Functional abdominal pain (FAP) is a common and costly pain condition of childhood that results in a marked disruption in daily functioning and psychosocial impairment. A large proportion of youth with FAP also suffer from significant anxiety (such as generalized anxiety, separation anxiety and social anxiety). These youth with FAP and co-occurring anxiety are at greatest risk for impairment in functioning, which can persist into their adult years if not successfully treated. Therefore, early and effective interventions for youth with FAP and co-occurring anxiety are critically needed. While cognitive-behavioral (CBT) techniques have shown promise in treating youth with FAP, these treatments are typically focused on teaching pain coping skills and are usually not designed to directly address specific types of anxiety symptoms. Such youth may benefit from a treatment approach that targets both pain and anxiety to achieve optimal and lasting outcomes. Findings from the PI's pilot study of youth with FAP at a pediatric hospital confirm findings from past research indicating that 1) a large number of patients with FAP (53.4% in the pilot study) experience clinically significant anxiety and 2) increased anxiety is associated with higher levels of pain an impairment. Based on the results of the pilot study, the applicant proposes to develop and test a tailored CBT intervention (Aim to Decrease Anxiety and Pain Treatment, """"""""ADAPT""""""""). ADAPT is designed to be a brief CBT intervention, with content derived from two well-established treatments for anxiety and pain. It will be individualized to address both pain and the three most common anxiety symptom presentations (generalized anxiety, separation anxiety/school avoidance and social anxiety), and will include a combination of in-person and web- based modules. The goal is to increase the accessibility of the intervention to patients and families and to ensure consistency of content delivery.
The aims of the current project are to 1) evaluate the feasibility and acceptability of the ADAPT intervention via focus groups and, 2) conduct a small randomized clinical trial (n=38, or 19 per group) to test whether ADAPT is superior to usual care (UC) in producing clinically significant pain reduction (e30%) along with reduction in anxiety to below clinical levels. This research meets the funding priorities of the pediatric behavior and health promotion research program of the NICHD, which encourages the development of tailored behavioral interventions specifically in the area of pediatric pain. This project will significantly advance the field by developing a brief and tailored CBT intervention for youth with FAP who are at greatest risk for long-term impairment. The applicant's long-term goal is to develop a programmatic line of research designing brief and disseminable interventions for youth with FAP, using a stepped care approach to align treatment content and intensity to the specific needs of the patients.

Public Health Relevance

A brief tailored behavioral intervention that is embedded in clinical care will target youth with FAP and co-occurring anxiety, as this group is at greatest ris for increased impairment and long-term adverse health outcomes. The goal is to reduce pain and anxiety symptoms, and to decrease disability associated with pain.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZRG1)
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Haverkos, Lynne
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Cunningham, Natoshia Raishevich; Jagpal, Anjana; Tran, Susan T et al. (2016) Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain. J Pediatr 171:227-33
Jones, Jordan T; Cunningham, Natoshia; Kashikar-Zuck, SusmitA et al. (2016) Pain, Fatigue, and Psychological Impact on Health-Related Quality of Life in Childhood-Onset Lupus. Arthritis Care Res (Hoboken) 68:73-80