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Morrow, Sara Bryn

Psychology

2004

Ph. D.

The study and treatment of pain in children has historically-been neglected. With recent increased interest in pain as an important indicator of health, pediatric pain has been conceptualized in a biopsychosocial model. Within this model, parental attitudes and behaviors are hypothesized to be important social determinants of children's pain. Research has shown that parental factors relate to children's physical health and emotional adjustment. However, the specific role parents play in children's emotional well-being and physical health is unclear and has been assessed in past research primarily through the use of questionnaires obtained from single informants, and from adult retrospective reports. Furthermore, children's emotional well-being/distress and physical health status are interrelated. The present study focuses on parenting behavior and children's emotional distress as determinants of children's pain within a population of children diagnosed with recurrent abdominal pain (RAP). RAP is a pediatric pain syndrome that affects 10% to 30% of children and is defined by the experience of at least three episodes of abdominal pain over a three-month period, resulting in functional impairment.
Fifty-nine children with RAP and one of their parents (97% mothers) participated in a laboratory-based, videotaped, parent-child interaction and also completed questionnaire measures of the children's emotional distress and somatic complaints. Videotapes were coded using the Iowa Family Interaction Rating Scale to assess Positive Parenting and Negative Parenting and children's Observed Emotional Distress. Results indicated that the observational method was effective in assessing both positive and negative parenting behaviors. These behaviors were seen with good variability and at a sufficiently high base rate of occurrence. The observational method was not as effective in assessing emotional distress in children. Descriptive statistics, based on parents' reports on the Child Behavior Checklist (CBCL), showed that children had moderately elevated levels of anxiety/depression (mean T score = 56.3) and highly elevated levels of somatic complaints (mean T score = 62.3). Children's reports on the Youth Self-Report (YSR) were similar. Gender differences were found on the YSR, with boys reporting significantly fewer symptoms of anxiety/depression (p = .049) and somatic complaints (p = .022) than girls.
Parents also showed significantly more positive behavior towards daughters (p = .037) and towards younger children (p = .009). Regression analyses showed that Positive Parenting was related to significantly lower anxiety/depression and somatic complaints in children (p < .05), and Negative Parenting was related to significantly higher levels of both types of symptoms (p< .05). Children's anxiety/depression was also a significant predictor of their own somatic complaints. Children's anxiety/depression did not act as a mediator between parenting behavior and child somatic complaints. Results provided support for the use of observational methods when studying parent-child interaction and also provided useful information regarding the role parents play in their children's emotional and physical well-being. Future directions using multiple methods and informants, and more sophisticated research designs, to study parents' impact on their children's well-being are discussed.