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.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-A (02))
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Haverkos, Lynne
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University of Washington
Schools of Social Work
United States
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Levy, Rona L; Langer, Shelby L; Romano, Joan M et al. (2014) Cognitive mediators of treatment outcomes in pediatric functional abdominal pain. Clin J Pain 30:1033-43
Levy, Rona L; Langer, Shelby L; Walker, Lynn S et al. (2010) Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol 105:946-56
van Tilburg, Miranda A L; Chitkara, Denesh K; Palsson, Olafur S et al. (2009) Parental worries and beliefs about abdominal pain. J Pediatr Gastroenterol Nutr 48:311-7
Levy, Rona L; Langer, Shelby L; Whitehead, William E (2007) Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults. World J Gastroenterol 13:2397-403
Walker, Lynn S; Levy, Rona L; Whitehead, William E (2006) Validation of a measure of protective parent responses to children's pain. Clin J Pain 22:712-6
van Tilburg, Miranda A L; Venepalli, Neeta; Ulshen, Martin et al. (2006) Parents' worries about recurrent abdominal pain in children. Gastroenterol Nurs 29:50-5; quiz 56-7
Levy, Rona L; Langer, Shelby L; Walker, Lynn S et al. (2006) Relationship between the decision to take a child to the clinic for abdominal pain and maternal psychological distress. Arch Pediatr Adolesc Med 160:961-5
Levy, Rona L; Linde, Jennifer A; Feld, Kayla A et al. (2005) The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants. Clin Gastroenterol Hepatol 3:992-6
Levy, Rona L; Whitehead, William E; Walker, Lynn S et al. (2004) Increased somatic complaints and health-care utilization in children: effects of parent IBS status and parent response to gastrointestinal symptoms. Am J Gastroenterol 99:2442-51
Levy, R L; Jones, K R; Whitehead, W E et al. (2001) Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology 121:799-804

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