Catastrophizing, Child Pain Behavior, and Parental Response

灾难化、儿童疼痛行为和家长反应

• 批准号: 8434850
• 负责人: Shelby Langer
• 金额: $ 21.82万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8434850
• 关键词: Abdomen; Abdominal Pain; Adult; Affect; Affective; Age; Anxiety; Attention; Beds; Behavioral; Books; Caring; Child; Childhood; Chronic; Code; Cognition; Cognitive; Development; Disease; Distress; Environment; Etiology; Exhibits; Family; Frequencies; Functional disorder; Health Care Costs; Home environment; Impairment; Intervention; Investigation; Irritable Bowel Syndrome; Lead; Learning; Maintenance; Measures; Mediating; Medical; Methodology; Modification; Mothers; Outcome; Pain; Pain intensity; Paper; Parent-Child Relations; Parents; Participant; Pathway interactions; Pattern; Personal Satisfaction; Persons; Pilot Projects; Play; Prevalence; Procedures; Process; Questionnaires; Recurrence; Research; Risk; Role; Schools; Sick Role; Simulate; Social Environment; Source; Symptoms; Testing; Toy; Videotape; Water; Work; aged; behavior observation; chronic pain; coping; cost; design; disability; drinking water; experience; functional disability; health care service utilization; in vivo; innovation; insight; pain behavior; peer; psychosocial; response; social; therapy design

DESCRIPTION (provided by applicant): Functional Abdominal Pain (FAP) of childhood is a disorder for which there is no identifiable organic etiology, yet which is associated with illness behavior of significant personal and societal cost. Prior research suggests that responses from the environment contribute to such illness behavior and dysfunction through social learning processes, as when parents respond solicitously to child symptom complaints, e.g., with increased attention and relief from responsibility. Catastrophizing (CAT), an overly negative appraisal in which pain is seen as signifying a high degree of threat or harm, is known to amplify the experience and expression of pain, but the relationship of CAT to social learning processes has not been adequately examined. In the present proposal, we focus on CAT cognitions on the part of significant others, specifically, mothers of children with FAP. Mothers' CAT about their child's pain may lead them to interpret pain behaviors exhibited by their child as indicative of harm, damage or threat to the well-being of the child, and thus may increase the likelihood that they intervene by taking action to reduce demands on the child or allay the child's discomfort via solicitous responding, thereby encouraging illness behavior. This project aims to: 1) assess feasibility of a symptom provocation and behavioral observation paradigm designed to examine FAP child pain behavior and maternal response, and 2) determine whether the association between child pain behavior and maternal solicitousness is mediated by maternal CAT. Seventy-five children with FAP aged 8-12 and their mothers will serve as participants. Mothers will complete measures designed to assess generalized anxiety, CAT cognitions regarding their child's pain, and typical responses to their child's symptom complaints. Children will rate their pain intensity and then participate in a safe and validated water load procedure intended to simulate abdominal discomfort; in so doing, they will be asked to drink water until they are completely full, not to exceed 15 minutes. Next, children will clean a room much as they would at home (e.g., put away books and toys and make a bed). Children will be instructed to take the lead in this task but may ask their mother for assistance; similarly, mothers may offer assistance with or without a request from their child. The water load procedure and ensuing cleaning task will be videotaped, affording behavioral coding of child pain behavior and maternal response. Post-task questionnaires will assess acceptability of the paradigm. Findings will lay the groundwork for conducting a larger study using this methodology to explore the cognitive, affective, and behavioral pathways by which FAP may be maintained. This in turn will help to determine appropriate targets for intervention for children with FAP and their families, with the aim of reducing associated dysfunction and distress.

描述（由申请人提供）：儿童功能性腹痛（FAP）是一种疾病，没有可识别的器质性病因，但与显著的个人和社会成本的疾病行为相关。先前的研究表明，来自环境的反应通过社会学习过程促成了这种疾病行为和功能障碍，例如，当父母对儿童症状的抱怨做出殷勤的反应时，更多的关注和减轻责任。灾难化（CAT）是一种过度负面的评价，其中疼痛被视为高度威胁或伤害的象征，被认为会放大疼痛的体验和表达，但CAT与社会学习过程的关系尚未得到充分研究。在目前的建议中，我们专注于CAT认知的重要他人的一部分，特别是，FAP儿童的母亲。母亲对孩子疼痛的CAT可能会导致他们将孩子表现出的疼痛行为解释为对孩子健康的伤害，损害或威胁，因此可能会增加他们通过采取行动减少对孩子的要求或通过关心的反应减轻孩子的不适进行干预的可能性，从而鼓励疾病行为。该项目旨在：1）评估症状激发和行为观察范式的可行性，旨在检查FAP儿童疼痛行为和母亲的反应，2）确定儿童疼痛行为和母亲的关怀之间的关联是否是由母亲CAT介导的。75名8-12岁的FAP儿童及其母亲将作为参与者。母亲将完成旨在评估广泛性焦虑、关于孩子疼痛的CAT认知以及对孩子症状投诉的典型反应的措施。儿童将评估他们的疼痛强度，然后参加一个安全和有效的水负荷程序，旨在模拟腹部不适;在这样做的时候，他们将被要求喝水，直到他们完全吃饱，不超过15分钟。接下来，孩子们会像在家里一样打扫房间（例如，收起书籍和玩具，整理床铺）。将指示儿童在这项任务中起带头作用，但可以要求母亲提供帮助;同样，母亲可以在儿童提出请求或不提出请求的情况下提供帮助。水负荷过程和随后的清洁任务将被录像，提供儿童疼痛行为和母亲反应的行为编码。任务后问卷将评估范式的可接受性。这些发现将为使用这种方法进行更大规模的研究奠定基础，以探索FAP可能维持的认知，情感和行为途径。这反过来将有助于确定对FAP儿童及其家庭进行干预的适当目标，目的是减少相关的功能障碍和痛苦。