The current study aimed to validate the child and parent pain catastrophizing scale in a large chronic pain sample and to identify child pain catastrophizing clinical reference points. Patients and parents (n= 697) evaluated at a pediatric pain program completed the Pain Catastrophizing Scale, child (PCS-C) and parent (PCS-P) report, along with additional measures of psychological functioning. The measure’s psychometric properties were examined, as well as relations across demographic, pain, and psychological characteristics and pain catastrophizing. Clinical reference points were identified for the PCS-C from differences in pain catastrophizing across levels of disability, depressive symptoms, and anxiety. Overall, we did not find support for the hypothesized three-dimension structure and recommend potentially removing items 7 and 8 for both the PCS-P and PCS-C due to floor/ceiling effects. The 11-item PCS-C is most parsimonious as a unitary construct, while the 11 item PCS-P is comprised of two factors. Although parent catastrophizing was significantly associated with child outcomes after controlling for pain level, it was no longer significant when accounting for child catastrophizing. When comparing PCS-C scores based on child outcomes, significant differences emerged for low, moderate, and high catastrophizing levels. It appears that the influence of parent catastrophizing on outcomes can be explained through its impact on child catastrophizing levels. Lastly, PCS-C reference points derived from this large sample can aid clinicians in assessment and treatment planning, in turn increasing the utility of the PCS-C for both clinical and research purposes.

The current study examined the Fear Avoidance (FA) model of chronic pain in pediatric chronic pain patients. Multiple structural equation models were tested in the current study with pairwise parameter comparisons made between younger children (8–12 years) and adolescents (13–17 years). Within a sample of 350 children and adolescents, we examined functional disability and depressive symptoms in separate models with the following predictor variables: pain, pain catastrophizing, fear of pain, and avoidance of activities, after controlling for duration of pain. For a subset of patients (n=151) we also tested a brief prospective outcome model with baseline predictor variables and functional disability at one-month follow-up. The FA models predicting functional disability concurrently and prospectively were an excellent fit to the data. The theorized FA model for depression was a poor fit. When the model was modified to include direct pathways from the cognitive processes of pain catastrophizing and fear of pain to depressive symptoms, the model fit was significantly improved. Examining developmental differences between younger children and adolescent patients, duration of pain contributed to the model for younger children while pain-related fears were more influential for adolescent patients.

Parenting was examined as a mediator of associations between marital and child adjustment, and parent gender was examined as a moderator of associations among marital, parental, and child functioning in 226 families with a school-age child (146 boys). Parenting fully mediated associations between marital conflict and child internalizing and externalizing behaviors. Parent gender did not moderate associations when data from the full sample or families with girls only were evaluated. Parent gender did moderate associations when families with boys were evaluated, with the association between marital conflict and parenting stronger for fathers than mothers. A trend suggested fathers' parenting may be more strongly related to internalizing behavior and mothers' parenting may be more strongly related to externalizing behavior in boys.

This study provides the first-known examination of the factor structure of the ARCS in a large sample of pediatric patients with diverse chronic pain conditions. Confirmatory factor analyses indicate that the ARCS is a valid measure for use with children and adolescents presenting to outpatient pain clinics with a variety of chronic pain complaints.