Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain

Abstract

Theoretical models of pediatric chronic pain propose longitudinal associations between children's pain experiences and parent and family factors. A large body of cross-sectional research supports these models, demonstrating that greater parent distress and maladaptive parenting behaviors are associated with greater child disability. Family-based cognitive-behavioral therapy interventions have been developed for youth with chronic pain which aim to improve child disability and reduce maladaptive parenting behaviors. However, little is known about temporal, longitudinal associations between parent and child functioning in this population. In the present study, we conducted a secondary analysis of data from 138 families of youth with chronic pain aged 11 to 17 years old who received family-based cognitive-behavioral therapy delivered through the Internet as part of a randomized controlled trial. Measures of child disability, parent protective behavior, and parent distress were obtained at pretreatment, immediate posttreatment, 6-month follow-up, and 12-month follow-up. Latent growth modeling indicated that child disability, parent protective behavior, and parent distress improved with treatment over the 12-month study period. Latent growth modeling for parallel processes indicated that higher parent distress at pretreatment predicted less improvement in child disability over 12 months. No other predictive paths between parent and child functioning were significant. These findings indicate that parent distress may increase the risk of poor response to psychological pain treatment among youth with chronic pain. At present, parent distress is not routinely targeted in psychological interventions for pediatric chronic pain. Research is needed to determine optimal strategies for targeting parent and family factors in the treatment of pediatric chronic pain.

Bottom‐up or top‐down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness

“…In line with previous studies (Hechler et al, 2011;Law et al, 2017;Wilson, Moss, Palermo, & Fales, 2014), Cordts, Stone, Beveridge, Wilson, and Noel (2019) found that parental pain-related catastrophizing -the tendency to highly focus on child pain, to magnify the threatening value of pain (Stone & Wilson, 2016) -was impactful on child pain and functioning. Behavioural responses such as solicitousness (positive reinforcement of child pain behaviours; Noel et al, 2015) are also associated with worsened child pain outcomes (Connelly, Bromberg, Anthony, Gil, & Schanberg, 2017;Hechler et al, 2011;Law et al, 2017).…”

“…Parents differ in pain-related catastrophizing and solicitousness (Frerker, Hirschfeld, Thielsch, & Hechler, 2018). However, the vast majority of studies have focused on the impact of parental responses on child outcomes (Connelly et al, 2017;Cordts et al, 2019;Hechler et al, 2011;Higgins et al, 2015;Hoftun et al, 2013;Law et al, 2017;Stone, Bruehl, Smith, Garber, & Walker, 2018;Stone & Wilson, 2016;Wilson et al, 2014), rather than investigating modulating factors. Modulating factors may be subdivided into top-down and bottom-up processes (Goubert et al, 2005).…”

Longitudinal Impact of Parent Factors in Adolescents With Migraine and Tension‐Type Headache

“…Adolescent Headache-Related Disability and Headache Frequency.-Adolescents completed the Pediatric Migraine Disability Assessment, 31 a 6-item measure where youth report the number of days they were unable to participate fully in activities in their school, home, and social environments due to headache over the past 3 months. Responses are summed to create a total score and there are validated cut-off scores to categorize disability severity, as follows: little to none (0-10), mild (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), moderate (31-50), or severe (greater than 50).…”

“…Both studies enrolled youth with mixed chronic pain and demonstrated that more frequent protective parenting behaviors and greater parental distress about the adolescent's pain at baseline were associated with less improvement in adolescent disability over short-term (4-month) 26 and long-term (12-month) follow-ups. 27 Little is known about whether adolescent and parent factors influence one another over time in pediatric headache. This information is critical to determine the optimal role of parents in the treatment of pediatric headache.…”

Psychological and procedural distress following a young child’s burn injury

“…However, the current sample size did not have sufficient power to conduct a mediation analysis. These findings are in line with the wider pediatric chronic pain literature, which has reported longitudinal effects of parental distress and behavior on child functioning (Chow, Otis, & Simons, 2016;Law et al, 2017;Palermo & Eccleston, 2009). It must be considered, however, that the variables utilized in this regression are solely parent-reported, which may have inflated the finding.…”