Abstract
Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.
Highlights
Pediatric chronic pain is often accompanied by mental health comorbidities such as depressive and anxiety symptoms, which contribute to lower quality of life and worse daily functioning
Significant levels of autism traits and attentiondeficit/hyperactivity disorder (ADHD) symptoms occurred in 13.2% (n = 5) and 22.5% (n = 9) of the patients, respectively
Ten percent (n = 4) of the patients scored greater than clinically significant levels for both autism traits and ADHD symptoms
Summary
Pediatric chronic pain is often accompanied by mental health comorbidities such as depressive and anxiety symptoms, which contribute to lower quality of life and worse daily functioning (i.e., school absenteeism, social withdrawal). Such comorbid problems posit additional physical and emotional burdens for patients and their families (Gold et al, 2009; Miller and Cano, 2009; Hoftun et al, 2011). While nearly half of the pediatric chronic pain patients suffer from comorbid mental health disorders including mood and anxiety disorders (Vinall et al, 2016; Fisher et al, 2018), neuropsychiatric disorders such as autism and attentiondeficit/hyperactivity disorder (ADHD) seem to go unrecognized (Lipsker et al, 2018; Low Kapalu et al, 2018). Chronic pain occurs in a large proportion of individuals diagnosed with clinical autism and/or ADHD (Asztély et al, 2019; Whitney and Shapiro, 2019)
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