Intergenerational Transmission of Illness Behavior

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DESCRIPTION (provided by applicant): This is an application for competitive renewal of RO1 HD36069. Recurrent Abdominal Pain (RAP) is a disorder in children for which there is no identifiable organic or physiological cause, yet which has significant societal and personal costs. We have conducted a series of studies which suggest that illness behavior is, at least in part, learned during childhood when parents model sick role behavior or respond to their children's somatic complaints in a way that encourages or reinforces sick role behavior. These results suggest that interventions to teach parents to reduce modeling and reinforcement of excessive illness behavior would be beneficial for children with RAP. However, prior research on interventions for RAP which have incorporated such parental training have been methodologically limited. The aim of the proposed study is to evaluate a comprehensive social learning and cognitive behavior therapy approach for children with recurrent abdominal pain derived from our previous research under this grant. This study will test three primary hypotheses: 1) Children in a social learning and cognitive behavior therapy group (SLCBT) will exhibit a greater decrease in symptoms of RAP, health care utilization for RAP symptoms, and functional disability, including school absences, at the end of treatment and during follow up than children in an education and support alone condition (ES). 2) Children in the SLCBT condition will demonstrate greater use of cognitive coping, relaxation and stress management skills, and parents in this condition will demonstrate greater reductions in solicitous responses to illness behavior at the end of treatment and during follow up than children and parents in the ES condition. 3) Children in the SLCBT condition will exhibit greater reductions in anxiety, depression, and somatization at the end of treatment and during follow up than children in the ES condition. A secondary objective will be to Investigate the influence of potential moderating variables on treatment effects. To test these hypotheses, we propose to randomize 200 children with RAP to two conditions: 1) a SLCBT and 2) an ES comparison condition that controls for therapist attention and contact. Information about children's symptoms and illness behaviors, among other variables, will be collected at baseline, end of treatment, and three, six, and 12 months post-treatment.