Asthma is the most common chronic disease of childhood. Children diagnosed with asthma are twice as likely to have a comorbid anxiety disorder as their non-asthmatic peers. The presence of both asthma and anxiety in the pediatric patient creates an environment of poor asthma control, and places them at risk for a variety of negative health events. Little is known about comorbid anxiety’s role in asthma health maintenance. Research has identified the link between these two conditions but causation is difficult to conclude. The aim of this thesis is to assess the current state of the science regarding pediatric asthma and anxiety. This integrated review of the literature will identify the factors contributing to the vicious cycle of pediatric anxiety and asthma. Recommendations for practice and future research will be made.

Anxiety and depression are among the most common psychiatric disorders in childhood and adolescence (Costello, Egger, & Angold, 2005). Although the parental environment appears to play a role in the development of emotional disorders (e.g., Abramson & Alloy, 2006), cognitive styles within the families of adolescents with internalising disorders have received little attention. The main aim of this thesis was to increase the understanding of maternal cognitions in relation to internalising disorders experienced by adolescents. Specifically, maternal attributional style, catastrophic worries, selective attention and perceptions of adolescents' social competence were examined through a combination of cross-sectional, correlational and experimental designs in the programme of five studies conducted with a clinical sample. Three groups of adolescents and their mothers participated in the studies: adolescents with clinical internalising disorders, adolescents with clinical externalising disorders and a non-referred group of school-children along with their mothers. In support of the hypotheses, mothers of adolescents with clinical internalising disorders had more negative attributional biases than the mothers in the two control groups. When parental attributions were examined from the child's perspective, adolescents in the clinical internalising group perceived that their parents had more negative attributions than both control groups. Examination of maternal evaluations of adolescents' social skills, revealed that even though adolescents did not have social deficits according to objective ratings, mothers of adolescents with internalising disorders underestimated the performance of their children compared to the non-referred control group. Significant relationships were found between maternal and adolescent attributions and perceptions of social competence, suggesting a link between maternal and adolescent cognitive style. Furthermore, mothers of the clinical internalising group produced a greater number of worries which were more catastrophic in content than mothers in the control groups. Contrary to predictions, mothers of adolescents with clinical internalising disorders did not selectively attend to threatening information related to adolescents' behaviours. Analyses using combined data from the four studies that showed significant relationships provided evidence that different cognitions in mothers and their children are interrelated, highlighting the importance of interactions between various cognitions within the family. Additionally, attributional style, catastrophic worries and negative perceptions were found to discriminate families with adolescents with internalising disorders from those with adolescents with externalising disorders or non-referred adolescents. The studies included in this thesis extend the current literature on maternal cognitions and adolescent internalising disorders and suggest that mothers of adolescents with internalising disorders are characterised by cognitive biases that should be taken into consideration in both research and clinical practice.

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This study investigated the relationship of parents' achievement-oriented and self- development goals (for their children) on youth reported anxiety, while taking parents' psychological control and responsiveness into account as possible mediating factors. More specifically, the purpose of this study was to further investigate the direct/indirect effects of (a) parents' reported achievement-oriented goals on youth anxiety via parental psychological control in two types of schools (key school for more academically advanced students and typical school for students with lower academic achievement); and (b) parents' reported self-development goals on youth anxiety via parental psychological control in key and typical schools. The current study also introduced parents' responsiveness as a new mediator and single-child family/ multiple- child family (family type/size) as a new moderator to investigate their effect on the overall model as related to youth anxiety. is study included 1,044 participants, reflecting 522 dyads (student and primary caregiver) from an urban city in Eastern Mainland China. Participating students were enrolled in the 11th grade in senior high school. Due to the high correlations of parents' achievement- oriented goals and parents' self-development goals (r = 0.975, p < 0.001), we combined and created one new variable--parents' achievement/self-development goals. Therefore, in the final multigroup SEM analyses we used this new variable in place of the previously hypothesized two goal-related variables. Additionally, rather than the initially proposed two types of schools, due to constricting limitations in the data, we were limited to making comparisons between single- child and multiple-child families. In our data analyses, no indirect effects were found among the identified variables. However, data analyses indicated a direct effect from parents' psychological control on youth anxiety in the key school regardless of family composition (single-child or multiple-child families), and in youth attending the typical school and from a single-child family. In general, the data analyses identified two major findings: (a) We found a positive relationship between parents' psychological control and youth anxiety for youth attending a typical school and living in a single-child family and for youth attending a key school, regardless of family type/size (single-child or multiple-child family); and (b) A marginally significant relationship (p = 0.053) was identified between parents' reported achievement/self-development goals and youth reported parent responsiveness. Some concerns were voiced among research team members about cultural sensitivity to one of the parents' survey questions. For example, one question referred to students being interested in and joining extracurricular activities. Students in China may or may not have had opportunities to participate in these types of activities. Data were reanalyzed after seven items were removed. In post hoc exploratory analyses, a new variable was defined and created, parents' reported achievement goals. Parents' reported achievement goals were found to be youth reported parents' psychological control only in (a) the typical school and single child family model and (b) the key school and multiple-child family model. Youth reported parents' psychological control is positively related to youth anxiety in all the models. Indirect paths were found from parents' achievement goals on youth anxiety via youth reported parents' psychological control were only found in (a) the multiple child model, (b) the multiple child and key school model, and (c) the single child and typical school model. We acknowledge that our data were collected in China during the COVID-19 global pandemic. During this pandemic, professionals note that youth, including youth in China, reported significantly higher levels of anxiety, making our current data more difficult to compare with pre-COVID-19 data collected in China. Future research should further explore the development of youth anxiety across time (longitudinal studies). To inform prevention and intervention efforts targeting youth anxiety, researchers must consider numerous variables that may directly or indirectly mitigate or exacerbate youth anxiety. Future research may consider and investigate the following variables: family composition; parenting styles and cultural factors that are embedded in parenting styles; parents' goals for and expectations of their children's academic achievement; family composition, including sibling relationships; and the type of school youth attend.

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