Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders.

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 follow-up 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: Patients with FAP carry long-term vulnerability to anxiety that begins in childhood and persists into late adolescence and early adulthood, even if abdominal pain resolves.

Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth before and after performance evaluation.

This study investigated attentional biases for pain and social threat versus neutral stimuli in 54 youth with functional abdominal pain (FAP) and 53 healthy control subjects (ages 10 to 16 years). We assessed attentional bias using a visual probe detection task (PDT) that presented pain and social threat words in comparison to neutral words at conscious (1250 ms) and preconscious (20 ms) presentation rates. We administered the PDT before and after random assignment of participants to a laboratory stressor--failure versus success feedback regarding their performance on a challenging computer game. All analyses controlled for trait anxiety. At the conscious rate of stimulus presentation, FAP patients exhibited preferential attention toward pain compared with neutral stimuli and compared with the control group. FAP patients maintained preferential attention toward conscious pain stimuli after performance feedback in both failure and success conditions. At the preconscious rate of stimulus presentation, FAP patients' attention was neutral at baseline but increased significantly toward pain stimuli after performance feedback in both failure and success conditions. FAP patients' somatic symptoms increased in both failure and success conditions; control youth's somatic symptoms only increased after failure. Regarding social threat, neither FAP nor control youth exhibited attentional bias toward social threat compared with neutral stimuli at baseline, but both FAP and control youth in the failure condition significantly increased attention away from social threat after failure feedback. Results suggest that FAP patients preferentially attend to pain stimuli in conscious awareness. Moreover, performance evaluation may activate their preconscious attention to pain stimuli.

Children's Somatization Inventory: psychometric properties of the revised form (CSI-24).

OBJECTIVE: To conduct a multimethod psychometric evaluation to refine the Children's Somatization Inventory (CSI) and to investigate its dimensionality. METHOD: The CSI was administered to 876 pediatric patients with chronic abdominal pain at their initial visit to a pediatric gastroenterology clinic. Tools from three psychometric models identified items that most effectively measured the construct of somatization and examined its dimensionality. RESULTS: Eleven statistically weak items were identified and removed, creating a 24-item CSI (CSI-24). The CSI-24 showed good psychometrics according to the three measurement models and correlated .99 with the original CSI. The CSI-24 has one dominant general factor but is not strictly unidimensional. CONCLUSIONS: The CSI-24 is a reliable and psychometrically sound refinement of the original CSI. Findings are consistent with the view that somatization has a strong general factor that represents a continuum of symptom reporting, as well as minor components that represent specific symptom clusters in youth with chronic abdominal pain.

A developmental perspective on functional somatic symptoms.

OBJECTIVE: To provide a new approach for conceptualizing and studying functional somatic symptoms (FSS) in children and adolescence. METHODS: A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents. RESULTS: Multiple risk and protective factors from child, familial, social, and environmental domains, the interactions across risk domains, and potential developmental pathways of FSS are identified. CONCLUSIONS: This article underscores the necessity of taking a broader, developmental view of FSS. The tenets of developmental psychopathology emphasize the utility of viewing FSS on a continuum of severity rather than as a discrete entity or diagnosis. This article concludes with directions for future research and treatment implications.

The influence of perinatal complications and environmental adversity on boys' antisocial behavior.

BACKGROUND: The purpose of the present study was to test components of Raine's (2002) biosocial model, specifically the interactive effects of perinatal complications, rejecting parenting, and family adversity on the development of early-onset antisocial behavior (ASB). Boys' internalizing problems were also tested to investigate the specificity of the model. METHODS: Birth records in addition to longitudinal data were collected on 310 low-income boys followed from birth until 10 years of age. RESULTS: Findings demonstrated support for a biosocial framework in predicting ASB but not internalizing problems. Family adversity, and to some extent rejecting parenting, consistently predicted youth outcome. Perinatal complications emerged as a predictor of ASB but only in the context of other family risk factors. According to maternal report, boys experiencing high levels of perinatal complications, rejecting parenting, and family adversity showed significantly higher levels of ASB than boys with lower levels of these risk factors. This finding was partially corroborated by youth self-report, such that boys experiencing high levels of perinatal complications and family adversity reported more antisocial activity than boys experiencing no risk or risk in only one domain. CONCLUSIONS: This study supports the specific prediction of ASB in middle childhood from a biosocial model. Findings also highlight the salience of a negative psychosocial environment on childhood maladjustment. Intervention efforts including parenting skills and coping strategies for mothers of children from multiple risk environments are advocated.

The development of family hierarchies and their relation to children's conduct problems.

Despite the intuitive richness of family systems theory, relatively little research has sought to test the validity of constructs theorized to be critical in the development of children's adjustment. One such cornerstone of structural and strategic family therapy is the family hierarchy. The present study investigated both the development of hierarchical structure in families from infancy to late middle childhood and relations between strong hierarchical structure and children's conduct problems. Using structural equation modeling, direct pathways to low hierarchical structure were evident for early caregiving behavior and parent-child conflict, with indirect associations present for parental adjustment, marital functioning, negative child behavior, and ecological disadvantage. In turn, family hierarchies were associated with youth antisocial behavior, an effect that was moderated by ethnic and neighborhood context. The results are discussed in reference to family systems' theory and implications for prevention and intervention.

Anger regulation in disadvantaged preschool boys: strategies, antecedents, and the development of self-control.

Emotion regulation strategies observed during an age 3 1/2 frustration task were examined in relation to (a) angry affect during the frustration task, (b) child and maternal characteristics at age 1 1/2, and (c) indices of self-control at age 6 in a sample of low-income boys (Ns varied between 189 and 310, depending on the assessment). Shifting attention away from sources of frustration and seeking information about situational constraints were associated with decreased anger. Secure attachment and positive maternal control correlated positively with effective regulatory strategy use. Individual differences in strategy use predicted self-control at school entry, but in specific rather than general ways: Reliance on attention-shifting strategies corresponded with low externalizing problems and high cooperation; reliance on information gathering corresponded with high assertiveness.