PEDIATRIC ASTHMA AND FOOD ALLERGIES: UNRAVELING THE PSYCHOLOGICAL DIMENSIONS CONNECTED TO CLINICAL CHARACTERISTICS IN CHILDREN AND FAMILIES

Introduction Asthma and food allergies are among the most common pediatric chronic diseases, imposing a considerable medical and psychological burden on children, adolescents, and their families. These conditions are multi-determined, shaped by the interaction of biological, psychological, and environmental factors. Although numerous studies have investigated the psychological aspects of pediatric asthma and food allergies, research exploring the interplay between medical and psychological parameters remains limited, and findings to date are often inconsistent. Furthermore, parental functioning and family dynamics, key elements in the management of chronic conditions, are still underexplored. The primary aim of this PhD project was to examine the co-occurrences of psychological and illness-related factors, with particular attention to their impact on the psychological adjustment of children and adolescents with asthma and food allergies and their parents. The project is articulated into four studies, each addressing specific research questions Methods The study involved 121 children/adolescents with mild-to-moderate asthma (M_age=13.09), with their 121 mothers and 68 fathers, and 52 children/adolescents with food allergies (M_age=12.68) with their 47 mothers, and 36 fathers, all recruited at the Padova Hospital. Clinical outcomes included self or parent reports of asthma control, clinicians’ evalutation of asthma control, spirometry, asthma severity and presence/absence of anaphylaxis (food allergy). Standardized questionnaires were used to assess coping, separation anxiety, state/trait anxiety, anxiety dimensions, and psychological adjustment in children and adolescents; adult separation anxiety symtpoms, parenting stress and psychological well-being in parents. The same sample was used across the four studies, with each study focusing on a specific subgroup. Results In children and adolescents with asthma (Study 1) distinct patterns emerged depending on the medical parameters considered. Among them, self-reported asthma control was the factor most strongly associated with children and adolescents’ psychological difficulties. Avoidant coping, trait anxiety, and worry about calamitous events were significantly linked to poorer adjustment, together with specific anxiety dimensions such as social phobia, obsessive–compulsive symptoms, and panic/agoraphobia. In mothers of the asthma group (Study 2), separation anxiety symtpoms were consistently associated with their children and adolescents’ poorer adjustment. In fathers (Study 3), no direct associations emerged, but triadic analyses showed higher mothers’ separation anxiety and higher fathers’ parenting stress, with fathers’ parenting stress strongly linked to mothers’ one. In food allergy (Study 4), children showed better adjustment than those with asthma but reported higher fear of physical illness and separation anxiety. Trait anxiety, social phobia and panic/agoraphobia were key factors linked to psychological difficulties, independent of medical parameters. No significant associations with parental variables were found in this group. Discussion This project highlights that children and adolescents’ adjustment in asthma and food allergy is influenced more by subjective illness perceptions than by objective medical indices, underscoring the importance of considering lived experience in care. Trait anxiety and condition-specific anxiety profiles emerged as central vulnerabilities, suggesting the need for tailored psychological assessments across conditions. At the family level, mothers’ separation anxiety symtpoms proved particularly salient in asthma, while parental functioning appeared less central in food allergy. Overall, the findings stress the value of a biopsychosocial, multidisciplinary, and family-oriented approach to pediatric chronic illness care.