repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had addit... more repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had additional repeat ED visits. 39% had at least one related clinic visit. There was one patient death from unexplained causes during follow-up. Conclusions: Infants with BRUE continue to be frequently admitted. Diagnostic testing remains common and of those tested for oropharyngeal dysphagia, 50% have abnormal swallow study results and 100% of those with aspiration have silent aspiration. BRUE symptoms are frequently blamed on reflux and many children are discharged on acid suppression. With the current approach, BRUE patients remain symptomatic and frequently represent to medical care.
Despite clinical observation of perfectionistic tendencies among youth with chronic pain and thei... more Despite clinical observation of perfectionistic tendencies among youth with chronic pain and their parents as well as established relationships between perfectionism and functional somatic symptoms in adults and youth, no research in the pediatric pain literature has examined perfectionism. This study explored the role of various types of youth and parent perfectionism on youth and parent pain-related distress and behavior and youth pain-related dysfunction. At admission, 239 parent-child pairs from outpatient and day-treatment rehabilitation settings completed several questionnaires assessing perfectionism, pain-related distress, and pain-related dysfunction. Bivariate correlations indicated that socially prescribed perfectionism in youth and parents was linked to youth pain duration, parent and youth pain-related distress and behavior, and youth somatization. Indirect relations demonstrated that youth socially prescribed perfectionism was the only form of perfectionism directly as...
Objectives: Individual understanding of and expectations for chronic pain treatment can influence... more Objectives: Individual understanding of and expectations for chronic pain treatment can influence treatment adherence and thus success, but little is known about these critical factors in parents and children presenting with pain-predominant functional gastrointestinal disorders. The aim of this study was to identify parent and patient understanding of pain-predominant functional gastrointestinal disorders, expectations for treatment, and interventions utilized before presenting to a multidisciplinary clinic. Materials and Methods: This was a prospective study of patients evaluated in a Multidisciplinary Functional Abdominal Pain Program. Before the clinic visit, parents and patients completed questionnaires regarding their understanding of chronic pain, perceptions of abdominal pain contributors, expectations regarding treatment, and identification of previous interventions utilized. Results: Participants were knowledgeable regarding the biology of chronic pain. Perceptions of contributors to abdominal pain included a sensitive stomach, general stress, and nerves/worry. Most had attempted to treat their pain with medication, exercise or physical therapy, or a psychological treatment. Participants reported that receiving a definite diagnosis would be the most helpful intervention, followed by psychological treatment. Discussion: Participants were knowledgeable regarding chronic pain, but still indicated that receiving a definite diagnosis would be the most helpful intervention. Most had tried multiple interventions and did not believe that further medication, testing, or surgery would solve their pain. Instead, parents presenting at this Functional Abdominal Pain Program appeared most hopeful about the benefits of multidisciplinary treatment approaches including psychological interventions, a focus on activity and functioning, and complementary and alternative medicine interventions.
Despite high levels of need, many federal assistance programs are underutilized, with differentia... more Despite high levels of need, many federal assistance programs are underutilized, with differential participation rates among demographic subpopulations. Outreach efforts seek to address challenges facing potentially eligible program recipients. This article examines a statewide initiative to address barriers to participation in the Supplemental Nutrition Assistance Program (SNAP), focusing on the elderly and people with disabilities, eligible immigrants, and low-income working households. We describe a dynamic approach that relies on community partnerships and utilizes media messaging, information dissemination, and direct client assistance to reach our target populations. The data illustrate how continuous evaluation allows for systematic adaptation of strategies, highlighting lessons learned for future outreach efforts. 1 KEYWORDS Community-based outreach, program evaluation, access to benefits
The relationship between childhood emotional maltreatment (CEM) and adverse health-related outcom... more The relationship between childhood emotional maltreatment (CEM) and adverse health-related outcomes is well-documented in the literature. However, mediators of such relationships are not fully understood. The present study examined alexithymia as a potential mediator of the relationship between CEM and somatic complaints in young adults. A sample of 270 undergraduates completed self-report questionnaires assessing CEM, alexithymia, and somatic complaints. All variables were moderately intercorrelated. Controlling for the effects of sex, path analyses supported a model in which alexithymia partially mediated the relationship between CEM and somatic complaints. This study provides further evidence for the occurrence and lasting sequelae of CEM in a sample of young adults. It also illuminates the role of emotions in the relationship between CEM and somatic complaints, suggesting that interventions emphasizing affective education may lessen somatic complaints. Individual differences in CEM and other mediators warrant further investigation.
Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annu... more Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision-making. Youth (n=321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (...
Youth with chronic headache disorders often experience sensitivities to light and sound that trig... more Youth with chronic headache disorders often experience sensitivities to light and sound that trigger or exacerbate their headaches and contribute to functional disability. At present, there are no known validated measures for assessing these sensitivities and their impact on functioning in youth with chronic headaches. This pilot study sought to develop and assess the feasibility of measures of headache-related light and sounds sensitivities in youth with chronic headache disorders. The initial item pools were generated via an intensive literature review, an informal quality improvement project, and a panel of experts in chronic pain. Then, youth (n = 20) presenting for clinical evaluation of headaches completed the revised items as well as assessments of the measures’ feasibility and items’ understandability. A subset (n = 2) completed formal cognitive interviews as well. The resulting 20-item Headache-Related Light Sensitivity Inventory (HALSI) and 18-item Headache-Related Sound S...
How parents attribute cause to their child’s physical symptoms is likely important in under... more How parents attribute cause to their child’s physical symptoms is likely important in understanding how the parent responds to the child, as well as the child’s health outcomes, especially within the context of chronic illness. Here, we adapt the Symptom Interpretation Questionnaire for parent report (SIQ-PR) and provide preliminary validation in a sample of parents of children with chronic pain ( = 311). Confirmatory factor analysis revealed that the SIQ-PR structure is consistent with the original measure, with three distinct attribution types: psychological (emotional/affective), somatic (illness/disease), and environmental (situational/transient) causes. All three subscales demonstrated satisfactory to good internal consistency, and temporal stability. Parents typically endorsed more than one attribution for each symptom, indicating that parents of children with chronic pain have a multidimensional interpretation of physical symptoms in their children. Further, paren...
This prospective study compared paternal versus maternal factors and their impact on child outco... more This prospective study compared paternal versus maternal factors and their impact on child outcomes in the context of an intensive pediatric pain rehabilitation program. METHODS: One hundred four youth with treatment refractory chronic pain and their parents enrolled in an intensive pediatric pain rehabilitation program completed measures of pain, functional disability, and parent pain-related attitudes, perceptions, and behaviors at admission and discharge. RESULTS: Linear mixed models were used. Controlling for significant demographic and clinical characteristics, mothers and fathers who were present for the program typically demonstrated significantly better improvement from admission to discharge compared with nonpresent fathers. Mothers made the most significant gains in protective parent responses. Children also had significant decreases in pain and improvements in functioning over time. CONCLUSIONS: Results indicate the efficacy of this treatment model for both childre...
Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annu... more Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision-making. Youth (n=321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (...
Strong evidence supports cognitive-behavioral therapy (CBT) for the treatment of childhood anxiet... more Strong evidence supports cognitive-behavioral therapy (CBT) for the treatment of childhood anxiety. Many studies suggest that parents play an etiological role in the development and maintenance of child anxiety. This pilot study examined the efficacy of a cognitive-behavioral intervention delivered to the parents of 31 anxious children (ages 7-13). Parents were randomly assigned to an individual parent-only CBT intervention (PCBT, n = 18) or wait-list control (WL, n = 13). PCBT demonstrated significant reductions in children's number of anxiety disorder diagnoses, parent-rated interference and clinician-rated severity of anxiety, and maternal protective behaviors at post-treatment, which were maintained at 3-months. WL did not demonstrate significant changes. There were no significant differences between conditions in child self-reported or parent-report of child anxiety symptoms. Findings were replicated in a combined sample of treated participants, as well as in an intent-to-t...
Objective: Parents" emotional, cognitive, and behavioral responses are highly influential upon ch... more Objective: Parents" emotional, cognitive, and behavioral responses are highly influential upon children"s pain and functional outcomes. One important response to pediatric pain is acceptance: the degree to which an individual participates in routine daily activities in the presence of pain and is willing to let pain be a part of their life without efforts to control or avoid it. However, no tool currently exists to assess parents" own acceptance of their child"s pain. The aim of this study was to validate the Parent Pain Acceptance Questionnaire (PPAQ).
Fear and avoidance have been consistently associated with poor pain-related outcomes in children.... more Fear and avoidance have been consistently associated with poor pain-related outcomes in children. In the context of the pediatric pain experience, parent distress and behaviors can be highly influential. The current study validated the Parent Fear of Pain Questionnaire (PFOPQ) to assess a parent's fears and avoidance behaviors associated with their child's pain. Using the PFOPQ in conjunction with measures of parent and child pain-related variables, we tested the Interpersonal Fear Avoidance Model (IFAM). The sample comprised of 321 parents and their child with chronic or new-onset pain who presented to a multidisciplinary outpatient pain clinic. An exploratory factor analysis yielded a 4-factor structure for the PFOPQ consisting of Fear of Pain, Fear of Movement, Fear of School, and Avoidance. As hypothesized, Fear of Pain was most closely related to parent pain catastrophizing and child fear of pain, while Avoidance was most closely related to parent protective behaviors and child avoidance of activities. In testing the IFAM, parent behavior contributed directly and indirectly to child avoidance while parent fear and catastrophizing contributed indirectly to child avoidance through parent behavior and child fear and catastrophizing, in turn, influencing child functional disability levels. The current study provides the first measure of parent pain-related fears and avoidance behaviors and evaluates the theorized IFAM. These results underscore the important influence of parents on child pain-related outcomes and puts forth a psychometrically sound measure to assess parent fear and avoidance in the context of their child's pain.
repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had addit... more repeat admissions with a mean of 1.52±0.18 admissions and 3.26±0.55 nights. 16% (n= 25) had additional repeat ED visits. 39% had at least one related clinic visit. There was one patient death from unexplained causes during follow-up. Conclusions: Infants with BRUE continue to be frequently admitted. Diagnostic testing remains common and of those tested for oropharyngeal dysphagia, 50% have abnormal swallow study results and 100% of those with aspiration have silent aspiration. BRUE symptoms are frequently blamed on reflux and many children are discharged on acid suppression. With the current approach, BRUE patients remain symptomatic and frequently represent to medical care.
Despite clinical observation of perfectionistic tendencies among youth with chronic pain and thei... more Despite clinical observation of perfectionistic tendencies among youth with chronic pain and their parents as well as established relationships between perfectionism and functional somatic symptoms in adults and youth, no research in the pediatric pain literature has examined perfectionism. This study explored the role of various types of youth and parent perfectionism on youth and parent pain-related distress and behavior and youth pain-related dysfunction. At admission, 239 parent-child pairs from outpatient and day-treatment rehabilitation settings completed several questionnaires assessing perfectionism, pain-related distress, and pain-related dysfunction. Bivariate correlations indicated that socially prescribed perfectionism in youth and parents was linked to youth pain duration, parent and youth pain-related distress and behavior, and youth somatization. Indirect relations demonstrated that youth socially prescribed perfectionism was the only form of perfectionism directly as...
Objectives: Individual understanding of and expectations for chronic pain treatment can influence... more Objectives: Individual understanding of and expectations for chronic pain treatment can influence treatment adherence and thus success, but little is known about these critical factors in parents and children presenting with pain-predominant functional gastrointestinal disorders. The aim of this study was to identify parent and patient understanding of pain-predominant functional gastrointestinal disorders, expectations for treatment, and interventions utilized before presenting to a multidisciplinary clinic. Materials and Methods: This was a prospective study of patients evaluated in a Multidisciplinary Functional Abdominal Pain Program. Before the clinic visit, parents and patients completed questionnaires regarding their understanding of chronic pain, perceptions of abdominal pain contributors, expectations regarding treatment, and identification of previous interventions utilized. Results: Participants were knowledgeable regarding the biology of chronic pain. Perceptions of contributors to abdominal pain included a sensitive stomach, general stress, and nerves/worry. Most had attempted to treat their pain with medication, exercise or physical therapy, or a psychological treatment. Participants reported that receiving a definite diagnosis would be the most helpful intervention, followed by psychological treatment. Discussion: Participants were knowledgeable regarding chronic pain, but still indicated that receiving a definite diagnosis would be the most helpful intervention. Most had tried multiple interventions and did not believe that further medication, testing, or surgery would solve their pain. Instead, parents presenting at this Functional Abdominal Pain Program appeared most hopeful about the benefits of multidisciplinary treatment approaches including psychological interventions, a focus on activity and functioning, and complementary and alternative medicine interventions.
Despite high levels of need, many federal assistance programs are underutilized, with differentia... more Despite high levels of need, many federal assistance programs are underutilized, with differential participation rates among demographic subpopulations. Outreach efforts seek to address challenges facing potentially eligible program recipients. This article examines a statewide initiative to address barriers to participation in the Supplemental Nutrition Assistance Program (SNAP), focusing on the elderly and people with disabilities, eligible immigrants, and low-income working households. We describe a dynamic approach that relies on community partnerships and utilizes media messaging, information dissemination, and direct client assistance to reach our target populations. The data illustrate how continuous evaluation allows for systematic adaptation of strategies, highlighting lessons learned for future outreach efforts. 1 KEYWORDS Community-based outreach, program evaluation, access to benefits
The relationship between childhood emotional maltreatment (CEM) and adverse health-related outcom... more The relationship between childhood emotional maltreatment (CEM) and adverse health-related outcomes is well-documented in the literature. However, mediators of such relationships are not fully understood. The present study examined alexithymia as a potential mediator of the relationship between CEM and somatic complaints in young adults. A sample of 270 undergraduates completed self-report questionnaires assessing CEM, alexithymia, and somatic complaints. All variables were moderately intercorrelated. Controlling for the effects of sex, path analyses supported a model in which alexithymia partially mediated the relationship between CEM and somatic complaints. This study provides further evidence for the occurrence and lasting sequelae of CEM in a sample of young adults. It also illuminates the role of emotions in the relationship between CEM and somatic complaints, suggesting that interventions emphasizing affective education may lessen somatic complaints. Individual differences in CEM and other mediators warrant further investigation.
Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annu... more Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision-making. Youth (n=321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (...
Youth with chronic headache disorders often experience sensitivities to light and sound that trig... more Youth with chronic headache disorders often experience sensitivities to light and sound that trigger or exacerbate their headaches and contribute to functional disability. At present, there are no known validated measures for assessing these sensitivities and their impact on functioning in youth with chronic headaches. This pilot study sought to develop and assess the feasibility of measures of headache-related light and sounds sensitivities in youth with chronic headache disorders. The initial item pools were generated via an intensive literature review, an informal quality improvement project, and a panel of experts in chronic pain. Then, youth (n = 20) presenting for clinical evaluation of headaches completed the revised items as well as assessments of the measures’ feasibility and items’ understandability. A subset (n = 2) completed formal cognitive interviews as well. The resulting 20-item Headache-Related Light Sensitivity Inventory (HALSI) and 18-item Headache-Related Sound S...
How parents attribute cause to their child’s physical symptoms is likely important in under... more How parents attribute cause to their child’s physical symptoms is likely important in understanding how the parent responds to the child, as well as the child’s health outcomes, especially within the context of chronic illness. Here, we adapt the Symptom Interpretation Questionnaire for parent report (SIQ-PR) and provide preliminary validation in a sample of parents of children with chronic pain ( = 311). Confirmatory factor analysis revealed that the SIQ-PR structure is consistent with the original measure, with three distinct attribution types: psychological (emotional/affective), somatic (illness/disease), and environmental (situational/transient) causes. All three subscales demonstrated satisfactory to good internal consistency, and temporal stability. Parents typically endorsed more than one attribution for each symptom, indicating that parents of children with chronic pain have a multidimensional interpretation of physical symptoms in their children. Further, paren...
This prospective study compared paternal versus maternal factors and their impact on child outco... more This prospective study compared paternal versus maternal factors and their impact on child outcomes in the context of an intensive pediatric pain rehabilitation program. METHODS: One hundred four youth with treatment refractory chronic pain and their parents enrolled in an intensive pediatric pain rehabilitation program completed measures of pain, functional disability, and parent pain-related attitudes, perceptions, and behaviors at admission and discharge. RESULTS: Linear mixed models were used. Controlling for significant demographic and clinical characteristics, mothers and fathers who were present for the program typically demonstrated significantly better improvement from admission to discharge compared with nonpresent fathers. Mothers made the most significant gains in protective parent responses. Children also had significant decreases in pain and improvements in functioning over time. CONCLUSIONS: Results indicate the efficacy of this treatment model for both childre...
Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annu... more Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision-making. Youth (n=321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (...
Strong evidence supports cognitive-behavioral therapy (CBT) for the treatment of childhood anxiet... more Strong evidence supports cognitive-behavioral therapy (CBT) for the treatment of childhood anxiety. Many studies suggest that parents play an etiological role in the development and maintenance of child anxiety. This pilot study examined the efficacy of a cognitive-behavioral intervention delivered to the parents of 31 anxious children (ages 7-13). Parents were randomly assigned to an individual parent-only CBT intervention (PCBT, n = 18) or wait-list control (WL, n = 13). PCBT demonstrated significant reductions in children's number of anxiety disorder diagnoses, parent-rated interference and clinician-rated severity of anxiety, and maternal protective behaviors at post-treatment, which were maintained at 3-months. WL did not demonstrate significant changes. There were no significant differences between conditions in child self-reported or parent-report of child anxiety symptoms. Findings were replicated in a combined sample of treated participants, as well as in an intent-to-t...
Objective: Parents" emotional, cognitive, and behavioral responses are highly influential upon ch... more Objective: Parents" emotional, cognitive, and behavioral responses are highly influential upon children"s pain and functional outcomes. One important response to pediatric pain is acceptance: the degree to which an individual participates in routine daily activities in the presence of pain and is willing to let pain be a part of their life without efforts to control or avoid it. However, no tool currently exists to assess parents" own acceptance of their child"s pain. The aim of this study was to validate the Parent Pain Acceptance Questionnaire (PPAQ).
Fear and avoidance have been consistently associated with poor pain-related outcomes in children.... more Fear and avoidance have been consistently associated with poor pain-related outcomes in children. In the context of the pediatric pain experience, parent distress and behaviors can be highly influential. The current study validated the Parent Fear of Pain Questionnaire (PFOPQ) to assess a parent's fears and avoidance behaviors associated with their child's pain. Using the PFOPQ in conjunction with measures of parent and child pain-related variables, we tested the Interpersonal Fear Avoidance Model (IFAM). The sample comprised of 321 parents and their child with chronic or new-onset pain who presented to a multidisciplinary outpatient pain clinic. An exploratory factor analysis yielded a 4-factor structure for the PFOPQ consisting of Fear of Pain, Fear of Movement, Fear of School, and Avoidance. As hypothesized, Fear of Pain was most closely related to parent pain catastrophizing and child fear of pain, while Avoidance was most closely related to parent protective behaviors and child avoidance of activities. In testing the IFAM, parent behavior contributed directly and indirectly to child avoidance while parent fear and catastrophizing contributed indirectly to child avoidance through parent behavior and child fear and catastrophizing, in turn, influencing child functional disability levels. The current study provides the first measure of parent pain-related fears and avoidance behaviors and evaluates the theorized IFAM. These results underscore the important influence of parents on child pain-related outcomes and puts forth a psychometrically sound measure to assess parent fear and avoidance in the context of their child's pain.
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