COPING
IN CHILDREN WITH RECURRENT ABDOMINAL PAIN
Colletti RB, Compas BE, Stanger C, Thomsen A, Boyer M, Konik B. Departments of Pediatrics,
Psychology and Psychiatry, University of Vermont, Burlington, Vermont, USA
Objective: To evaluate
differences in coping and stress responses in children with either
functional or pathological recurrent abdominal pain (RAP).
Study design:
Retrospective and prospective questionnaire evaluations.
Methods: 174 children
and adolescents with RAP were evaluated medically by a pediatric
gastroenterologist and by the Abdominal Pain Index, the Child Behavior
Checklist and the Responses to Stress Questionnaire completed by parents.
Statistical analysis was by t-test and multivariate ANOVA.
Results: There were
174 children, ages 11.6 ± 2.9
years (mean ± SD, range 7
to 18), 67% female. Functional RAP (including irritable bowel syndrome and
dyspepsia) was present in 53%; pathological conditions (including GE
reflux, lactose malabsorption, Crohn’s disease and infection) were
identified in 34%; and the cause of pain was uncertain in 12%. Children with functional pain had
more symptoms (4.4 ± 2.1
versus 3.4 ± 1.5,
p<0.01) but were not different from children with a pathological
condition in gender, age, ethnicity, socioeconomic status, duration of pain
or number of medical tests. There were no differences between the two
groups in the abdominal pain score or measures of depression, anxiety and
somatization. However, patients with a pathological condition were more
likely to use voluntary engagement accommodative coping behaviors, such as
distraction, acceptance, positive thinking and cognitive restructuring
(p<0.05). In addition,
patients with a functional disorder were more likely to experience
involuntary engagement responses to stress, such as intrusive thoughts,
obsession, emotional and physiological arousal, and impulsive action
(p<0.01).
Conclusions: Children
with RAP due to a functional disorder appear to experience more involuntary
engagement responses to stress, and are less likely to use voluntary
engagement accommodative coping behaviors. These findings may lead to
advances in therapeutic approaches.