Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain

Abstract

The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain (N = 104) and well children (N = 119), ages 8-16 years. Parents were randomly assigned and trained to interact with their children according to one of three conditions: Attention, Distraction, or No Instruction. Children's symptom complaints and parents' responses were audiotaped and coded. Children completed a self-report measure of gastrointestinal (GI) symptoms before and after interacting with their parents. Parents' and children's perceptions of their interaction were assessed. Compared to the No Instruction condition, symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition. The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children. Findings for self-report GI symptoms were similar to those for audiotaped symptom complaints. Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition. Parents of pain patients rated distraction as having greater potential negative impact on their children than attention. Parents' responses to children's symptom complaints can significantly increase or decrease those complaints. Girls with functional abdominal pain are particularly vulnerable to the symptom-reinforcing effects of parental attention. KeywordsFunctional abdominal pain; Attention; Distraction; Social learning; Parent-child interaction While sympathy with joy intensifies the sum of joy in the world, sympathy with pain does not really diminish the amount of pain.-Oscar Wilde, The Soul of Man under Socialism

Social modulation of facial pain display in high-catastrophizing children: An observational study in schoolchildren and their parents

“…The coding system used in the present study was based upon the coding procedure developed by Walker et al [70]. This coding system is a modification of the Child Adult Medical Procedure Interaction ScaleRevised (CAMPIS-R) [3] and comprises codes for parents' utterances including (1) Attending or pain-related talk, defined as any talk by the parent that focuses upon the child's pain experience (e.g 'Did it hurt a lot?…”

“…In line with Walker et al [70], codes for children's utterances included (1) Child pain talk, defined as statements about the pain experience (e.g. 'My hand feels numb'; 'It was painful) and (2) Other, defined as all other child utterances.…”

“…Reliability was assessed by having a second independent coder completing the same coding process for 25% of the transcripts. Coders were trained by studying and discussing the training manual based upon the procedure used by Walker et al [70]. Raters were also familiar with the CAMPIS-R !+" " manual, from which the current coding procedure was derived.…”

Validation of a Measure of Protective Parent Responses to Children's Pain

“…For example, solicitous behavior by spouses is associated with increased pain complaints and disability in adults with chronic pain. [1][2][3] Similarly, the pediatric literature shows that increased attention from parents is associated with higher levels of pain complaints and disability in children with chronic pain [4][5][6][7] and delayed recovery by children undergoing painful oral surgery. 8 This research is grounded in social learning theory 9 and the findings have been interpreted as evidence that significant others may reinforce patients' pain behavior.…”

“…Notable exceptions are laboratory studies that assessed patients' verbal pain complaints 6 or performance on functional tasks such as lifting and walking. 2,13 Objective measures of pain behavior that occurs outside the laboratory have rarely been obtained.…”