ILLNESS BEHAVIOR AND SOMATIZATION IN CHILDREN

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DESCRIPTION: The central goal of this project is to identify psychosocial factors and social-cognitive processes associated with the development and maintenance of children's illness behavior (i.e., somatic complaints, functional disability, and health service utilization). The investigators aim particularly to understand illness behavior that appears to be out of proportion to medical findings, and thus they focus on pediatric patients with recurrent abdominal pain (RAP) without identifiable organic etiology as a prototype of exaggerated illness behavior. They include patients with organic diagnosis for abdominal pain as a comparison group in order to assess the generalizability of their conceptual model in explaining illness behavior in patients with organic disease. This program of research is guided by a conceptual model of stress and coping. It examines the hypothesis that children with certain psychosocial characteristics (e.g., RAP, low social or academic competence, low social support) appraise stressors (including life stressors and pain episodes) as more severe, appraise their coping potential as lower, and respond with particular coping strategies (such as passivity and lack of active problem-solving) that are hypothesized to contribute to higher levels of illness behavior. The next step in this program of research is to explore mechanisms explaining the links between negative life events, competence, and illness behavior that they have found in previous work. The proposed study uses a methodology that focuses on children's daily life and assesses children's appraisals and responses to stressors close in time to when these events actually occur. Specific aims are: (1) to investigate the relation between stress and illness behavior within the context of daily life stressors; (2) to examine, within the context of specific stressors and pain episodes, the processes underlying the relation of stress and coping responses to pediatric illness behavior; (3) to examine the links between children's styles of coping with pain and their coping responses to specific pain episodes; and, (4) to assess the degree to which the processes contributing to excessive illness behavior in RAP patients are also relevant to illness behavior in patients with an organic basis of abdominal pain. These aims will be pursued in the context of the child's daily life, using a daily diary telephone interview methodology in which children report on their experience and coping with common stressors as well as pain episodes over the course of several days. Subjects will be pediatric patients with RAP and with organic diagnosis for abdominal pain, and well children, between 8 and 15 years of age.