Parent training to address pediatric functional abdominal pain

描述（由申请人提供）：这是R 01 HD 36069的竞争性更新申请。功能性腹痛（FAP）影响10%至15%的儿童，并具有显著的社会，情感和经济成本，但没有已知的器质性原因，也没有公认的药物或行为治疗。我们已经进行了研究，为理论模型提供支持，在该模型中，认知行为和社会学习过程（建模和/或潜在的加强父母的反应）可能有助于维持FAP儿童的疾病行为和功能障碍。随后，我们测试了社会学习和认知行为干预的父母-孩子的二人组，其重点是改变这些父母的行为，以及应对技巧的教学儿童。结果支持干预的有效性和理论的解释价值，表明父母的变化是减少儿童症状的关键因素。这项拟议的研究将建立在这些发现的基础上，通过评估一个只有父母的干预。此外，我们的经验和其他调查人员的经验表明，需要替代干预模式，以更广泛地为有需要的家庭提供干预。虽然只有父母的格式预计将增加可访问性，我们也将评估远程电话干预的使用。本研究的具体操作目标是将来自两个中心的300名FAP儿童的父母随机分为三种情况：1）三次家长面对面的社会学习和认知行为治疗干预（SLCBT），2）同一干预措施的三个会话电话版本（SLCBT-R）和3）教育和支持比较条件（ES）控制治疗师的时间和注意力也通过电话传递。将在基线、治疗结束时以及治疗后3个月、6个月和12个月从父母和儿童收集有关儿童症状、功能残疾、医疗保健利用、生活质量、父母对儿童疾病行为的反应和儿童疼痛应对的信息。在这项研究中测试的干预措施，如果成功的话，提供了有用的模型，为发展有效的，可访问的干预措施，为广泛的医疗问题，父母的反应，儿童的躯体症状可能是一个重要组成部分。 公共卫生相关性：功能性腹痛（FAP）是儿童时期常见的主诉，与相当大的医疗保健费用、正常活动中断、情绪困扰和长期健康影响相关。这项拟议的研究将测试一种治疗方法，如果成功，将大大改变FAP的治疗方法，并可能改变父母对症状的反应导致这些不良影响的各种儿童医学问题。这项研究还将提供一种模式，比传统的面对面治疗更容易为比目前得到服务的更广泛的有需要的家庭所利用。

DESCRIPTION (provided by applicant): This is an application for competitive renewal of R01 HD36069. Functional Abdominal Pain (FAP) affects 10 to 15% of children and has significant social, emotional, and financial costs, but no known organic cause and no accepted medical or behavioral treatment. We have conducted studies that provide support for a theoretical model in which cognitive-behavioral and social learning processes (modeling and/or potentially reinforcing responses by parents) may contribute to the maintenance of illness behaviors and functional disability in children with FAP. We subsequently tested a social learning and cognitive-behavioral intervention for parent-child dyads which focused on changing these parent behaviors as well as teaching coping skills to children. Results support the effectiveness of the intervention and the explanatory value of the theory, demonstrating that parental change is a key element in reducing children's symptoms. The proposed study will build on these findings by evaluating a parent-only intervention. Furthermore, our experience and that of other investigators indicates that alternative intervention models are needed for wider accessibility to the intervention for families in need. While a parent-only format is expected to increase accessibility, we will also evaluate the use of a remote telephone intervention. Specific operational objectives of the study are to randomize 300 parents of children with FAP from two centers to three conditions: 1) a three session parent only face-to-face social learning and cognitive behavior therapy intervention (SLCBT), 2) a three session telephone version of the same intervention (SLCBT-R) and 3) an education and support comparison condition (ES) that controls for therapist time and attention also delivered by telephone. Information about children's symptoms, functional disability, health care utilization, quality of life, parental responses to children's illness behavior, and child pain coping will be collected at baseline, end of treatment, and three, six, and 12 months post-treatment from both parents and children. The interventions tested in this study will, if successful, provide useful models for the development of effective, accessible interventions for a wide range of medical problems for which parental reactions to children's somatic symptoms may be an important component. PUBLIC HEALTH RELEVANCE: Functional abdominal pain (FAP) is a common complaint of childhood, associated with considerable health care costs, disruption of normal activity, emotional distress, and long-term health effects. The proposed study will test a treatment approach which, if successful, would substantially change the treatment for FAP and potentially for a wide range of childhood medical problems where parental responses to symptoms contribute to these adverse effects. The study would also provide a model which would be much more accessible than traditional face- to-face therapies to a broader range of families in need than are currently served.