with medical requirements. J Psychosom Res. 1993;37(7):697-707.
42. Schöbinger R, Florin I, Zimmer C, Lindemann H, Winter H. Childhood asthma: paternal critical attitude and father-child interaction. J Psychosom Res. 1992;36(8):743-50.
43. Pat-Horenczyk R, Cohen S, Ziv Y, Achituv M, Asulin-Peretz L, Blanchard TR, et al. Emotion regulation in mothers and young children faced with trauma. Infant Ment Health J. 2015;36(3):337-48.
44. Uzun H, Karaca NH, Metin S. Assessment of parent-child relationship in COVID-19 pandemic. Child Youth Serv Rev. 2021;120:105748.
2. Bereda G. Bronchial asthma: etiology, pathophysiology, diagnosis and management. Austin J Pulm Respir Med. 2022;9(1):1085.
3. González-Freire B, Vázquez I, Pértega-Díaz S. The relationship of psychological factors and asthma control to health-related quality of life. J Allergy Clin Immunol Pract. 2020;8(1):197-207.
4. Stanescu S, Kirby SE, Thomas M, Yardley L, Ainsworth B. A systematic review of psychological, physical health factors, and quality of life in adult asthma. NPJ Prim Care Respir Med. 2019;29(1):37.
5. Keteyian SR, Leo HL. Parenting asthmatic children: identification of parenting challenges. Pediatrics. 2009;124 Suppl 2:S144-S.
6. Ferraro VA, Spaggiari S, Zanconato S, Traversaro L, Carraro S, Di Riso D. Psychological well-being of children with asthma and their parents. J Clin Med. 2024;13(17):5100.
7. Verkleij M, Van de Griendt EJ, Colland V, Van Loey N, Beelen A, Geenen R. Parenting stress related to behavioral problems and disease severity in children with problematic severe asthma. J Clin Psychol Med Settings. 2015;22:179-93.
8. Fang Y, Luo J, Boele M, Windhorst D, van Grieken A, Raat H. Parent, child, and situational factors associated with parenting stress: a systematic review. Eur Child Adolesc Psychiatry. 2024;33(6):1687-705.
9. Yamamoto N, Nagano J. Parental stress and the onset and course of childhood asthma. Biopsychosoc Med. 2015;9:7.
10. Langan SM, Mulick AR, Rutter CE, Silverwood RJ, Asher I, García‐Marcos L, et al. Trends in eczema prevalence in children and adolescents: a Global Asthma Network Phase I study. Clin Exp Allergy. 2023;53(3):337-52.
11. Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, et al. Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies. Br J Dermatol. 2021;184(4):627-37.
12. Teasdale E, Sivyer K, Muller I, Ghio D, Roberts A, Lawton S, et al. Children’s views and experiences of treatment adherence and parent/child co-management in eczema: a qualitative study. Children (Basel). 2021;8(2).
13. Lee HJ, Lee GN, Lee JH, Han JH, Han K, Park YM. Psychological stress in parents of children with atopic dermatitis: a cross-sectional study from the Korea National Health and Nutrition Examination Survey. Acta Derm Venereol. 2023;103:adv00844.
14. Chong YY, Kwan JY, Yau PT, Cheng HY, Chien WT. Roles of parental psychological flexibility, self-compassion, and self-efficacy in affecting mental health and quality of life in parents of children with eczema. Healthcare (Basel). 2023;11(20).
15. Cooke JE, Kochendorfer LB, Stuart-Parrigon KL, Koehn AJ, Kerns KA. Parent–child attachment and children’s experience and regulation of emotion: a meta-analytic review. Emotion. 2019;19(6):1103.
16. Steinhausen HC, Schindler HP, Stephan H. Correlates of psychopathology in sick children: an empirical model. J Am Acad Child Psychiatry. 1983;22(6):559-64.
17. Juffer F, Bakermans-Kranenburg MJ, Van Ijzendoorn MH. Promoting positive parenting: an attachment-based intervention. London: Taylor & Francis; 2023.
18. Cassibba R, van Ijzendoorn MH, Bruno S, Coppola G. Attachment of mothers and children with recurrent asthmatic bronchitis. J Asthma. 2004;41(4):419-31.
19. Ehrlich KB, Miller GE, Shalowitz M, Story R, Levine C, Williams D, et al. Secure base representations in children with asthma: links with symptoms, family asthma management, and cytokine regulation. Child Dev. 2019;90(6):e718-28.
20. Bilge Y, Sezgin E. Anne ve çocuk duygu düzenleme arasındaki ilişkide annenin kişilik özelliklerinin ve bağlanma stillerinin aracı rolü. Anatolian J Psychiatry. 2020;21(3):310-8.
21. Posada GE, Trumbell JM, Lu T, Kaloustian G. The organization of attachment behavior in early childhood: links with maternal sensitivity and child attachment representations. Monogr Soc Res Child Dev. 2018;83(4):35-59.
22. Bailey HN, Bernier A, Bouvette-Turcot AA, Tarabulsy GM, Pederson DR, Becker-Stoll F. Deconstructing maternal sensitivity: predictive relations to mother-child attachment in home and laboratory settings. Soc Dev. 2017;26(4):679-93.
23. Wijirahayu A, Krisnatuti D, Muflikhati I. Kelekatan ibu-anak, pertumbuhan anak, dan perkembangan sosial emosi anak usia prasekolah. J Ilmu Keluarga Konsumen. 2016;9(3):171-82.
24. Soleimani H, Bashash L, Latifiyan M. Psychometric properties of the kinship center attachment questionnaire (KCAQ) of latency-aged for children. Iran J Psychiatry. 2014;9(2):112-20.
25. Mashhadi A, Hasani J, Mirdoraghi F. Factor structure, reliability and validity of Persian version of the cognitive emotion regulation questionnaire-children form (CERQ-KP). J Fundam Ment Health. 2012;14(55):59-246.
26. Ashori M, Afrooz GHA, Arjmandnia AA, Pormohammadreza-Tajrishi M, Ghobari-Bonab B. The effectiveness of positive parenting program (triple-P) on parental self-efficacy and mother-child interaction in children with intellectual disability. SSU J. 2015;23(5):489-500.
27. Hui VK, Chan CH, Fung YL, Chan CL, Luk MS. Efficacy of the integrative body–mind–spirit group intervention for improving quality of life in parent–child dyads adjusting to atopic dermatitis: protocol for a randomised controlled trial. BMJ Open. 2022;12(3):e059150.
28. Kilic N, Kilic M. Investigation of quality of life of patients with atopic dermatitis and quality of life, psychiatric symptomatology, and caregiver burden of their mothers. Children (Basel). 2023;10(9):1487.
29. Absolon CM, Cottrell D, Eldridge SM, Glover MT. Psychological disturbance in atopic eczema: the extent of the problem in school-aged children. Br J Dermatol. 1997;137(2):241-5.
30. Arshadi M, Valizadeh S, Babapour J, Shameli R. Comparison of the attachment situation of kindergarten and non-kindergarten preschools in Tabriz, 2011. J Nurs Educ. 2013;1(1):10-8.
31. Mellblom AV, Korsvold L, Ruud E, Lie HC, Loge JH, Finset A. Sequences of talk about emotional concerns in follow-up consultations with adolescent childhood cancer survivors. Patient Educ Couns. 2016;99(1):77-84.
32. Fearon R, Roisman GI. Attachment theory: progress and future directions. Curr Opin Psychol. 2017;15:131-6.
33. Firoozi M. Distress tolerance in mothers of children with cancer for predicting her parenting style and child’s attachment behaviors: a cross-sectional study. Int J Cancer Manag. 2020;13(3):e102345.
34. Saeedi F, Aghdasi A. The relationship of three attachment styles with depression and anxiety in seventh and eighth grade female students. Women Fam Stud. 2018;10(40):165-89.
35. Bovenschen I, Lang K, Zimmermann J, Förthner J, Nowacki K, Roland I, et al. Foster children’s attachment behavior and representation: influence of children’s pre-placement experiences and foster caregiver’s sensitivity. Child Abuse Negl. 2016;51:323-35.
36. Khodabakhsh M, Hashemi-Razini H, Nouri Ghasemabadi R. Structural model of social skills in children with learning disabilities based on attachment styles with the mediating role of academic self-efficacy. Child Ment Health J. 2021;8(1):1-13.
37. Mrazek DA, Casey B, Anderson I. Insecure attachment in severely asthmatic preschool children: is it a risk factor? J Am Acad Child Adolesc Psychiatry. 1987;26(4):516-20.
38. Simbar S, Hosseinkhanzadeh AA, Abolghasemi A. Hope for the future, attachment relationships, and emotional-behavioral problems in child labor. Q J Child Ment Health. 2019;6(3):51-65.
39. Salehi Shahrabi M, Shahrabi M, Heidari A, Ghaderi H. Role of attachment style in prediction of behavior of 3- to 6-year-old children. Eur Arch Paediatr Dent. 2020;21:647-56.
40. Sicouri G, Sharpe L, Hudson JL, Dudeney J, Jaffe A, Selvadurai H, et al. Parent-child interactions in children with asthma and anxiety. Behav Res Ther. 2017;97:242-51.
41. Schöbinger R, Florin I, Reichbauer M, Lindemann H, Zimmer C. Childhood asthma: mothers’ affective attitude, mother-child interaction and children’s compliance with medical requirements. J Psychosom Res. 1993;37(7):697-707.
42. Schöbinger R, Florin I, Zimmer C, Lindemann H, Winter H. Childhood asthma: paternal critical attitude and father-child interaction. J Psychosom Res. 1992;36(8):743-50.
43. Pat-Horenczyk R, Cohen S, Ziv Y, Achituv M, Asulin-Peretz L, Blanchard TR, et al. Emotion regulation in mothers and young children faced with trauma. Infant Ment Health J. 2015;36(3):337-48.
44. Uzun H, Karaca NH, Metin S. Assessment of parent-child relationship in COVID-19 pandemic. Child Youth Serv Rev. 2021;120:105748.
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| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Asthma Attachment behavior Atopic dermatitis Child Chronic disease Emotions Parent-child relations | ||
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How to Cite
1.
Bastani N, Shirkhoda S, Bemanian B, Aghaie F, Bemanian MH. Investigating and Comparing Child Attachment, Mother’s Emotion Regulation and Mother-child Relationships in Children with Asthma and Children with Eczema: A Cross-sectional Study. Iran J Allergy Asthma Immunol. 2026;:1-13.
