| 1. |
- Balter, Leonie J. T., et al.
(författare)
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Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy
- 2021
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8-18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.
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| 2. |
- Kanstrup, Marie, et al.
(författare)
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A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents : Effects of Acceptance and Commitment Therapy on Functioning
- 2016
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Ingår i: Children. - : MDPI AG. - 2227-9067. ; 3:4
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Tidskriftsartikel (refereegranskat)abstract
- Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
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| 3. |
- Lipsker, Camilla Wiwe, et al.
(författare)
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Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Associated With Greater Pain Interference and Depression, and Reduced Health-Related Quality of Life in Children With Chronic Pain
- 2021
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Ingår i: Frontiers in Neuroscience. - : Frontiers Media SA. - 1662-4548 .- 1662-453X. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain (n = 146, 8-17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents (n = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.
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| 4. |
- Lipsker, Camilla Wiwe, et al.
(författare)
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Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain
- 2018
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Ingår i: Journal of Pain Research. - 1178-7090. ; 11, s. 2827-2836
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Recent research has suggested that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) may be comorbid to pediatric chronic pain, but the empirical support is yet scarce. Therefore, the current study aimed to investigate the occurrence of traits and symptoms consistent with clinically significant ASD and ADHD in a group of children and adolescents with chronic debilitating pain and examine potential differences in pain and demographic variables between children with and without clinically significant traits and symptoms of ASD and ADHD. Patients and methods: This cross-sectional study included 146 parent-child dyads (102 girls, 111 mothers, children 8-17 years) consecutively referred to a tertiary pain clinic. Parents completed the Social Responsiveness Scale to assess autistic traits, and Conners-3 to measure symptoms of ADHD in their children. Children completed the Liibeck Pain Questionnaire to evaluate experienced pain. Results: Among children, 20 (13.7%) received scores consistent with clinically significant ASD and 29 (19.9%) received scores consistent with clinically significant ADHD, with a combined prevalence of clinically significant ASD/ADHD traits and symptoms of 26% of the total sample. Only 4.8% of children were previously diagnosed with either disorder. Among children with clinically significant ASD traits, girls were more prevalent, parents reported lower health, and the pain was more likely triggered by being in school. Among children with clinically significant ADHD symptoms, there were no gender differences and pain was more likely triggered by the family situation and new situations. No differences regarding pain intensity, duration, or frequency were found between children with and without clinically significant ASD traits or ADHD symptoms. Conclusion: Children with debilitating chronic pain, particularly girls, may present with an elevated risk of having a comorbid, possibly high-functioning, neurodevelopmental disorder. Results suggest that clinical assessment of pediatric chronic pain should include screening for neurodevelopmental disorders.
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| 5. |
- Wiwe Lipsker, Camilla
(författare)
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Children and adolescents with chronic pain : parental factors, functioning, and neurodevelopmental comorbidity
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pediatric chronic pain affects between 11 and 38% of all children. Although pain may result from injury or disease, the cause of chronic pain is commonly unclear. The interaction between biological, psychological, and social aspects has been emphasized as key to the understanding of the chronic pain experience, as well as risk and resilience factors. Pediatric chronic pain may result in significant impairment affecting both child and family functioning, and addressing family factors such as parental distress and protective behaviors, are generally considered important to pediatric chronic pain management. However, there is still a need to identify resilience factors that can be targeted in parental support programs, and to develop and evaluate effective parent support interventions. The complexity of the pain experience in pediatric chronic pain is well known with a large number of patients suffering from co-occurring disorders such as depression or insomnia. However, despite a considerable number of clinical observations suggesting an elevated prevalence of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with chronic pain, and similarities in terms of clinical correlates, the empirical support has been scarce. More research on the co-occurrence of pediatric chronic pain, ADHD, and ASD, including relationships with functioning, is therefore warranted. Purpose and aims: The purpose of the present research project was to identify and assess parental and child factors of importance for functioning and treatment effects in pediatric chronic pain. More specifically, the aims of the project were to: validate an instrument for parental psychological flexibility (Study I); evaluate the effects of a brief parental ACTintervention on parent outcomes (Study II); assess the prevalence of clinically significant traits and symptoms of ASD and ADHD in children, and relations to pain- and demographic variables (Study III); and, to explore the relationships between traits and symptoms of ASD and ADHD, functioning, and health-related quality of life (HRQoL) (Study IV). Methods: In Study 1, utilizing a cross-sectional design, the Parent Psychological Flexibility Questionnaire (PPFQ) was translated and psychometrically evaluated in a sample of parents (n=263) of children with chronic pain using principal component analysis (PCA), correlation and regression analyses, and analysis of internal consistency. In Study II, the effects of individual and group ACT-interventions for adolescents (n=48) with chronic pain, and a brief support program for their parents (n=28), were evaluated using a randomized (group/individual) uncontrolled pilot design and non-parametric analyses of differences between groups and over time. In Study III, the prevalence of clinically significant ASD-traits and ADHD-symptoms was evaluated in a descriptive cross-sectional study on children with chronic pain (n=146) and their parents (n=146). Differences in painand demographic variables between children below and above cutoff for clinically significant traits and symptoms of ADHD or ASD were also assessed. Study IV, using the same sample as Study III, examined the relationships between ASD-traits and ADHDsymptoms, functioning (depression and pain interference), and HRQoL in correlation- and regression analyses and with independent t-tests, and assessed the indirect effects of insomnia and psychological inflexibility on the relationships between ASD-traits or ADHD-symptoms as predictors and functioning and HRQoL as dependents. Results: In Study 1, results supported a three-factor solution for the PPFQ with 10 items (PPFQ-10), showing good internal consistency and explaining a significant amount of variance in the criteria variables anxiety (29%) and depression (35.6%). In Study II, significant improvements in parental pain reactivity and psychological flexibility were found with clinically significant changes in the direction of better functioning for 54-76% of parents, with no differences between individual and group formats. In Study III, 13.7% of the sample presented with clinically significant ASD-traits and 19.9% of the sample presented with clinically significant ADHD-symptoms. The combined prevalence of clinically significant ASD/ADHD-traits and symptoms was 26%. Children with clinically significant ASD-traits were more likely to be girls and clinically significant ADHDsymptoms showed no gender differences. In Study IV, children with clinically significant ASD-traits and ADHD-symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower HRQoL, compared to the rest of the sample. ASD-traits and ADHD-symptoms explained a significant amount of variance in pain interference and depressive symptoms, as well as in HRQoL. Psychological inflexibility was shown to mediate the influence of both ADHD-symptoms and ASD-traits, and insomnia the effect of ADHD-symptoms, on depression, pain interference, and HRQoL. Conclusions: Although tentative, the results suggests the utility of addressing parental psychological flexibility in relation to pediatric chronic pain. However, more research is warranted and future studies should e.g. evaluate the predictive utility of the PPFQ for child treatment outcomes, and evaluate if parental support programs that increase parental psychological flexibility also have positive effects on the children. Also, the results provide empirical support regarding elevated levels of clinically significant ADHD-symptoms and ASD-traits in pediatric chronic pain, and illustrate significant relationships between such traits and symptoms and functioning in children. Children with debilitating chronic pain, particularly girls, may be at risk for having a comorbid, and possibly undetected highfunctioning neurodevelopmental disorder. Results thus suggest the utility of screening for neurodevelopmental disorders in children with chronic pain, and may indicate insomnia, and psychological flexibility as potential treatment targets to improve functioning and HRQoL. The results also warrant further research to e.g. validate these findings in larger studies, evaluate the utility of tailored interventions, and examine the shared neuropathophysiology of chronic pain and neurodevelopmental disorders, including dopamine function and sensory abnormalities.
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