Pain in children: psychosocial: Issues in measuring children's preferred style of coping with pain

Abstract

Some children cope with medical procedures by closely watching while others prefer to look away. Matching specific distress reducing cognitive behavioral interventions with a child's preferred coping style may increase the effectiveness of the interventions (Fanurik et al., 1993; Miller et al. 1995). However determining coping style is difficult because the few existing validated child self report coping instruments are cumbersome to use. Sometimes parent report is accepted as a proxy for children's preferred coping style. This poster presents preliminary comparisons between child and parent report of child coping style, and between two self report measures of preferred coping style for children. Subjects are children (4 to 10 years old) scheduled for an IV insertion in the outpatient setting, and their parents. Children and parents independently answer one question: “If you (your child) fell down and scraped a knee and your mom or dad (you) were going to wash it off and put a band-aid on it, what would you rather do, watch or look away?” Then children complete the Child Behavior Style Scale or CBSS (Miller et al., 1995), a validated measure of monitoring and blunting coping styles. Results are presented for the first 100 child-parent dyads from a large study evaluating predictors of child distress during IV insertion. There are significant differences between child and parent responses to the coping style question, with just 67% overall agreement among child-parent dyads and a kappa coefficient of .23. Children who said they would watch had a significantly higher mean score on the CBSS monitoring subscale. Parents may not be accurate judges of their children's preferred coping style. A simple screening question about watching or looking away from a painful event may be a useful alternative to more complicated screening tools for coping style.