Intergenerational Transmission of Illness Behavior

描述（由申请人提供）：这是RO1 HD36069的竞争性更新申请。复发性腹痛（RAP）是一种儿童疾病，没有可识别的有机或生理原因，但具有显著的社会和个人成本。我们已经进行了一系列的研究，这些研究表明，疾病行为至少部分是在儿童时期学习的，当时父母以鼓励或加强疾病角色行为的方式模仿疾病角色行为或对孩子的躯体抱怨做出反应。这些结果表明，干预措施，教导父母减少过度疾病行为的建模和强化将是有益的RAP儿童。然而，以前的研究干预RAP已纳入这样的父母的培训方法是有限的。这项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，用于治疗我们以前在这项资助下进行的研究中发现的复发性腹痛儿童。本研究将检验三个主要假设：1）在治疗结束时和随访期间，社会学习和认知行为治疗组（SLCBT）的儿童比单独接受教育和支持的儿童在RAP症状、RAP症状的医疗保健利用和功能障碍（包括缺课）方面表现出更大的减少。2)在SLCBT条件下的儿童将表现出更多的认知应对，放松和压力管理技能的使用，在这种情况下的父母将表现出更大的减少在治疗结束时和随访期间的疾病行为的关怀反应比儿童和父母在ES条件。3)在治疗结束时和随访期间，SLCBT条件下的儿童比ES条件下的儿童在焦虑、抑郁和躯体化方面表现出更大的减少。次要目的是研究潜在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RAP儿童随机分为两种情况：1）SLCBT和2）ES比较条件，控制治疗师的注意力和接触。将在基线、治疗结束、治疗后3个月、6个月和12个月收集有关儿童症状和疾病行为等变量的信息。

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.