This application, Feelings and Body Investigators (FBI): Interoceptive Exposure for Child Abdominal Pain is in response to PA-11-177, Translational Research for the Development of Novel Interventions for Mental Disorders (R21/R33). We propose development and pilot-testing of an acceptance- based behavioral treatment for young children (5-8 years old) with functional abdominal pain (FAP; R21, n=26, R33, n=100). FAP is one of the most frequent somatic syndromes in young children, causes significant impairment, and is predictive of psychiatric and pain disorders later in childhood and in adulthood. No treatments exist for very young children with FAP. Research supports that FAP is influenced by: (1) early pain on the neurodevelopment of the gut-brain axis and (2) maladaptive interactions with the social environment that inadvertently increase somatic fear. These vulnerabilities provide targets for early intervention. OBJECTIVE: To develop and pilot an intervention for FAP based on fundamental neuroscience research on the aberrant neurodevelopment of the gut-brain axis and subsequent modification by the social environment. Our treatment 1) links intervention strategies to unique patterns of neural circuit maturation associated with early visceral pain on the gut-brain axis, 2) adapts acceptance-based behavioral strategies used to address psychopathology in older children to younger children, and 3) incorporates caregivers as role models and facilitators based on attachment research. METHODS: Our ten session intervention trains children to be Feeling and Body Investigators. Half of the sessions will be done in clinic and half at home via web-camera to facilitate generalization. During the treatment child/caregiver dyads will 1) gather body clues (Learn), 2) investigate (Experience: perform interoceptive mystery missions to explore a body sensation), 3) organize body clues (Contextualize: recall other contexts that evoke similar sensations), and 4) go on increasingly daring missions (Challenge: decrease avoidance and safety behaviors). In the R21 phase we will develop and refine the FBI intervention in 26 child- caregiver dyads. In the R33 phase we will randomize 100 children with FAP to FBI or an active control (parent education with standard medical care) to conduct a pilot-test of the feasibility, acceptability, an clinical significance of FBI compared with an active control treatment. We will use epidemiological methods to screen all eligible children attending primary care practices so that our sample will be representative of young children with FAP, not simply a convenience sample. If we are successful, young children with FAP who complete our FBI early intervention will learn to experience changes in the viscera as fun and fascinating, rather than scary, and will develop new capacities for pain management, adaptive functioning, and emotion regulation. The success of our early intervention for FAP in young children will also have broad implications for the treatment and prevention of mental illness and chronic abdominal pain.

Public Health Relevance

Abdominal pain is one of the most frequent somatic complaints in young children. Early childhood recurrent abdominal pain is associated with impairment: absences from preschool or daycare, stress on the parent-child relationship, and costly doctor bills. Some children with early abdominal pain also learn to fear body sensations in general - becoming afraid whenever the body fluctuates but is functioning normally (e.g., the gut pangs of hunger). Recurrent childhood abdominal pain predicts chronic pain and psychiatric disorders later in childhood and into adulthood. There are no interventions for very young children with functional abdominal pain. We propose to develop and pilot an innovative early intervention for FAP based on research that FAP results from (1) the influence of pain on the neurodevelopment of the gut-brain axis and (2) maladaptive parent-child interactions that inadvertently increase the child's somatic fear. Our ten session intervention teaches 5-8 year old children with recurrent abdominal pain to be 'Feeling and Body Investigators.' Children will learn to go on 'missions' to investigate and test the functioning of their body and to record their observations (clues). Children will become 'FBI' explorers of the mysteries of the body with their caregivers who will participate in the treatment as role models and supports for their children. By creating an early intervention within the context of fun and curiosity, we aim not only to diminish young children's somatic symptoms, pain, and fear, but also to improve young children's self-regulatory capacities more generally. Children will learn to use body signals to guide adaptive behavior (e.g., to eat when they experience the gut pangs of hunger) while not allowing body sensations to get in the way of activities (e.g., to not let gut butterflies lead to school absence). The study has two phases: (1) an R21 phase for development of the intervention and testing with 26 child-parent pairs and (2) an R33 phase to conduct a pilot-test with 100 children and parents to examine the feasibility, acceptability, and clinical significance of our FBI treatment compared with an active control treatment. With this innovative early childhood intervention for a common childhood somatic complaint, we hope to both treat and prevent recurrent pain disorders, fear-based psychiatric disorders, and body preoccupation/distortion disorders that impair so many children and adults. The success of our neuroscience-based early intervention approach will also have broad public health implications for how we treat and prevent chronic pain and promote physical and mental health across the lifespan.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants Phase II (R33)
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Special Emphasis Panel (ZMH1)
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Wagner, Ann
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Duke University
Schools of Medicine
United States
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Zucker, Nancy; Mauro, Christian; Craske, Michelle et al. (2017) Acceptance-based interoceptive exposure for young children with functional abdominal pain. Behav Res Ther 97:200-212
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Zucker, Nancy; Copeland, William; Franz, Lauren et al. (2015) Psychological and Psychosocial Impairment in Preschoolers With Selective Eating. Pediatrics 136:e582-90
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