title: Behavior problems antecede the development of wheeze in childhood: a birth cohort study.
abstract: BACKGROUND
  It is not clear to what extent behavior problems observed in children with asthma antecede asthma development, or are a consequence of the disease.
  
  
  OBJECTIVE
  We investigated psychologic factors at age 3 years and subsequent development of wheeze by age 5 in an unselected birth cohort study. Children were recruited prenatally, followed prospectively, and reviewed at age 3 and 5 years. The rate of significant behavior problems at age 3 (above the clinically relevant cut-off on the Eyberg Child Behavior Inventory) was compared between children who had never wheezed (n = 397) and those developing late-onset wheezing (after age 3 years; n = 39). Late-onset wheezers were more likely to be above cut-offs for behavior problems at 3 years (before wheeze onset), compared with children who never wheezed, on Intensity (23.1% vs. 6.0%, p < 0.001) and Problem scores (10.8% vs. 1.3%, p < 0.001). Families of late-onset wheezers had poorer scores on family functioning variables, but we found no evidence of increased anxiety or depression scores in parents. In the multivariate analysis, significant and independent associates of late-onset wheeze were as follows: maternal asthma (odds ratio [OR] 5.4, 95% confidence intervals [CI] 2.1-13.8, p < 0.001), maternal smoking when child was 3 years (OR 3.3, CI 1.2-8.7, p = 0.02), expressiveness (OR 0.71, CI 0.55-0.9, p = 0.005), and significant behavior problems at age 3 years (OR 3.5, CI 1.2-9.9, p = 0.02).
  
  
  CONCLUSIONS
  Behavior problems in early life are associated with increased risk of subsequent development of wheeze.
authors.affiliation: Academic Division of Clinical Psychology, 2nd Floor, Education and Research Centre, Wythenshawe Hospital, Manchester M23 9LT, UK. rachel.calam@man.ac.uk
authors.forename: Rachel
authors.initials: R
authors.lastname: Calam
authors.forename: Lynsey
authors.initials: L
authors.lastname: Gregg
authors.forename: Angela
authors.initials: A
authors.lastname: Simpson
authors.forename: Bridget
authors.initials: B
authors.lastname: Simpson
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodcock
authors.forename: Adnan
authors.initials: A
authors.lastname: Custovic
mesh_terms: D017668:Age of Onset; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D002652:Child Behavior / Q000523:psychology; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology*; D002675:Child, Preschool; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012135:Respiratory Sounds / Q000175:diagnosis / Q000209:etiology*; D012923:Social Class; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology