Adaptive Noncompliance in Pediatric Asthma: The Parent as Expert

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Abstract
The present paper questions the assumptions inherent in previous compliance literature that (a) noncompliance is uniformly maladaptive, and (b) the physician is the sole expert in the treatment of pediatric patients. Thirty asthmatic children (6–14 years) and their parents participated in this study. Interview data were collected on parental knowledge of asthma treatment, decisions regarding compliance, and predictions of their child's performance on various tasks. Data on the children's actual task performance, the rated adaptiveness of compliance decisions, and medical and quality of life outcomes were also gathered. Results indicated that parents varied in the adaptiveness of their compliance decisions. Greater adaptiveness was associated with better outcomes; degree of compliance was not. In addition, accuracy of parental predictions was predictive of outcome. These findings suggest the need for a refocusing of pediatric compliance research to include recognition of parental expertise and awareness that noncompliance may, in some cases, be adaptive.

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