It is estimated that between twenty to fifty percent of asthmatic children also struggle with anxiety and/or depressive disorders, more than twice what is seen in non-asthmatic children. In the 1920's and 1930's, it was felt depression and anxiety caused asthma and that a child's wheeze could be thought of as a cry for his mother. It is now known that asthma is an abnormal respiratory response to allergens and other triggers that are harmless to most other individuals, but at the same time it is clear that psychological factors may also be involved.

Children with asthma may experience symptoms of anxiety and depression including fatigue, trouble concentrating, decreased motivation, and sadness. They may feel isolated from their peers because they may not be able to participate in the same activities. Irritability, weight gain or loss, and anxiety when separated from their parents may occur. Fear of an asthma attack may contribute to this separation anxiety.

These symptoms may be influenced by a genetic link between asthma and depression or by medications such as corticosteroids that are known to cause depression. Asthmatic children may also develop what is referred to as "learned hopelessness" which is caused by feeling out of control of their lives and their health. Children who feel hopeless may be less likely to take their medications as directed and thus be more likely to develop complications.

It is extremely important that parents, physicians, and others who care for children with asthma be on the lookout for signs of depression in these children. Research has shown that depressed asthmatic children have a higher mortality rate than non-depressed asthmatic children. Although their death may not directly be caused by depression, it is clear that they are less likely to survive a severe asthma attack. Children who have experienced other losses in their lives including divorce, death, or extreme family conflict seem to be particularly at risk. If these signs occur, parents need to discuss this with their child's physician and referred for help from a counselor with experience in dealing with children with chronic diseases.

Asthmatic children must be taught that although their disease may not be curable, it is certainly manageable. They have the knowledge and power to recognize when they may be getting into trouble and take early steps to get their asthma back under control. Asthma education and support groups such as the American Lung Association's Open Airways Program and taught in many elementary schools or specialized asthma camps for children may be helpful in giving children this knowledge and sense of power. Parents and schools need to make sure each child is given an asthma action plan by their primary care physician so children and their caregivers need not feel panicked when there is an acute exacerbation of their symptoms and know exactly what to do. Early intervention in treating depression and anxiety will increase medication compliance, improve the child's sense of well-being, improve their ability to function well in school, and may even save their lives.