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ABSTRACT. Objective. To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.Methods. A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.Results. Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current treatment with psychoactive medication, and generalized anxiety in first degree relatives. There were trends suggesting associations between childhood RAP and lifetime psychiatric disorder, depression, migraine, and family history of depression, but group differences on abdominal pain, IBS, other somatic symptoms, and history of maltreatment were not statistically significant.Conclusions. There is a strong and relatively specific association between childhood RAP and anxiety in young adulthood. Affected children may be at special risk to perceive physical symptoms as threatening, and should be evaluated for psychiatric disorder on initial presentation. Pediatrics 2001;108(1). URL: http://www. pediatrics.org/cgi/content/full/108/1/e1; abdominal pain, pain, anxiety, depression, colonic diseases, functional.ABBREVIATIONS. RAP, recurrent abdominal pain; FGD, functional gastrointestinal disorder; IBS, irritable bowel syndrome; DSM, Diagnostic and Statistical Manual of Mental Disorders; SCID-NP, Structured Clinical Interview for DSM-IV, Non-patient Version; BSI, brief symptom inventory; NS, not significant. R ecurrent abdominal pain (RAP) has been most consistently defined in the pediatric literature as at least 3 episodes of abdominal pain occurring during a period of at least 3 months that are severe enough to affect the activities of the child. 1,2 RAP is common, affecting between 7% to 25% of school-aged children and adolescents, 1,3-11 and may be responsible for 2% to 4% of pediatric office visits. 12 RAP becomes more prevalent with increasing age into adolescence 1,5,7,10 and is more common in girls, 4,13 with an equal gender ratio in early childhood, 11,14 but greater female symptom reporting in late childhood and adolescence. 1,9,10 Specific structural, infectious, inflammatory, or laboratory abnormalities are unusual in RAP, particularly in the absence of "red flags" such as weight loss, gastrointestinal bleeding, pain awakening the child at night, systemic symptoms such as fever, or laboratory evidence of anemia or inf...

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Psychologic adjustment, assessed by self-ratings of anxiety, self-esteem, and depression, and cognitive as well as behavioral coping strategies, elicited by interview, were monitored longitudinally among school-age children with recent-onset insulin-dependent diabetes mellitus (IDDM). Our article documents the findings over the 1st yr of illness. From the start, the children viewed themselves as self-confident and emotionally comfortable. The diagnosis of IDDM created minimal emotional upheaval (which faded within 6 mo), despite this cohort's consistent report that the diet, insulin injections, and urine tests were difficult. The most prevalent cognitive strategies for coping with IDDM included wishful thinking, thoughts of forbidden foods, and resentful thoughts. Behavioral coping strategies, including information seeking, were evident from the beginning. The frequency of socially oriented coping behaviors (e.g., showing IDDM management to peers) indicated that the young patients actively tried to adapt to the illness and were more comfortable with aspects of home care than previously thought. Self-rated psychologic adjustment, psychiatric diagnosis, and illness-related coping behaviors were unrelated to one another; psychologic variables were similarly unrelated to the use of socially oriented coping strategies. Therefore, in juvenile cohorts, the presumed association between psychologic status and coping behaviors requires further examination.

Objectives-Adverse childhood experiences are associated with poor mental health outcomes, including vulnerability to mood disorders and/or antisocial behavior. A functional polymorphism in the regulatory region of the monoamine oxidase A gene (monoamine oxidase A untranslated variable nucleotide tandem repeat, MAOA-uVNTR) may moderate the degree of risk conferred by early trauma. Experiential factors may mitigate or exacerbate the effects of trauma on individuals at genetic risk. We examined the association among MAOA-uVNTR genotype, early stress (family death, family separation, parents' divorce, physical and/or sexual abuse), quality of parental care, and disadvantageous outcomes (trait impulsivity/aggression and depression severity) in adult women.Methods-Diagnostic assessments were completed for 159 female participants. All were either healthy or were diagnosed with major depressive disorder or bipolar disorder. Participants were assessed for lifetime trait aggression and impulsiveness and current severity of depression, and were genotyped for the MAOA-uVNTR polymorphism. Participants rated the level of parental care they experienced, and were asked to report specific childhood stressors and abuse.Results-High perceived parental care mitigated the effect of a childhood stressor on impulsivity scores in low-expressing MAOA-uVNTR allele carriers, but level of perceived care had no effect in the group homozygous for the high-expressing MAOA-uVNTR allele. Gene-environment interactions did not influence depression severity in the mood disorder group, indicating that the effects of parenting we observed in our participants were independent of depression status.Conclusion-These results suggest that gene-environment interactions influence not only disadvantageous outcomes, but also sensitivity to features of the environment that could alleviate these outcomes.

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