Advertisement

Clinical Autonomic Research

, Volume 15, Issue 6, pp 400–407 | Cite as

Autonomic reactivity and clinical severity in children with sickle cell disease

  • Sarah R. Pearson
  • Abbey Alkon
  • Marsha Treadwell
  • Brian Wolff
  • Keith Quirolo
  • W. Thomas BoyceEmail author
RESEARCH ARTICLE

Abstract

Individual differences in autonomic nervous system reactivity have been studied in relation to physical and mental health outcomes, but rarely among children with chronic disease. The purpose of this study was to examine the associations among autonomic reactivity, clinical severity, family stressors, and mental health symptoms in children with homozygous sickle cell disease. Nineteen children with homozygous sickle cell disease participated in a cross-sectional study involving parent-completed measures, medical record reviews and laboratory-based measures of autonomic nervous system responses to social, cognitive, physical and emotional challenges. Autonomic reactivity was significantly associated with both clinical severity and externalizing behavior symptoms. Children with greater parasympathetic withdrawal during challenges compared to rest had significantly more severe disease (r=–0.45, p<0.05); greater sympathetic activation during challenges compared to rest was associated with more externalizing behavior symptoms (r=0.44, p<0.05). Children experiencing major family stressors had internalizing behavior symptoms but no difference in autonomic reactivity or clinical severity compared to children experiencing fewer family stressors. Individual differences in autonomic reactivity may offer a new, biologically plausible account for observed variation in painful episodes, other physical complications and behavioral symptoms among children with sickle cell disease.

Key words

children sickle cell disease behavior autonomic measures clinical severity 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Adams R, Ohene-Frempong K, Wang W (2001) Sickle cell and the brain. Hematology, pp 31–46Google Scholar
  2. 2.
    Alexander N, Higgs D, Dover G, Serjeant G (2004) Are there clinical phenotypes of homozygous sickle cell disease? Br J Haematol 126:606–611CrossRefPubMedGoogle Scholar
  3. 3.
    Alkon A, Goldstein L, Smider N, Essex MJ, Kupfer DJ, Boyce WT, and the MacArthur Assessment Battery Working Group (2003) Developmental and contextual influences on autonomic reactivity in young children. Dev Psychobiol Vol 42:64–78Google Scholar
  4. 4.
    Allen M, Matthews K (1997) Hemodynamic responses to laboratory stressors in children and adolescents: the influences of age, race, and gender. Psychophysiology 34:329–339PubMedGoogle Scholar
  5. 5.
    Barbarin O, Whitten C, Bonds S (1994) Estimating rates of psychosocial problems in urban and poor children with sickle cell anemia. Health Social Work 19:112–119PubMedGoogle Scholar
  6. 6.
    Bennett D (1994) Depression among children with chronic medical problems: a meta analysis. J Pediatr Psychol 19:149–169PubMedGoogle Scholar
  7. 7.
    Berntson G, Cacioppo J, Quigley K (1991) Autonomic determinism: The modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic constraint. Psychol Rev 98:459–487PubMedGoogle Scholar
  8. 8.
    Boyce W, Quas J, Alkon A, Smider NA, Essex M, Kupfer D (2001) Autonomic reactivity and psychopathology in middle childhood. Br J Psychiatry 179:144–150CrossRefPubMedGoogle Scholar
  9. 9.
    Brown R, Lambert R, Devine D, Baldwin K, Casey R, Doepke K, Ievers C, Hsu L, Buchanan I, Eckman J (2000) Risk-resistance adaptation model for caregivers and their children with sickle cell syndromes. Ann Behav Med 22:158–169PubMedGoogle Scholar
  10. 10.
    Burlew K, Telfair J, Colangelo L, Wright E (2000) Factors that influence adolescent adaptation to sickle cell disease. J Pediatr Psychol 25:287–299CrossRefPubMedGoogle Scholar
  11. 11.
    Cacioppo J, Berntson G, Binkley P, Quigley K, Uchino B, Fieldstone A (1994) Autonomic cardiac control. II. Noninvasive indices and basal response as revealed by autonomic blockades. Psychophysiology 31:586–598PubMedGoogle Scholar
  12. 12.
    Charache S, Terrin M, Moore R, Dover G, Barton F, Eckert S, McMahon R, Bonds D (1995) Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. N Engl J Med 332:1317–1322CrossRefPubMedGoogle Scholar
  13. 13.
    Coddington R (1972) The significance of life events as etiologic factors in the diseases of children. II. A study of a normal population. J Psychosom Res 16:205–213PubMedGoogle Scholar
  14. 14.
    Dampier C, Ely E, Brodecki D, O’Neal P (2002) Home management of pain in sickle cell disease: a daily diary study in children and adolescents. J Ped Hem/Oncol 24:643–647Google Scholar
  15. 15.
    Dampier C, Setty B, Eggleston B, Brodecki D, O’Neal P, Stuart M (2004) Vaso-occlusion in children with sickle cell disease: clinical characteristics and biologic correlates. J Ped Hem/Oncol 26:785–790Google Scholar
  16. 16.
    Davidson J (1997) Biological therapies for posttraumatic stress disorder: an overview. J Clin Psychiatry 58(Suppl 9):29–32PubMedGoogle Scholar
  17. 17.
    Dukes M, Aronson J (2000) Meyler’s side effects of drugs: an encyclopedia of adverse reactions and interactions. Elsevier, AmsterdamGoogle Scholar
  18. 18.
    Essex M, Boyce W, Goldstein L, Armstrong J, Kraemer H, Kupfer D (2002) The confluence of mental, physical, social, and academic difficulties in middle childhood. II: developing the Macarthur health and Behavior Questionnaire. J Am Acad Child Adolesc Psychiatry 41:588–603PubMedGoogle Scholar
  19. 19.
    Fuggle P, Shand P, Gill L, Davies S (1996) Pain, quality of life, and coping in sickle cell disease. Arch Dis Child 75:199–203PubMedGoogle Scholar
  20. 20.
    Gil K, Carson J, Porter L, Ready J, Valrie C, Redding-Lallinger R, Daeschner C (2003) Daily stress and mood and their association with pain, health ca-use, and school activity in adolescents with sickle cell disease. J Pediatr Psychol 28:363–373CrossRefPubMedGoogle Scholar
  21. 21.
    Joyner M, Halliwill J (2000) Sympathetic vasodilatation in human limbs. J Physiol 526(Pt 3):471–480PubMedGoogle Scholar
  22. 22.
    Kazdin A, Kagan J (1994) Models of dysfunction in developmental psychopathology. In: Clinical Psychology: Science and Practice, pp 35–52Google Scholar
  23. 23.
    Kell R, Kliewer W, Erickson M, Ohene-Frempong K (1998) Psychological adjustment of adolescents with sickle cell disease: relations with demographic, medical and family competence variables. J Pediatr Psychol 23:310–312Google Scholar
  24. 24.
    Lepore S (1998) Problems and prospects for the social support-reactivity hypothesis. Ann Behav Med 20:257–269PubMedCrossRefGoogle Scholar
  25. 25.
    Lorber M (2004) Psychophysiology of aggression, psychopathy, and conduct problems: A meta-analysis. Psychol Bull 130:531–552CrossRefPubMedGoogle Scholar
  26. 26.
    Matthews K (1986) Summary, conclusions and implications. In: Matthews KA, Weiss SM, Detre T, Dembrowski TM, Falkner B, Manuck SB, Williams RB (eds) Handbook of Stress, Reactivity and Cardiovascular Disease. Wiley-Interscience, New YorkGoogle Scholar
  27. 27.
    Miller B, Wood B (1994) Psychophysiologic reactivity in asthmatic children: a cholinergically mediated confluence of pathways. J Am Acad Child Adolesc Psychiatry 33:1236–1245PubMedGoogle Scholar
  28. 28.
    Miller S, Sleeper L, Pegelow C, Enos L, Wang W, Weiner S, Wethers D, Smith J, Kinney T (2000) Prediction of adverse outcomes in children with sickle cell disease. N Engl J Med 342:83–89PubMedCrossRefGoogle Scholar
  29. 29.
    Monaghan J, Robinson J, Dodge J (1979) The children’s Life Events Inventory. J Psychosom Res 23:63–68CrossRefPubMedGoogle Scholar
  30. 30.
    Offord D, Lipman E, Duku E (2000) Epidemiology of problem behavior. In: Loeber R, Farrington DP (eds) Child Delinquents. Development, Intervention and Service Needs. Sage Publications, Inc, California, pp 95–116Google Scholar
  31. 31.
    Platt O, Thorington B, Brambilla D, Milner P, Rosse W, Vichinsky E, Kinney T (1991) Pain in sickle cell disease. Rates and risk factors. N Engl J Med 325:11–16PubMedCrossRefGoogle Scholar
  32. 32.
    Porges S (1995) Orienting in a defensive world: mammalian modifications of our evolutionary heritage. A Polyvagal Theory. Psychophysiology 32:301–318PubMedGoogle Scholar
  33. 33.
    Raine A (1996) Autonomic nervous system factors underlying disinhibited, antisocial, and violent behavior. In: Grisso CFFaT (ed) Understanding Aggressive Behavior in Children. Annals of the NY Academy of Sciences, New York, pp 46–59Google Scholar
  34. 34.
    Raine A, Venables P, Mednick S (1997) Low resting heart rate at age 3 years predisposes to aggression at age 11 years: Evidence from the Mauritius Child Health Project. J Am Acad Child Adolesc Psychiatry 36:1457–1464PubMedGoogle Scholar
  35. 35.
    Reis D, Golanov E (1997) Autonomic and vasomotor regulation. Int Rev Neurobiol 41:121–149PubMedCrossRefGoogle Scholar
  36. 36.
    Robertson D, Low P, Polinsky R (1996) Primer on the Autonomic Nervous System. Academic Press, New YorkGoogle Scholar
  37. 37.
    Romero Mestre J, Hernandez A, Agramonte O, Hernandez P (1997) Cardiovascular autonomic dysfunction in sickle cell anemia: a possible risk factor for sudden death? Clin Auton Res 7:121–125PubMedGoogle Scholar
  38. 38.
    Romero-Vecchione E, Perez O, Wessolosky M, Rosa F, Liberatore S, Vasquez J (1995) Abnormal autonomic cardiovascular responses in patients with sickle cell anemia. Sangre 40:393–399PubMedGoogle Scholar
  39. 39.
    Sakhalkar V, Rao S, Weedon J, Miller S (2004) Elevated plasma sVCAM-1 levels in children with sickle cell disease: impact of chronic transfusion therapy. Am J Hematol 76:57–60CrossRefPubMedGoogle Scholar
  40. 40.
    Salomon K, Matthew K, Allen M (2000) Patterns of sympathetic and parasympathetic reactivity in a sample of children and adolescents. Psychophysiology 37:842–849CrossRefPubMedGoogle Scholar
  41. 41.
    Sarason I, Johnson J, Siegel J (1979) Assessing the impact of life changes: development of the Life Experiences Survey. In: Stress and Anxiety. John Wiley and Sons, New York, pp 131–14Google Scholar
  42. 42.
    Steinberg MH (2003) Therapies to increase fetal hemoglobin in sickle cell disease. Curr Hematol Rep 2:95–101PubMedGoogle Scholar
  43. 43.
    Thompson R, Armstrong F, Link C, Pegelow C, Moser F, Wang W (2003) A prospective study of the relationship over time of behavior problems, intellectual functioning, and family functioning in children with sickle cell disease: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr Psychol 28:59–65CrossRefPubMedGoogle Scholar
  44. 44.
    Thompson R, Gil K, Burbach D, Keith B, Kinney T (1993) Role of child and maternal processes in the psychological adjustment of children with sickle cell disease. J Consult Clin Psychol 61:469–474Google Scholar
  45. 45.
    Tremblay R, LaMarquand D (2001) Individual risk and protective factors. In: Loeber R, Farrington DP (eds) Child Delinquents: Development, Intervention, and Service Needs. Sage Publications, Inc., Thousand Oaks, pp 137–164Google Scholar
  46. 46.
    Trzepacz A, Vannatta K, Gerhardt C, Ramey C, Noll R (2004) Emotional, social, and behavioral functioning of children with sickle cell disease and comparison peers. J Pediatr Hematol Oncol 26:642–648PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • Sarah R. Pearson
    • 1
    • 2
  • Abbey Alkon
    • 2
    • 3
  • Marsha Treadwell
    • 4
  • Brian Wolff
    • 1
    • 2
  • Keith Quirolo
    • 4
  • W. Thomas Boyce
    • 1
    • 2
    Email author
  1. 1.School of Public HealthUniversity of CaliforniaBerkeley (CA) 94720-1190USA
  2. 2.Institute for Human DevelopmentUniversity of CaliforniaBerkeley (CA)USA
  3. 3.School of NursingUniversity of CaliforniaSan Francisco (CA)USA
  4. 4.Sickle Cell Center, Dept. of HematologyChildren’s Hospital and Research CenterOakland (CA)USA

Personalised recommendations