WHAT'S KNOWN ON THIS SUBJECT: At the time of their pediatric medical evaluation, patients with functional abdominal pain (FAP) have higher levels of emotional symptoms compared with youth without FAP. No controlled prospective study has evaluated psychiatric outcomes for FAP patients in adulthood. WHAT THIS STUDY ADDS:This prospective study showed that pediatric FAP was associated with high risk of anxiety disorders in adolescence and young adulthood. Risk was highest if abdominal pain persisted, but was significantly higher than in controls even if pain resolved. abstract BACKGROUND: Cross-sectional studies link functional abdominal pain (FAP) to anxiety and depression in childhood, but no prospective study has evaluated psychiatric status in adulthood or its relation to pain persistence.METHODS: Pediatric patients with FAP (n = 332) and control subjects (n = 147) were tracked prospectively and evaluated for psychiatric disorders and functional gastrointestinal disorders (FGIDs) at followup in adolescence and young adulthood (mean age = 20.01 years). Participants were classified according to presence (FGID-POS) or absence (FGID-NEG) of FGIDs at follow-up.RESULTS: Lifetime and current risk of anxiety disorders was higher in FAP than controls (lifetime: 51% vs 20%; current: 30% vs 12%). Controlling for gender and age, the odds ratio was 4.9 (confidence interval = 2.83-7.43) for lifetime anxiety disorder and 3.57 (confidence interval = 2.00-6.36) for current anxiety disorder at follow-up for FAP versus controls. Lifetime risk of depressive disorder was significantly higher in FAP versus controls (40% vs. 16%); current risk did not differ. In most cases, initial onset of anxiety disorders was before pediatric FAP evaluation; onset of depressive disorders was subsequent to FAP evaluation. Within the FAP group, risk of current anxiety disorders at follow-up was significantly higher for FGID-POS versus FGID-NEG (40% vs 24%), and both were higher than controls (12%); current depressive disorders did not differ across FGID-POS, FGID-NEG, and controls. CONCLUSIONS:

Assessment of coping with specific pain episodes may enhance understanding of pain coping.

Cognitive appraisals inform and shape individuals’ pain experiences. As researchers examine mechanisms of cognitive behavioral interventions for chronic pain, psychometrically sound measures based in cognitive theory are needed to directly assess pain beliefs. The Pain Beliefs Questionnaire (PBQ), a 32 item self-report measure informed by coping and appraisal theory, was designed to assess children's pain threat appraisals, problem-focused pain coping efficacy, and emotion-focused pain coping efficacy. The present study aimed to 1) create a short form of the PBQ and 2) evaluate the psychometric properties of the reduced measure in a large database of pediatric patients with functional abdominal pain (FAP; n = 871). Item reduction analyses identified an 18-item short form of the PBQ (PBQ-SF) that exhibited similar psychometric properties to the original measure. All three subscales of the PBQ-SF exhibited strong internal consistency (α's ranged from 0.79-0.80) and adequate test-retest reliability at two weeks. Evidence for construct validity was provided by examining patterns of partial correlations for each subscale. The PBQ-SF represents a valid and reliable measure for evaluating children's pain beliefs. Future studies should investigate the treatment sensitivity of the PBQ-SF in order to evaluate its appropriateness for use in clinical trials.

Summary: This report describes the naturalistic observation of secondary behaviors performed by 66 drivers who took part in the Automotive Collision Avoidance System Field Operational Test (ACAS FOT). The ACAS FOT included two driver assistance systems, adaptive cruise control (ACC) and forward collision warning (FCW). Each driver participated in both baseline (no driver assistance systems for one week) and treatment conditions (both ACC and FCW available for 3 weeks). The method employed was to sub-sample video data, and code drivers' secondary behaviors using 4 s video clips of the driver, collected every 5 minutes. Eight-hundred and ninety video clips were reviewed and coded while participants drove manually, with conventional cruise control, ACC, and FCW. The results show that drivers who took part in the field test were no more likely to engage in secondary behaviors when driving with ACC and FCW in comparison to manual control. When the driver assistance systems became available to the participants, there was an increase in the number of conversations drivers had with passengers, probably related to the driver explaining the novel ACAS system to passengers. The results have important implications in that, at least for the duration of exposure examined, they counter the concern often raised that driver assistance systems will promote driver distraction, lapses in attention or modification in perceived risk.

Objectives To identify symptoms and psychosocial factors that predicted referral for esophagogastroduodenoscopy (EGD) and discriminated between patients with positive versus negative biopsy findings. Patients and Methods Children age 8 to 16 years old and parents completed validated questionnaires assessing gastrointestinal symptoms and psychosocial characteristics. Biopsy results of esophagus, stomach, and duodenum were reviewed. Results From the total sample of 461 patients (mean age 11.87 years, 62% girls), 127 (28%) underwent EGD with biopsy (mean age 12.1 years, 57% girls). Upper abdominal gastrointestinal symptoms predicted EGD referral, and psychosocial characteristics did not. From the total of 127 patients who underwent EGD, complete biopsy results were available for 124 patients and were negative at all sites for 34.7% of patients (n = 43), equivocal for 20.2% (n = 25), and positive at 1 or more sites for 45.2% (n = 56). Boys were more likely than girls to have positive biopsy results (56.6% vs 36.6%, P < 0.03) because of the higher rate of positive esophageal biopsy results (47.2% vs 26.8%, P < 0.04). Among boys, vomiting (P < 0.02) and family stress (P < 0.04) predicted positive esophageal biopsy findings. Among girls, depressive symptoms predicted positive biopsy findings (P = 0.015). Conclusions Upper abdominal symptoms, sex, stress, and depressive symptoms predict positive EGD biopsy findings in patients with chronic abdominal pain. Research on mechanisms linking these factors to mucosal damage in the gut is warranted.