Does Maternal-infant Bonding Therapy
Improve Breathing in Asthmatic Children?

by Antonio Madrid, Ralph Ames, Sue Skolek,
and Gary Brown

ABSTRACT: Six mothers of asthmatic children with histories of non-bonding were treated with a therapy aimed at repairing the bond between them and their children. Four of the children were then briefly treated to repair the bond and two infants were not treated. Eighteen variables were studied before treatment, after the mother’s treatment, and after the children’s treatment. There was improvement in all 18 variables. Five children experienced complete or nearly total improvement in their breathing. The two infants had total remission of symptoms.

This study is the fourth in a series that examines the relationship between Maternal-Infant Bonding and pediatric asthma (Feinberg, 1988; Schwartz, 1988; Pennington, 1992). While there have been clinical reports that asthmatic children improve when the bonding is repaired (Madrid and McPhee, 1986; Madrid and Pennington, 2000), this study looks at the question in a more formal manner and presents a detailed description of the therapy employed.

Since French and Alexander’s 1941 article, linking pediatric asthma to some impairment in the mother-child relationship, clinicians and researchers have been looking into the mother’s impact on childhood asthma. In their seminal article, French and Alexander hypothesized that conflict around excessive, unresolved dependence upon the mother was responsible for the child’s asthma and that fear of separation from her could trigger an asthma attack. These children were preoccupied with thoughts of maternal rejection, and the asthma attack itself was considered a suppressed cry for the mother. They further observed that maternal rejection is found as a recurrent theme in the life of the asthmatic and that the child feels a need of maternal care and protection. When the child does not achieve this basic nurturance, he reacts with clinging and insecurity.

The theme of maternal rejection found supporters in most of the studies of psychological antecedents of childhood asthma. In reviews of this literature, Schwartz (1988) and Pennington (1992) cite dozens of articles that focused upon the mother’s rejection and the child’s overdependency as central to the development of asthma. For example, Harris et al.(1949) showed that asthmatic children appeared to have a greater fear of separation from their mother than controls. Knapp and Nemetz (1957) found that asthmatics showed an intense, clinging dependence. Miller and Baruch (1948) found that 98% of asthmatics studied gave evidence of maternal rejection, as compared to 24% of non-asthmatics. Later, Miller and Baruch (1958) found that 97% of mothers in a group of allergic children expressed rejection of their children, as compared to 37% of the non-allergic group.

Pennington cited several articles which identify overprotection in mothers of asthmatics. Pinkerton (1967) discerned three main groups of parental attitudes: over-protective, rejective, and ambivalent. Bentley (1975) found that the parents of non-steroid dependent children were openly resentful of their children. Purcell et al. (1961) found that parents of non-steroid dependent children subscribed to attitudes on child rearing that were hostile and rejecting.

Pennington (1992) summarized that “rejection of the asthmatic child by the mother has been a dominant theme in the findings of a majority of investigators who have studied asthma as a psychosomatic disease.” Schwartz (1988) stated that the “prevailing view in the literature emphasizes disturbances in the mother-child relationship as central to the etiology of childhood asthma.” She goes on to say, that “a host of researchers mention this strained mother-child relationship, but few studies have attempted to explain how the relationship became strained, other than as a result of intra-psychic factors in the mothers’ personality or interpersonal factors in the family constellation.”

A few studies, conducted at the Erickson Institute in Santa Rosa, CA, including those of Pennington and Schwartz, focused upon the etiology of the strained relationship. These researchers studied the relationship between childhood asthma and disruptions in maternal-infant bonding. “Maternal-infant bonding,” as used by these authors, is a term specifically defined by Marshall Klaus and John Kennell, in their 1976 book, Maternal-Infant Bonding .

According to Klaus and Kennell, bonding is a physical, emotional, and biological attachment between a mother and her child, similar in many ways to bonding in animals. It is almost guaranteed to be present, unless something interferes with it. As in animal cases, human impediments to bonding are brought about by physical separation at birth or soon afterward. Physical separation can occur for several reasons, including hospital procedures that keep a mother from being with her child after birth: viz., anesthesia; C-sections; events which place the child in an incubator away from the mother; adoption procedures; twin or triplet births; and any other medical or life event which separates the mother from a child immediately after birth or for a considerable time afterwards.

Klaus and Kennell contend that bonding can be impeded in humans by another type of separation: emotional separation. Emotional separation is likely to occur when the mother is undergoing another emotion which is so strong that it competes with or prevents normal bonding emotions. Bonding, then, is incompatible with this type of maternal preoccupation. Klaus and Kennell identify grief as the primary incompatible emotion. Typical events which may cause this grief include the death of someone close to the mother, a recent miscarriage, or spousal separation. Incompatible emotions may also include extreme fright, the anguish of an unwanted pregnancy, or addiction.

Using the concept of maternal-infant bonding as a mediating variable, three studies examined the relationship between bonding failures and asthma. Feinberg (1988) compared the bonding of 30 pairs of mothers and their asthmatic children with 30 pairs of non-asthmatics. As a measure of bonding, he employed the Maternal-Infant Bonding Survey (MIBS) (Brown et al., 1981), a questionnaire that lists most events which are thought to impede bonding. He found that bonding failures occurred three times as frequently in the asthma group as in the non-asthma group (24% and 84%).

Schwartz (1988) studied another set of mother-child pairs (N=30) using expert judges to rate their responses to the MIBS to determine if they were bonded. Of the non-asthmatic group, 29% were judged non-bonded as compared with 86% of the asthmatic group. She also found that two or more critical events were endorsed on the MIBS by 24% of non-asthmatic mothers as compared to 70% of asthmatic mothers. Her conclusions were that there existed a “concomitant variation between non-bonding events and pediatric asthma,” adding, “if a child has asthma, he most likely is not bonded.”

Pennington (1992) found that there was a significant relationship between early separation of the mother and infant and the subsequent development of pediatric asthma. Early separation was also associated with severity of asthma. Emotional difficulties were found more in mothers of asthmatic children, although they had no bearing on the disease severity. Pennington found that four non-bonding events occurred more frequently in the asthmatic groups: emotional problems during pregnancy, delay in holding the baby, family death in first year, and emotional problems in the first year.

These studies offered maternal-infant bonding as a reasonable and parsimonious mediating variable between childhood asthma and “maternal rejection/over-protection” noted by other authors. From Klaus and Kennell’s evidence, lack of bonding is directly linked with maternal rejection. From the Erickson Institute studies, asthma is linked with lack of bonding. We think failure to bond contributes to maternal rejection which, in some children, leads to asthma.

The question which this pilot study addresses is the next logical one of this series: When there is a history of non-bonding in an asthmatic child, can repairing the bonding help this child breathe better?

Method

Subjects

Six mothers completed the treatment for this study, from an original pool of 19 who initially volunteered to participate. Two mothers did not wish to participate because they did not think the hypothesis for this study was valid. Six mothers did not attend their first session for no reported reason. Two mothers only participated in an initial treatment session (one mother was in the middle of a divorce and decided not to continue; the other mother was not comfortable with the theoretical assumptions). Two children were excluded because their symptoms were so minimal that a change would not be observable. One child did not want to participate in the study when it came time for her to be treated.

All subjects volunteered in response to announcements at grammar schools and health centers in a rural area of Sonoma County, CA. The mothers were sent a research package that included a Maternal-Infant Bonding Survey, a Mother’s Report, and a Child’s Report. All forms, when completed, were mailed back to the researchers. The subjects for the study were selected by their responses to the MIBS and the Mother’s Report, which were evaluated by the senior author. If there was evidence on the MIBS of an event that is thought to interfere with bonding and there were asthma symptoms in the child, the mother and child were included in the study. They were invited to an initial individual interview, in which the study was described in more detail and their questions could be answered.

Instruments

Maternal-Infant Bonding Survey (MIBS)

Each mother was administered the MIBS (Brown et al., 1981) to determine if there was an event in her life that is usually associated with failures in bonding. From the response of each participant’s MIBS, the child was ruled to be either “Bonded” or “Non-bonded” by the senior investigator. The MIBS is a 17 item survey that lists events which have been identified by Klaus and Kennell as associated with ailures in bonding (see Appendix A).

Mother’s Report

The Mother’s Report is a 9 item questionnaire, adapted from Zlatnich and associates (1982), that asks her about her child’s asthmatic condition. The questions include objective data such as days absent from school and types of medication the child uses, as well as subjective opinions such as how she rates her child’s health. Subjective questions have five forced choice responses (excellent, good, satisfactory, poor, bad) (see Appendix B).The test was given three times: before the study began, two weeks after the mother’s treatment was completed, and one month after the child’s treatment was completed.

Child’s Report

The Child’s Report is a 9 item questionnaire that asks the child to evaluate his or her own breathing, under specific conditions, such as “how is your breathing when you wake up in the morning.” Except for two questions, responses were of the forced five choice variety. (See Appendix C).

The children’s test was also administered three times: before the study began, two weeks after the mother’s treatment was completed, and one month after the child’s treatment was completed. Two children were too young to be questioned.

Clinical Scoring Check List (CSCL)

The CSCL, from which the Mother’s Report was adapted, is a check list developed by Zlatnick et al. (1982) to measure the severity of asthma. Responses to the Mother’s Report were converted to the CSCL for some presentations of the data in order to determine the changes in the severity of a child’s asthma. The CSCL uses 8 variables to measure the severity of asthma (see Appendix D).

Treatment

The treatment was a two-part therapy: the mother was treated first, and then the child was treated if old enough to participate.

Mother’s Treatment

The mother’s treatment had three parts. Each of the parts was explained to the mother before work was initiated.

First, the event or events which prevented the mother from bonding with her child was identified. As mentioned above, the events which usually qualify for an impediment to bonding are physical separation after birth or an emotional separation due to some serious competing emotion before or after birth. It was not uncommon for there to be several MIB inhibitors, and it often took a bit of investigating to find them all.

Secondly, the event or events were “worked through” so that the mother no longer felt that they bothered her. In this study this was done with the help of hypnosis. The pain or unsettling feeling was repaired or healed with age regression to the time of her pregnancy so that she could know what it was like to give birth to her child without this upsetting experience. For example, if a mother had lost a child before she became pregnant with her asthmatic child, she resolved the grief, then experienced the pregnancy and birth of her child, this time without a troubled heart. Even if she no longer felt the sorrow at the time of treatment, she still was asked to return to the time of the pregnancy and resolve it then. We have said, “You are today no longer suffering from this sorrow; so bring that feeling back to the time of the pregnancy with your son.”

Often a mother had not resolved the competing emotion at all. With the help of hypnosis, she was instructed to resolve it, using simple general suggestions such as, “Your unconscious mind knows how to heal you from this hospital procedure (or separation, or loss of your husband, or guilt).” When it was clear that the physical and/or emotional separation was resolved, the third step was introduced. A new pregnancy and birth was created and the mother was asked to experience this new beginning with her child. In hypnosis the mother was taken through her pregnancy in this new way, indicating at each trimester that everything was fine, up to the birth. She was brought through an easy birth, and her child was kept with her, without any interruptions in her closeness with her child. She was then taken forward to the present, focusing on any time in the child’s history that was previously sensitive. She was asked to experience all of this with her healthy child.

In cases where there was emotional separation after birth, the emotional event causing this maternal preoccupation was repaired and she was taken through the birth and through this event without distraction. She was asked to experience her connection with her child from the beginning, through this difficult time, up to the present.

At each stage of the repaired history, the mother was asked if everything was all right. If she could not experience a time as good, it typically meant that there was more work to do on the original impediment to bonding. Time was then spent on this problem, and she was returned again to experience the new history. The mother’s therapy was completed when, under hypnosis, she was able to respond that she was connected to her child from conception to the present moment. These questions were answered using ideomotor signals, in the method explained by Cheek and LeCron (1966).

Child’s Treatment

The second part of the treatment was with the child, in the presence of the mother. It had three parts. Each of the parts was explained to the child before the work was initiated.

First, the child was hypnotized and the impediments to bonding (as identified by the mother) were removed. For example, if the mother was grieving her father’s death during pregnancy, he was told that his mother’s sadness would be removed from her and from him as well. If he was removed from his mother for 36 hours, he was told that this separation and the memory and feeling of it would be removed from him. If the mother was struck by some great grief during the first year, the child was told that the mother’s pain was removed and now his sadness would be erased. Various hypnotic metaphors were used to accomplish this, such as:

We are going to clean out the sadness and the memory of the sadness that occurred when you were six months old, when your mother was upset and you got asthma. Go to that time, and take all that sadness and dump it in the garbage. When it’s all dumped in there, your index finger will start floating.

Secondly, a new birth story was created along with a new history up to the present time. This was done with the mother present, experiencing it again while in hypnosis. At each stage, the child was asked to confirm that “everything is OK” using ideomotor signals. The new history went through each part of the old history, this time cleaned up and smoothed out so that none of the bonding impediments was present. A typical intervention sounded like this:

Now we are going to go through your birth in a new way. And your mother is here going through it with you. Mrs. Jones, would you like to go into hypnosis right now? So your mother and father want to have a baby, and you are conceived. Your mother is very happy (originally, she was grieving the loss of her father), and she is thinking about you all the time. And you know her. You get big inside her, and you know she’s happy. You can hear her heart beat, and you can feel her voice when she talks. Everything is perfect. You get to be three months along, and when you know this, your index finger will float.

(This was developed, trimester by trimester, until the child’s birth.) Now you are getting ready to be born, and it’s a quick and easy birth. When you are born and take your first breath, your index finger will float. (It floats.) Now you are placed on your mother and you hear her heart beat again, and you know her voice, and you see her. And when you know this, your index finger will float. You stay there with your mother. And you know how happy she is. After a while you nurse. After a while you fall asleep and stay with your mother.

(Mention was made of the child’s lungs being perfect.) You are a healthy baby. You can breathe perfectly. Your lungs are good lungs and know how to breathe. When you know this, your index finger will float.

This story was developed, through each historically important time in the child’s life, up to the present time. The child’s good health was emphasized. The child’s connection to the mother was also emphasized.

Third, the child’s memory of being sick was removed. He was told that he would remember what he needed to remember to be medically safe but that he did not need to remember all of the sick times. He was asked through ideomotor signals if this was safe to do. Then he was instructed to “dump” all the unwanted memories, using some metaphor that was suitable, such as:

You can take all those yukky memories of being sick and throw them in the river and watch them float out to the ocean, and they go away for ever. You can always know what to do to be physically safe, but you don’t need those memories and feelings and fear anymore. There they go, and when they are gone, your index finger will float.

At the end of this therapy, the child was asked if there was anything else that needed work. If there was, that work was attended to. The child and mother were brought out of hypnosis. This completed the child’s therapy.

Results

Statistical Analysis of Complete Treatment

The responses of four mothers and their children (two children were too young to answer the child’s questionnaire) were totaled across each of the eighteen variables. Those data are presented in Table 1 along with probabilities obtained from a distribution-free test for the slope coefficient (Theil, 1950.)2

Table 1

Responses Summed Across Four Subjects
and Probabilities from Theil’s Test for Slope Coefficient



    Episodes or Rating                                                         PreMIB/ Post MIB /PostChild/ P
     (smaller is better)
MOTHERS' RESPONSES        
emergency medical visits 14 2 0 0.0571
day-long episodes of wheezing 15 4 0 0.0571
days of mild wheezing 3 1 0 0.0571
exercize wheezing 3 2 0 0.0571
nights tending child 43 1 0 0.0571
days housebound 172 0 0 0.1469
medications 10 7 5 0.0571
rating of child's health 10 7 5 0.0571
level of child's activity 11 7 7 0.1469
CHILDREN'S RESPONSES       0.1469
rating of breathing in general 11 8 6 0.0571
rating of breathing when exercizing 13   4 0.0571
rathing of breathing at bedtime 8 7 4 0.0571
rating of breathing during night 7 6 6 0.1469
rating of breathing upon awakening 9 4 5 0.1469
rating of breathing during day 10 8 7 0.0571
rating of energy 8 8 5 0.1469
improvement lately 8 6 4 0.0571
fear about breathing 7 7 6 0.1469

It can be noted that there were large perceived improvements following MIB treatment and somewhat lesser ones after the children’s therapy. The individual probabilities range from 0.0571 to .1469, all missing significance at the five percent level. These probabilities may be low enough to be suggestive, but no one of them may be sufficiently low to establish statistical significance. The eighteen probabilities can be combined, however, employing the method of Fisher (1954). The statistic is distributed as Chi-square with degrees of freedom computed as twice the number of separate tests. When applied to the data in this study, high significance is obtained across all variables and also when the mother’s responses are examined separately from those of the children. The results are summarized in Table 2.

Table 2
Fisher’s Technique for Combining Probabilities


Statistic        All Variables          Mothers      Children

Chi-square              84.17               45.86          38.30
                            df                                 36                    18              18
                            P                        < 0.0001          < 0.0001      < 0.005

The probability of achieving these results strictly by chance is quite remote. It is very likely that the children's breathing improved due to the treatment of both the mothers and children.

What Happened When Just the Mother Was Treated?

Some of the effects of MIB therapy done with the mother alone, without any therapy for the child, are presented in Tables 3 through 7.

Table 3

Asthma Severity Scores (as rated by mothers) of the Children

pretest                   posttest


Total scores                            386.5                     60.50
Median scores                         043.5                    01.75

Individual scores
Subject A                                 024.0                     02.0
Subject B                                 055.0                     35.0
Subject C                                 025.0                     32.0
Subject D                                 195.5                     01.5
Subject E                                 038.0                     00.0
Subject F                                 049.0                     00.0


Note. The CSCL was used to obtain the asthma severity scores. Scores of < 20 indicates mild asthma; 20 to 50 indicates moderate asthma; >50 indicates severe asthma.

In Table 3 the median pretest CSCL score was 43.5, indicating moderate asthmatic symptoms, and the median posttest CSCL score was 1.75, indicating quite minimal asthmatic symptoms. This finding suggests an immediate improvement in the children’s asthmatic symptoms after MIB therapy with the mother.


Table 4

Children’s Medication Use

pretest                posttest


Total scores                             137.50                 36.50
Median scores                           25.00                 00.75

Individual scores
Subject A                                 017.0                     01.0
Subject B                                  035.0                    35.0
Subject C                                    10.0                    10.0
Subject D                                   25.5                     00.5
Subject E                                   25.0                      00.0
Subject F                                   25.0                      00.0


Note. The CSCL was used to obtain the medication usage scores.

Less medication was used by all but two of the children. Child B did not improve until after therapy was done with him; child C only used Proventil before sports events, which she continued to do.

Table 5

Mother’s Rating of Child’s Health and
Level of Activity Since Treatment

posttest

Median score                                           0.0 (improved) >Individual scores
Subject A                                                  0.0 (improved)
Subject B                                                   0.0 (improved)
Subject C                                                  5.0 (worse)
Subject D                                                  0.0 (improved)
Subject E                                                    0.0 (improved)
Subject F                                                     0.0 (improved)
Note. The CSCL was used to score the mother’s rating of her child’s health and level of activity since treatment.

The median posttest Mother’s Rating of Child’s Health and Level of Activity Since Treatment score was 0 (improved). An examination of the individual scores shows hat one of the six subjects (Subject C) rated her child’s health and level of activity as worse since the treatment, while five out of the six subjects rated their child’s health and level of activity as having improved since the treatment. Mother C, however, reported that six months after her daughter’s treatment was completed she was off all medications and was symptom free, even when playing sports.

Table 6
Table 6

Child’s Self-Report Rating of Breathing and Energy

pretest                           posttest

Median scores                    satisfactory-good          good-excellent Median scores

Individual scores
Subject A                             good                              excellent
Subject B                            good                               good
Subject C                            satisfactory                    satisfactory
Subject D                            satisfactory                    excellent
Subject E                             (a)                                  (a)
Subject F                             (a)                                  (a)



(a) Data unavailable; child was an infant.

The median scores show a pre-treatment child’s self-report rating of breathing and energy in the satisfactory to good range, and a post-treatment child’s self-report rating in the good to excellent range.

Table 7
Children’s Ages and Perceived Posttest Improvements

                        Age          CSCL(a)        Med Usage(b)           Mother’s Rating(c)


Subject A      06.0 yrs.   Improved         Improved                    Improved
Subject B      11.5 yrs.   Improved         No change                   Improved
Subject C      12.0 yrs.   No change        No change                   Worse
Subject D      11.0 yrs.   Improved         Improved                     Improved
Subject E        0.6 yrs.   Improved          Improved                    Improved
Subject F      01.2 yrs.   Improved          Improved                    Improved

(a)Asthma Severity Scores of the Children.
(b) Medication Usage of the Children.
(c) Mother’s Rating of Child’s Health and Level of Activity Since Treatment.

From this table it appears that the younger the child, the greater the likelihood of improvement.

Types of MIB Inhibitors (MIBI) and Total CSCL Scores

A summary of the factors involved in impeding the bonding for each mother and the overall change in the Clinical Scoring Check List is presented in Table 8.

Table 8

Types of MIB Inhibitors and CSCL Scores for Each Patient

Patients

  A B C D E F
Type of MIBI            
sick during
pregnancy
    bed-
ridden
  tox-
emia
tox-
emia
competing emotion
during pregnancy
father left bad
delivery
  marital
problems
fr left  
delay in holding baby   over-
anesthetized
      18 hr
separation during
first two years
           
competing emotion
during yrs 0-2
bad
relationship
very sad
about
miscarriages
  divorce,
poverty
guilt  
other     sep
from
husb
     
CSCL (a)            
pre-therapy 24 55 25 195.5 38 49
post mother 2 35 32 1.5 0 0
post child 2.5 31 5 2.5 n/a n/a
(a) << 20 indicates mild asthma; 20 to 50 indicates moderate asthma; >50 indicates severe asthma.

Each mother had at least two MIB inhibitors involved in non-bonding. The severity of asthma scores showed improvement for all patients by the end of treatment. All but one improved after treating just the mother, with four of those improving dramatically. Both infants improved completely after the mother’s treatment.

Discussion

The indications from this pilot study are that Maternal-Infant Bonding therapy helps asthmatic children breathe better. From the evaluations of their mothers and from the children’s own impressions, improvement occurred for all children in every category measured. Mothers of five children felt that their children had improved completely or almost totally.

The findings suggest that for some children a dramatic reduction occurs in the severity of the children’s asthmatic symptoms by just doing bonding with the mothers. In the treatment of the two infants it is clear that work with the mother alone had a complete remission in symptoms for their babies.

For some children, however, treatment with the mother alone was not totally effective. Some children who did not improve completely after their mother’ bonding treatment, showed further improvement after their own treatment was initiated. These children seemed to be the older children, and it is the impression of the investigators that age may be a factor. It is hypothesized that impaired bonding may be easier to remedy at a younger age. Since one of the developmental tasks of adolescence is to individuate from one’s parents, strengthening the mother’s connection with her child may have little effect on an older child. Further, by the time a non-bonded child is older, he or she may have individual issues which need to be addressed and remedied in individual treatment.

From this study and in our clinical experience, a child’s breathing difficulties can return, for a variety of reasons. Improved breathing can be restored, however, with additional treatment, by identifying the cause for the trouble and remediating it. In a case apart from this study, a mother several months after treatment reported that her 9 year old son was again asthmatic. Through questioning and hypnosis, we discovered that his asthma returned when she, in anger, said that he would miss her when she died. She returned home and apologized to her son and reassured him. By the end of the day, he was no longer wheezing.

The number of subjects used, the time frames from which the measures were taken, and subjective impressions used for several of the measures all limit the power of this pilot study. Nevertheless, it is clear that the children improved with treatment. A larger sample and stronger objective measures are needed for future study. It is important, however, to value the mother’s subjective statements about her child’s health, because her opinion can describe something which numbers cannot capture. In our study, when some mothers said about their children, “She’s OK now. She’s finally a healthy girl,” that portrayed much more than statistical significance.

Pediatric asthma accounts for more medical interventions with children than any other chronic disease and involves large amounts of time and money. Asthma is among the top three illnesses that prevent children from going to school. There is a great amount of suffering associated with pediatric asthma, both for patients and their families. Any treatment method that can be shown to quickly and effectively relieve the symptoms of pediatric asthma at a low cost and with no detrimental side effects has untapped value.



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Appendix A
Appendix A


Maternal-Infant Bonding Survey
Maternal-Infant Bonding Survey
(Brown et al., 1981)

NAME__________________________

How old were you when this child was born:

What were the ages of your older children at that time?

Did you have any miscarriages during the two years before this child’s birth?

If yes, how far along were you?

What was your physical condition during the pregnancy? (Please check one.)

_____very seriously ill

_____poor

_____average

_____good

_____excellent

Please describe any conditions you experienced:



What was your emotional condition during the pregnancy? (Please check one.)

_____very seriously ill

_____poor
_____average
_____good
_____excellent

Please describe any conditions you experienced.



Please describe any complications at birth:



Please describe any anesthesia used during birth.



Was your child delivered by cesarean section?

Was your child a twin, triplet, etc?

How long was it after your child’s birth before you first saw him/her?

_____0 - 30 minutes
_____30 - 60 minutes
_____1 - 2 hours
_____longer than 2 hours. How long? __________

How long was it after your child’s birth before you first held him/her?

_____0 - 30 minutes
_____30 - 60 minutes
_____1 - 2 hours
_____longer than 2 hours. How long? ____________

How long were you together?
_____0 - 30 minutes
_____30 - 60 minutes
_____1 - 2 hours
_____longer than 2 hours. How long? ____________

After deliver, where was your child placed?

_____the hospital nursery
_____an intensive dare nursery
_____an incubator
_____with you
_____other: ___________________________________________________

Was there any significant separation from your child in the first year?
If so, for how long?
_____less than one week
_____1 - 2 weeks
_____2 - 4 weeks
_____over 4 weeks. Please describe:


Were there any deaths in the family during the child’s first year?
Please describe:


Did you experience any serious emotional difficulties during your child’s first two years?            Please describe:





How did you feel when you first held your baby? Please describe:












Appendix B
Appendix B

Mother
’s Report

Did your child require any emergency medical visits for asthma during last semester (hospital, doctor visit, school nurse)? Yes___ How many ___ No ____

Did your child experience episodes of wheezing during last semester which lasted more than one day? Yes___ How many___ No

Did your child experience frequent, mild wheezing during last semester?
Yes___ No___

Did your child experience shortness of breath on physical exertion during last semester? Yes__ No___

Did you have to get up for your child during the night last semester?
Yes___ How many nights _____ No___

Medications your child used during last semester:
____________________________________
____________________________________
____________________________________
____________________________________

Was your child housebound because of asthma during last semester ( no school or no play)? Yes___ How many days___ No___

Please rate your child’s health during last semester:
Excellent __ Good___ Satisfactory____ Poor___ Bad___

What has been the level of your child’s activity during last semester?
Excellent __ Good___ Satisfactory____ Poor___ Bad___

Please describe any other medical conditions your child has:








Appendix C
Appendix C

Children
Children’s Report

Please circle one answer for each question:

How has your breathing been?
excellent    good    satisfactory    poor      bad

When you exercise how is your breathing?
excellent     good     satisfactory    poor      bad

When you go to bed how is your breathing?
excellent    good     satisfactory     poor     bad

How is your breathing when you wake up?
excellent     good     satisfactory    poor     bad

How is your breathing during the day?
excellent    good     satisfactory     poor     bad

How is your breathing during the night?
excellent    good     satisfactory     poor     bad

How is your energy?
excellent     good     satisfactory     poor     bad

Has there been any improvement in the last 3 months in your breathing?
gotten better     about the same     has been worse

Have you been frightened by your breathing?
not at all       sometimes        a lot

Comments in General:











Appendix D
Appendix D

Clinical Scoring Checklist Protocol
Clinical Scoring Checklist Protocol
(Zlatnick et al. 1982)





Criteria

Hospitalization for asthma (each): 10

Acute care (ER) visit (each): 3

Episode of wheezing (more than a day) (each): 1

Mild frequent wheezing (during year): 10

Shortness of breath on physical exertion (during year): 5

Continuous steroids (during year): 15

Short-course steroid (each): 1

Continuous bronchodilators (during year):10

Bronchodilator (each episode): 0.5

Chromolyn, continuous (during year): 11

School missed 1-7 days (during year): 2

School days missed 1-4 weeks (during year): 5

School missed more than 4 weeks (during year): 10

Mother’s rating of child’s progress

Improved : 0
Same : 2.5
Worse: 5