Confirmatory factor analysis of the childhood anxiety sensitivity index: a gender comparison.

The Childhood Anxiety Sensitivity Index (CASI) is an 18-item self-report tool designed to measure the construct of anxiety sensitivity (i.e. the belief that anxiety may have harmful consequences such as sickness, embarrassment, or loss of control) in children and adolescents. Previous factor analytic examinations of the CASI have produced varied results. Gender may play a role in this observed variability. In an effort to confirm the factor structure of the measure across gender, CASI items for 671 children and adolescents were subjected to confirmatory factor analysis. Results indicated that for boys two-, three-, and four-factor structures provided a relatively good fit to the data, with the three-factor structure emerging as having the best fit overall. In contrast, for girls only the three-factor structure fitted the data well. Direct comparison of fit of the three-factor model across gender provided evidence to support the notion that childhood anxiety sensitivity is similar in structure across gender.

Attachment dimensions and young children's response to pain.

BACKGROUND/OBJECTIVE: The present study examined the relationship between attachment dimensions and child pain behaviour following both an everyday pain incident (eg, bumps and scrapes) and acute pain incident (eg, immunization) in 66 five-year-old children. METHODS: Secure, avoidant, ambivalent and controlling attachment dimensions were assessed using aggregates of laboratory-based reunion behaviour, performance on representational measures of attachment and the measure of emotion regulation. Child pain behaviour, during immunization and everyday pain incidents, was rated in terms of reactivity, anger and calming time. RESULTS: The ambivalence and controlling attachment dimensions were differentially related to child pain behaviour. Specifically, children with either more ambivalent or controlling attachment had a relatively greater reaction to both the immunization procedure and everyday pain incident. Children with more controlling attachment also took more time to calm down following the immunization and displayed greater anger. Security and avoidance, however, were not systematically related to child pain behaviour. CONCLUSIONS: Results are discussed in terms of Bowlby's theory of attachment relationships and pain as an important distress signal to children.

Social problem solving, conduct problems, and callous-unemotional traits in children.

This study examined the association between social problem solving, conduct problems (CP), and callous-unemotional (CU) traits in elementary age children. Participants were 53 children (40 boys and 13 girls) aged 7-12 years. Social problem solving was evaluated using the Social Problem Solving Test-Revised, which requires children to produce solutions to eight hypothetical social problems, including five problems involving acquiring a desired object and three problems gaining access to a peer. Regression analyses showed that greater frequency of CP symptoms was associated with producing less flexible, relevant, and prosocial solutions and more overtly aggressive solutions. However, this pattern was present only when CU traits were low. Results add to a growing body of literature demonstrating that CU traits are an important moderator of CP in children.

Gender differences in Childhood Anxiety Sensitivity Index (CASI) dimensions.

We examined the hierarchical structure of the Childhood Anxiety Sensitivity Index (CASI) as a function of gender and examined the occurrence of gender differences in anxiety sensitivity (AS) dimensions in a large nonclinical sample of children and adolescents (N = 1698). Separate principal components analyses (PCAs) on the 18 CASI items for the total sample, boys, and girls revealed similar lower-order three-factor structures for all groups. The three factors reflected Physical, Social/Control, and Psychological Concerns. PCAs on the lower-order factor scores revealed similar unidimensional higher-order solutions for all groups. Girls scored higher than boys on the Physical and, to a lesser extent, Social/Control Concerns factors; girls scored higher on the Physical Concerns factor relative to their scores on the Social/Control and Psychological Concerns factors; and boys scored higher on the Social/Control and Psychological Concerns factors relative to their scores on the Physical Concerns factor. Girls also scored higher than boys on the higher-order factor representing the Global AS construct. The present study provides additional support for the theoretical hierarchical structure of AS and suggests that there is a difference in the manifestation of AS between girls and boys.

Relations between young children's responses to the depiction of separation and pain experiences.

This study examined relations between young children's representations of separation and pain experiences in 60, 4- and 5-year-old children. Separation representations were assessed with the Separation Anxiety Test (SAT) and pain representations were assessed by examining responses to pictures of children about to experience pain in the presence of parent figures. Results showed that representations of separation and pain experience were systematically related and the patterns were not accounted for by the child's ability to differentiate emotional states, language ability, or reports of emotional regulation. These findings are consistent with Bowlby's (1982) concept of secure base behaviour in response to a variety of distress, and support the hypothetical construct of an internal working model of attachment which organizes children's behaviours, thoughts, and feelings in response to both separation experience and painful events.

The parents' postoperative pain measure: replication and extension to 2-6-year-old children.

Pain assessment is a difficult task for parents at home following children's surgery. The purpose of the present study was to confirm the psychometric properties of a behavioural measure of postoperative pain developed to assist parents with pain assessment in children aged 7-12 years following day surgery. The study also examined the reliability and validity of the measure with children aged 2-6 years. Participants were 51 parents of children aged 7-12 years and 107 parents of children aged 2-6 years. For the 2 days following surgery, parents completed a pain diary that included global ratings of their children's pain and the 15-item Parents' Postoperative Pain Measure (PPPM). The older children provided self-reports of their pain intensity. The PPPM items showed good internal consistency on the two postoperative days for both samples (alpha's=0.81-0.88) and scores on the PPPM were highly correlated with children's (for the older children) and parents' (for the young children) global ratings of pain (r's=0.53-0.72). As global pain ratings decreased from Days 1 to 2, so did scores on the PPPM. Scores on the PPPM were successful in discriminating between children who had undergone low/moderate and high pain surgeries. The results of this study provide evidence of the reliability and validity of the PPPM as a measure of postoperative pain among children aged 2 through to 12 years.

Construct validity of the parents' postoperative pain measure.

OBJECTIVES: Pain assessment can be a challenging task for parents, who increasingly provide the care for their children after surgery. This research provides evidence of the construct validity of the Parents' Postoperative Pain Measure (PPPM), a 15-item behavioral scale. METHODS: Study 1 examined the ability of scores on the PPPM to discriminate between pain and anxiety in a sample of 75 children (30 girls) between the ages of 7 and 12 years undergoing day surgery. Study 2 examined the sensitivity of scores on the PPPM to analgesic intervention among a sample of 28 children (7 girls) between the ages of 7 and 12 years undergoing day surgery. RESULTS: In Study 1, scores on the PPPM closely followed the pattern of children's self-reported pain intensity and not state-related anxiety. Results from Study 2 showed that scores on the PPPM, like children's self-reported pain intensity ratings, were sensitive to analgesic intervention. DISCUSSION: The results of these studies provide further support for the construct validity of the PPPM and confirm that the measure is a valid pain assessment tool for use by parents at home following children's surgeries.

Menstrual pain intensity, coping, and disability: the role of pain catastrophizing.

OBJECTIVE: Menstrual pain or primary dysmenorrhea has not received much attention in the field of pain research. Little is understood about the effects menstrual pain has on the women who experience it. No studies to date have examined the cognitive factors related to the perceived intensity and coping of menstrual pain. To investigate these areas further, this study examined the associations between pain catastrophizing and how women perceive and cope with menstrual pain. DESIGN: A prospective and retrospective between-subjects study. PARTICIPANTS: Ninety-three undergraduate women, with a regular menstrual period and no preexisting pain disorder (e.g., endometriosis) that affects menstrual pain, were classified into high or low pain catastrophizing groups. OUTCOME MEASURES: Participants completed several self-reported questionnaires assessing pain catastrophizing, menstrual pain intensity, coping, and disability. RESULTS: High pain catastrophizers, in comparison with low pain catastrophizers, reported greater menstrual pain intensities, greater affective menstrual pain intensity, greater variability in the use of pain coping strategies, lower perceived effectiveness of over-the-counter medications and nonmedical pain coping strategies, and greater disability. CONCLUSIONS: The results extend our knowledge about the associations between pain catastrophizing and menstrual pain, reemphasize that pain experience is best viewed as a multidimensional construct, and have implications for the management of menstrual pain.