Intergenerational Transmission of Illness Behavior

描述(申请人提供)：这是一份RO1 HD36069的竞争性续签申请。复发性腹痛(RAP)是一种儿童疾病，没有可识别的器质性或生理性原因，但会造成巨大的社会和个人代价。我们进行了一系列研究，表明患病行为至少在一定程度上是在童年时期学会的，当时父母以病态角色行为为榜样，或者以鼓励或强化病态角色行为的方式回应孩子的躯体抱怨。这些结果表明，教育父母减少建模和加强过度患病行为的干预措施对患有RAP的儿童是有益的。然而，先前关于RAP干预的研究纳入了这样的父母培训，在方法上是有限的。这项拟议研究的目的是评估一种综合的社会学习和认知行为治疗方法，用于治疗复发性腹痛儿童，该方法源于我们之前在这项拨款下的研究。这项研究将检验三个主要假设：1)在治疗结束和随访期间，社会学习和认知行为治疗组(SLCBT)的儿童在RAP症状、RAP症状的医疗利用和功能障碍(包括缺课)方面的降幅比仅接受教育和支持条件(ES)的儿童更大。2)SLCBT条件下的儿童将表现出更多地使用认知应对、放松和压力管理技能，这种情况下的父母在治疗结束时和随访期间对疾病行为的关怀反应比ES条件下的儿童和父母表现出更大的减少。3)在治疗结束和随访期间，SLCBT组儿童在焦虑、抑郁和躯体化方面比ES组儿童表现出更大的减少。第二个目标将是调查潜在的调节变量对治疗效果的影响。为了验证这些假设，我们建议将200名患有RAP的儿童随机分为两种情况：1)SLCBT和2)ES对照条件，以控制治疗师的注意力和接触。关于儿童症状和疾病行为的信息，以及其他变量，将在基线、治疗结束以及治疗后3、6和12个月收集。

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.