Introduction
Stress Responses in Children
with Chronic Pain and Anxiety
RECURRENT ABDOMINAL PAIN
•Recurrent abdominal pain (RAP) is the most
common chronic pain complaint among
children---between 10 and 20% of children
experience RAP
•To qualify for a classification of RAP, a child
must have experienced at least 3 pain episodes
in 3 months that impaired an activity (Apley,
1975)
•Underlying mechanisms could be the same in
these two clinical populations, but children
present with different primary complaints
•Children with RAP and anxious children are
hypervigilant to perceived environmental
threats (Boyer & Compas, 2006)
Method
Results
Participants:
•63 participants (29 male, 34 female):
•21 RAP, 21 anxious, 21 healthy
•Ages 8 to 16 (M = 11.64)
•Groups matched for age and gender
•Ethnic makeup of the sample:
•71% white 19% African American, 3%Asian,
6% other, and 2% Hispanic
•Participants excluded pair-wise for analyses
Mean Heart Rate Across Time for Groups
100.00
Measures:
97.00
94.00
Well
91.00
RAP
ANX
88.00
85.00
82.00
Baseline
•Chronic stress plays a role in the maintenance
of RAP and anxiety disorders (Walker, Garber,
Smith, Van Slyke, & Claar, 2001)
•RAP could be similar to anxiety in that they
both involve an overall maladaptive reactivity to
stress
•Heart rate monitors
•Psychological Stress Tasks
•Serial Subtraction Task
•Social Stress Interview
•Physical Stress Task: Cold Pressor
•Recovery Period
•Questionnaires
•Youth Self Report (YSR)
•112-item parent-version of the YSR
•assesses the parent’s perception of the child’s
internalizing and externalizing problems in the
past six months
•Children with RAP and anxious children will
react similarly to stress, reflected in their
similar mean heart rates. These two groups
will have higher mean heart rates than the
healthy controls.
•We will be able to predict the variance in selfreported psychological and somatic symptoms
from physiological and self-reported stress
reactivity beyond what group label tells us.
0.24
RAP
Anxious
Healthy
0.23
0.22
0.22
0.2
**p < .01, F (2, 54) = 5.59, p = .006
*
0.44
0.4
**
0.54
0.47
**
0.47
*
**
**
0.38
*
*
0.35
0.35
+
0.3
**
**
0.44
0.44
0.4
*
YSR
Anx/Dep
CBCL
Somatic
Inv.
Engage.
0.3
0.26
0.2
YSR
Somatic
0
Stress
Cold
Recovery:
Tasks:
Pressor:
Mean
Mean
Mean
Heart Rate
Heart Rate Heart Rate
Pain
Intensity
Regression Equation Predicting
Regression Equation Predicting
YSR Anxious/Depressed Symptoms
YSR Somatic Complaints
T-Scores
66.0
Group Label
(RAP, Anxious, Healthy)
*
63.8
*
RAP
Anxious
Healthy
60.1
58.0
56.8 56.8
56.0
56.5
54.6
54.0
53.6
β = .36*
YSR Anxious/Depressed
Symptoms
β = -.16
53.4
50.0
CBCL
Anx/Dep
YSR Somatic
Complaints
*
β = .51*
β = .32
YSR
Somatic
Complaints
β = .17
Mean Heart Rate
(beats per minute)
Mean Heart Rate
(beats per minute)
52.4
YSR
Anx/Dep
Group Label
(RAP, Anxious, Healthy)
63.3
61.8
62.0
β = .35*
CBCL
Somatic
Complaints
YSR Som: F (2, 34) = 7.30, p = .002
CBCL Anx/Dep: F (2, 60) = 12.1, p < .001
CBCL Som: F (2, 60) = 7.5, p = .001
Involuntary Engagement
Proportion Scores (RSQ)
At the final step: F (3, 28) = 6.44, p =.002, Final R2 = .41
* p < .05
Involuntary Engagement
Proportion Scores (RSQ)
At the final step: F (3, 28) = 2.43, p =.09, Final R2 = .21
* p < .05
Future Directions
•Future studies should use a larger sample
size to determine presence of differences in
physiological reactivity, namely with the RAP
group.
•Future research should investigate parent
perceptions of child difficulties to address the
difference in parent and child reports of
psychological and somatic symptoms.
•Future analyses with the current sample will
divide the groups based solely on the presence
vs. absence of RAP and/or an anxiety disorder.
•Future analyses with the current sample will
also use additional physiological measures that
were collected, including Galvanic Skin
Response and Respiratory Sinus Arrhythmia.
References
70.0
•(3) Relations among the variables?:
•Physiological reactivity will be positively
correlated with psychological and somatic
symptoms, and self-reported stress reactivity.
0.26
*p < .05, **p< .01, +p = .06
Descriptive Statistics:
Psychological Symptoms
•(2) Self-reported Stress reactivity:
•Children with RAP will self-report being more
stress reactive than the other two groups, as
measured by the Involuntary Engagement
scale of the RSQ.
**
Baseline:
Mean
Heart Rate
•57-item RSQ assess coping mechanisms in
reference to age-appropriate social stressors
•One scale of the RSQ is involuntary
engagement, which includes physiological
reactivity, emotional reactivity, intrusive
thoughts, rumination, and impulsive action
•(1) Physiological stress responses:
**
0.26
Involuntary Engagement Responses to Stress
0.6
•Responses to Stress Questionnaire (RSQ)
Hypotheses
0.28
Correlational Data
•Child Behavior Checklist (CBCL)
•Stress reactivity is associated with more
somatic symptoms and symptoms of anxiety
and depression (Thomsen & Compas, 2002)
Recovery
0.3
Main Effect for Time: Wilks’ Lambda: F (3, 49) = 12.64, p < .001
Quadratic Effect for Time: F (1, 51) = 20.65, p < .001
•112-item questionnaire provides information on
the participants’ perceptions of their
psychological and somatic symptoms as well as
level of functioning
•Automatic stress responses play a role in both
clinical populations: biological, psychological,
and emotional reactions to perceived stressors
Stress Tasks Cold Pressor
Time Intervals
Correlation Coefficients (r = )
STRESS REACTIVITY
Self-reported Stress Reactivity
Physiological Stress Reactivity
Proportion Scores from the RSQ
•RAP is comorbid with symptoms of anxiety
and anxiety disorders (Blanchard & Scharff,
2002)
•Children with RAP and anxious children may
be more similar than different in reactivity to
stress.
•RAP (n = 21): 11 (52%) also met criteria for a
DSM-IV anxiety disorder
•Anxious (n = 21): 5 (24%) also met criteria for
RAP
•The results of this study provide support for the
theory that the commonality between the
clinical groups is stress reactivity.
•Implications for intervention include focusing
on altering automatic stress responses both by
bringing physiological reactivity under control
and focusing on the cognitive and behavioral
factors on stress reactivity (e.g. intrusive
thoughts, rumination, and impulsive action).
Madeleine Jackson, Lynette Dufton, M.S., & Bruce E. Compas, Ph.D.
Mean Heart Rate (bpm)
PAIN AND ANXIETY
Conclusions
•Apley, J. (1975). The Child with Abdominal Pain
(2nd edition) (2nd ed.). Oxford: Blackwell Scientific
Publications.
•Blanchard, E. B., & Scharff, L. (2002).
Psychosocial aspects of assessment and treatment
of irritable bowel syndrome in adults and recurrent
abdominal pain in children. Journal of Consulting
and Clinical Psychology, 70, 725-738.
•Boyer, M. C., Compas, B. E., Stanger, C., Colletti,
R. B., Konik, B. S., Morrow, S. B., et al. (2006).
Attentional biases to pain and social threat in
children with recurrent abdominal pain. Journal of
Pediatric Psychology, 31(2), 209-220.
•Thomsen, A.H., Compas, B.E., Colletti, R.B.,
Stanger, C., Boyer, M., & Konik, B. (2002). Parent
reports of coping and stress responses in children
with recurrent abdominal pain. Journal of Pediatric
Psychology, 27, 215-226.
Acknowledgments
•Dr. Bruce E. Compas, for his constant
encouragement and untiring attention and care to
both this thesis and my learning experience. I
attribute to him my love of psychology and
research.
•Lynette Dufton, M.S., the graduate supervisor of
the project. I thank her for her extensive role in
teaching me about research methods and data
analysis, and for her generous nature as a
consultant for so many questions.
•Supported by a National Research Service Award
from NIMH to Lynette Dufton.