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.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD036069-12
Application #
8687696
Study Section
Special Emphasis Panel (ZRG1-RPHB-A (02))
Program Officer
Haverkos, Lynne
Project Start
1999-04-01
Project End
2016-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
12
Fiscal Year
2014
Total Cost
$610,453
Indirect Cost
$147,757
Name
University of Washington
Department
Type
Schools of Social Work
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Claar, Robyn Lewis; van Tilburg, Miranda A L; Abdullah, Bisher et al. (2017) Psychological Distress and Quality of Life in Pediatric Crohn Disease: Impact of Pain and Disease State. J Pediatr Gastroenterol Nutr 65:420-424
van Tilburg, Miranda A L; Claar, Robyn Lewis; Romano, Joan M et al. (2017) Psychological Factors May Play an Important Role in Pediatric Crohn's Disease Symptoms and Disability. J Pediatr 184:94-100.e1
Levy, Rona L; Langer, Shelby L; van Tilburg, Miranda A L et al. (2017) Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial. Pain 158:618-628
Noel, Melanie; Alberts, Nicole; Langer, Shelby L et al. (2016) The Sensitivity to Change and Responsiveness of the Adult Responses to Children's Symptoms in Children and Adolescents With Chronic Pain. J Pediatr Psychol 41:350-62
Levy, Rona L; Langer, Shelby L; van Tilburg, Miranda A L et al. (2016) Brief telephone-delivered cognitive-behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial. Pain :
van Tilburg, Miranda A L; Levy, Rona L; Walker, Lynn S et al. (2015) Psychosocial mechanisms for the transmission of somatic symptoms from parents to children. World J Gastroenterol 21:5532-41
van Tilburg, Miranda A L; Claar, Robyn L; Romano, Joan M et al. (2015) Role of Coping With Symptoms in Depression and Disability: Comparison Between Inflammatory Bowel Disease and Abdominal Pain. J Pediatr Gastroenterol Nutr 61:431-6
Noel, Melanie; Palermo, Tonya M; Essner, Bonnie et al. (2015) A developmental analysis of the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms in children versus adolescents with chronic pain or pain-related chronic illness. J Pain 16:31-41
Langer, Shelby L; Romano, Joan M; Mancl, Lloyd et al. (2014) Parental Catastrophizing Partially Mediates the Association between Parent-Reported Child Pain Behavior and Parental Protective Responses. Pain Res Treat 2014:751097
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

Showing the most recent 10 out of 25 publications