Children's Somatization Inventory Research Articles

Psychological distress and coping efficacy in children with disorders of gut-brain interaction.

Multiple psychological factors influence disorders of gut-brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs. We included children ages 8-18 years without organic medical conditions from largest regional public schools in Colombia. Children completed Spanish versions of Rome III diagnostic questionnaire for DGBIs, State Trait Anxiety Inventory for Children (STAIC), Children's Somatization Inventory (CSI), and a measure of coping efficacy. These data, demographic and socioeconomic characteristics, were compared between children with DGBIs and healthy peers. Exploratory analyses investigated differences between youth with symptoms of functional abdominal pain disorders (FAPDs) compared with healthy peers. Of 1496 children, 281 (mean age 12.9 ± 2.2 years, 49.8% females) self-reported criteria for DGBIs and 125 reported (44.5%) FAPDs. Children with DGBIs had higher trait anxiety, emotional sensitivity, somatization including GI, non-GI, pain-related, and non-pain-related subscales (p < 0.001 each) and lower coping efficacy (p = 0.02) compared to healthy peers. Females had higher trait anxiety and somatization (p = 0.04 and p = 0.005, respectively). State and trait anxiety and coping efficacy differed based on location in children with DGBIs (p = 0.02, p = 0.03, and p < 0.001, respectively). Children with FAPDs had higher trait anxiety (p = 0.02) and somatization (p < 0.001) compared to healthy youth. Children with DGBIs had higher anxiety, emotional sensitivity, and somatization, and lower coping efficacy compared with healthy youth. This highlights the importance of appraising psychological distress characteristics as well as incorporating conflict resolution, assertiveness training, and resilience building during the treatment of DGBIs.

Self-esteem, emotional and behavioral problems, and psychopathology in children with somatic symptoms and related disorders

ABSTRACT &#x0D; Objective: There are few studies in the literature on somatic symptoms and related disorders (SSRD) in children. The aim of this study is to investigate emotional and behavioral difficulties, self-esteem, psychopathology, and clinical characteristics in children with somatic symptoms.&#x0D; Method: This study included 44 children with recurrent and distressing somatic complaint(s) and 49 healthy children. The diagnosis of SSRD was evaluated in detail according to DSM-5 criteria. Self-esteem, emotional and behavioral difficulties, and somatization were assessed using the Rosenberg Self-Esteem Scale (RSES), Strengths and Difficulties Questionnaire (SDQ), and Children's Somatization Inventory (CSI-24), respectively.&#x0D; Results: Children with somatization had significantly greater rates of having at least one comorbid mental disorder, emotional symptoms scores, and peer relationship problems. On the other hand, these children's prosocial behavior scores (Strengths Score), self-esteem scores, and academic performance were significantly lower than the control group. In addition, children with SSRD had more disadvantaged familial characteristics such as low father education, high family history of psychiatric and medical illness and somatization, high marital problems, and domestic violence.&#x0D; Conclusions: This study revealed that somatization in children is associated with increased emotional, peer, and academic problems and psychopathology rates, and low self-esteem and prosocial behaviors. In clinical practice, it would be advisable to evaluate thoroughly children with SSRD in terms of familial disadvantages, emotional, peer, and academic problems, and psychopathology, rather than focusing solely on somatic symptoms.

Investigation of the psychometric properties of children's somatization inventory in Iranian adolescents.

BACKGROUND:This study aimed to investigate the psychometric properties of children's somatization inventory (CSI-24) in a sample of Iranian school adolescents.MATERIALS AND METHODS:In this study, after translating and back-translating CSI-24, comparisons were made with the original version. The study population consisted of 394 school adolescents. Cronbach's alpha method was used to examine the reliability of the scale. Furthermore, the correlation of the scale with the Symptom Checklist-90-Revised was evaluated to determine its criterion validity, using Pearson's correlation coefficient. Exploratory and confirmatory factor analysis methods were applied for construct validity.RESULTS:Investigation of the psychometric properties of the Iranian version of CSI-24 showed its high reliability and confirmatory factor analysis results show the model's satisfactory fitting.CONCLUSION:The Persian version of CSI-24 is a useful self-report tool for evaluating the physical complaints of Iranian school adolescents aged between 12 and 18 years.

Somatization Symptoms Regulate Emotional Memory Bias in Adolescents With Major Depressive Disorder.

Objective: Somatization symptoms are commonly comorbid with depression. Furthermore, people with depression and somatization have a negative memory bias. We investigated the differences in emotional memory among adolescent patients with depressive disorders, with and without functional somatization symptoms (FSS).Methods: We recruited 30 adolescents with depression and FSS, 38 adolescents with depression but without FSS, and 38 healthy participants. Emotional memory tasks were conducted to evaluate the emotional memory of the participants in the three groups. The clinical symptoms were evaluated using the Hamilton Depression Rating Scale (HDRS) and the Children's Somatization Inventory (CSI).Results: The valence ratings and recognition accuracy rates for positive and neutral images of adolescent patients were significantly lower than those of the control group (F = 12.208, P < 0.001; F = 6.801, P < 0.05; F = 14.536, P < 0.001; F = 6.306, P < 0.05, respectively); however, the recognition accuracy rate for negative images of adolescent patients of depression without FSS was significantly lower than that of patients with FSS and control group participants (F = 10.316, P < 0.001). These differences persisted after controlling for HDRS scores. The within-group analysis revealed that patients of depression with FSS showed significantly higher recognition accuracy rates for negative images than the other types (F = 5.446, P < 0.05). The recognition accuracy rate for negative images was positively correlated with CSI scores (r = 0.352, P < 0.05).Conclusion: Therefore, emotional memory impairment exists in adolescent patients of depression and FSS are associated with negative emotional memory retention.

Social anxiety and social skills via problematic smartphone use for predicting somatic symptoms and academic performance at primary school

Mobile phones have become an indispensable tool in different areas of life, however this often results in some negative effects, especially among their youngest users. The aim of the present study is to analyze the relationship between social anxiety and social skills via problematic smartphone use (PSU) for predicting somatic symptoms and academic performance. A total of N = 427 primary school students aged from 10 to 14 participated in the study and the following tools were used: the Smartphone Addiction Scale, the Liebowitz Social Anxiety Scale for Children and Adolescents, the Children's Self-Report Social Skills Scale, the Children's Somatization Inventory, and reported grade point average (GPA). The study showed that girls use smartphone applications such as talking, text messages, social networking, camera and organizer more often than boys. Our results showed a positive relationship between social skills and GPA, whereas PSU was negatively associated with GPA. Additionally, there was a positive relationship between social anxiety: avoidance and somatization. Social anxiety: fear was positively associated with GPA, whereas social anxiety: avoidance was negatively associated with GPA. In girls group there was a partial mediation between social skills and GPA via PSU, whereas in boys group there was a partial mediation between social skills and somatization via PSU.

Psychiatric basics of alopecia areata in pediatric patients: Evaluation of emotion dysregulation, somatization, depression, and anxiety levels.

Alopecia areata (AA) is a skin disease characterized by sudden-onset hair loss. The relationship between psychiatric status and AA has not been fully elucidated. The aim of this study was to evaluate emotion dysregulation, somatization, depression, and anxiety levels in children and adolescents with AA. The study included 27 patients aged 8-18years diagnosed with AA, and an age and gender-matched control group consisting of 30 cases without a known chronic medical disease. All individuals were screened for existing psychiatric illnesses by a pediatric psychiatrist through the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version (K-SADS-PL). The patients were then evaluated using the Children's Depression Inventory (CDI), Screen for Child Anxiety-Related Emotional Disorders (SCARED), State-Trait Anxiety Inventory for Children (STAI-C), and Children Somatization Inventory (CSI-24). In addition, the patients' parents were asked to complete the Emotion Regulation Checklist-Family Form (ERC). When comparing the scale scores of the AA and control group, there was a statistically significant difference between the groups in terms of the Emotional Lability/Negativity subscale scores on ERC. K-SADSPL ratios denoted features of at least one psychiatric condition in 62.9% and 16.6% of the AA group and control group, respectively. Our results emphasize the importance of psychiatric evaluation in patients with AA. Our study also reveals the need for further studies with a larger sample of AA patients being evaluated in terms of emotion regulation.

School Bullying and Association with Somatic Complaints in Victimized Children

To examine the relationship between peer victimization and psychosomatic symptoms among school-going children. A total of 213 school-going children (Mean = 11.49 y, SD = 1.44) studying in grades 5 to 8 were recruited from 2 schools from a north Indian city. The children were administered the California Bullying Victimization Scale (CBVS), Pre-Adolescent Adjustment Scale (PAAS), and the Children's Somatization Inventory (CSI). The total score on the somatization inventory and the total number of psychosomatic symptoms endorsed were used as the main outcome measures. Out of the 213 students, 42.7% were involved in bullying either as victims or as perpetrators. A little more than one-fourth (26.8%) were victims. A consistent positive association between victimization and somatic complaints was found. The most common physical symptoms reported by victims included headache (60.7%), chest pain (35.7%), stomach pain (33.9%), weakness (30.4%), and pain in arms and legs (19.6%). Stepwise multiple regression analysis revealed that 22.6% of the variance in the total CSI scores was accounted by the total victimization score, self-reported adjustment with school teachers, and academic performance (F = 20.97, P = 0.0001). The total number of functional somatic symptoms were predicted by the total victimization score, academic performance, and age of the child (F = 16.03, P = 0.0001). These variables together predicted 18% of the variance in the total number of symptoms. Primary health care clinicians and pediatricians need to consider bullying as one of the potential risk factors when they encounter physical symptoms among pediatric patients in their clinical practice.

Quality of life, emotion dysregulation, attention deficit and psychiatric comorbidity in children and adolescents with vitiligo.

Vitiligo is an acquired pigmentation disorder, which can have a negative effect on patient quality of life (QoL). To evaluate QoL and psychiatric comorbidity in paediatric patients with vitiligo. In total, 30 patients aged 8-18years who were diagnosed with vitiligo and 30 age- and sex-matched healthy controls (HCs) were included in the study. The Children's Depression Inventory, Screen for Child Anxiety Related Disorders, State-Trait Anxiety Inventory for Children and Child Somatization Inventory were completed for both patients and controls. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was administered to all patients by a child psychiatrist. Families were also asked to complete the Pediatric Quality of Life Inventory and Emotion Regulation Checklist for children. The K-SADS-PL evaluation showed that 90% of the patients in the vitiligo group had at least one psychiatric diagnosis, whereas this rate was 20% in the HCs (P<0.001). There were statistically significant differences between vitiligo and HCs in terms of anxiety, state and trait anxiety scores (P<0.05). Attention deficit and hyperactivity disorder (ADHD) was detected in 36.6% of the patients. The most important finding of this study is that anxiety disorders are more prominent than depression in childhood vitiligo. Another important finding of this study is that the prevalence of ADHD is significantly higher than the normal population.

Self-reported physical and psychological symptoms among victims and perpetrators of bullying in Arab American Adolescents.

The adverse effects of bullying victimization among adolescents have been examined extensively. However, few studies have examined how bullying perpetration affects health. Moreover, ethnic or religious minorities are particularly at risk for bullying involvement, but little is known about bullying among Arab Americans. The purpose of this study is to examine how bullying perpetration and victimization are related-independently and concurrently-to physical and psychological problems among Arab American adolescents. Arab American adolescents (N = 150), ages 12-16, were recruited from a community center and a mosque located in Southeast Michigan. Participants completed the Adolescent Peer Relations Instrument, the Children's Somatization Inventory, the Kessler Psychological Distress Scale, and the Perceived Stress Scale. Both bullying perpetration and victimization correlated positively with physical and psychological symptoms. Hierarchical regressions indicated that both perpetration and victimization simultaneously and significantly predicted physical and psychological symptoms, and these relationships were independent of the demographic factors and general life stress. Bullying perpetration and victimization are associated with adverse health outcomes in Arab American adolescents, independent of life stress. These findings are among the first ones in this population and pave the way for future research and intervention programs.

Somatic Symptoms in Pediatric Patients With Chronic Pain: Proposed Clinical Reference Points for the Children's Somatic Symptoms Inventory (Formerly the Children's Somatization Inventory)

Among youth with chronic pain, elevated somatic symptoms across multiple body systems have been associated with greater emotional distress and functional disability and could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory (formerly the Children's Somatization Inventory) is commonly used to assess somatic symptoms in children. However, no studies have evaluated the clinical usefulness of the measure in the assessment of pediatric patients with chronic pain. This study evaluated the factor structure and clinical relevance of the 24-item Children's Somatic Symptoms Inventory (CSSI-24) in youth (n = 1,150) with mixed chronic pain complaints presenting to a tertiary pain clinic. The CSSI-24 total scores were equal or superior to factor scores as indicators of patients' clinical characteristics (functional disability, pain catastrophizing, fear of pain, and anxiety and depressive symptoms) and parental catastrophizing and protective responses. Tertile-derived clinical reference points for the CSSI-24 total score (<18, low; 19-31, moderate; ≥ 32, high) significantly differed on measures of clinical characteristics and parent factors. Controlling for age, sex, pain intensity, and primary pain complaint, the high somatic symptoms group exhibited significantly greater health care use compared with the moderate and low groups. The assessment of somatic symptoms in pediatric patients with chronic pain may provide useful information regarding patients' psychosocial risk and tendency to access health services. Perspective: Clinical reference points based on the CSSI-24 total scores meaningfully differentiated youth with chronic pain on measures of emotional distress, functioning, parent catastrophizing and protective responses, and health care use. Assessing somatic symptoms could provide useful information regarding a pediatric patient's psychosocial risk, tendency to access health services, and need for enhanced care coordination.

Linking Family Functioning and Self-Discrepancies among Children with Functional Somatic Symptoms

Functional somatic symptoms (FSS), defined as physical symptoms of unknown pathology, are common among children and adolescents and are often associated with high levels of functional impairment. Self-discrepancy theory (SDT) suggests that discrepancies between one’s ideal, ought, or undesired self-states and one’s actual self-representation may lead to emotional distress. Among families with dysfunctional patterns, such emotional distress may result in FSS. The current study examined the relationship between familial patterns and children’s levels of self-discrepancies, among children with and without FSS. Twenty-three children diagnosed with FSS and 23 children with orthopedic problems (non-FSS) and their mothers participated in the study. Mothers and children completed the Child Somatization Inventory and the Integrated Self-Discrepancies Index. Mothers also completed the general scale of the Family Assessment Device. Higher levels of symptom intensity were found in the FSS group than in the non-FSS group. Dysfunctional familial patterns were significantly higher in the FSS group, and higher levels of discrepancies were reported in the FSS group, compared with the non-FSS group. No significant relationship was found in the FSS group between level of self-state discrepancies and level of family functioning. Higher levels of dysfunctional patterns are observed among families of children with FSS. Furthermore, children with FSS and their mothers hold relatively high levels of self-state discrepancies. However, these elevated discrepancies are not significantly related to familial dysfunctional patterns. Viewing self-state discrepancies together with family maladaptive patterns might help address both inter- and intrapersonal conflicts within the family and reduce children’s symptoms.

A comprehensive approach to understand somatic symptoms and their impact on emotional and psychosocial functioning in children.

IntroductionSomatic symptoms are frequently reported by children with significant impairment in functioning. Despite studies on adult populations that suggest somatic symptoms often co-occur with difficulties in identifying and describing feelings, little research has been done in childhood. This study aimed to investigate the prevalence and frequency of somatic symptoms as well as to investigate the functional impairment in children with high number of self reported somatic symptoms versus those with fewer somatic symptoms. Additionally the parental perception of their children's somatic symptoms and functioning was explored. Finally, we explored the direct and indirect effects of difficulties in identifying feelings in predicting somatic symptoms and functional disability among school-aged children.Methods356 Italian school-aged children and their mothers participated in this study. Children (mean age = 11.43; SD = 2.41) completed the Children’s Somatization Inventory (CSI-24) to assess somatic symptoms, the Functional Disability Inventory (FDI) to assess physical and psychosocial functioning and the Alexithymia Questionnaire for Children (AQC) to evaluate alexithymic features. Mothers completed the parental forms of the CSI and the FDI.ResultsAmong children, 66.3% did not declare somatic symptoms and 33.7% reported one or more somatic symptoms in the last two weeks. A significant positive correlation emerged between children’s and mothers’ CSI total scores. Both children’s and mothers’ FDI total scores were significantly correlated with CSI scores. A significant correlation was observed between somatic symptoms and alexithymic features. Furthermore, the data showed that somatic symptoms mediated the relationship between difficulties in identifying feelings and functional impairment. Finally, it was showed that alexithymia facet of difficulty in identifying feelings contributed in large part to the prediction of the somatic symptomatology (b = 0.978, p < 0.001; R2 = 0.164, F(5, 350) = 10.32, p < 0.001).ConclusionsFindings from this study provide evidence that a higher frequency of somatic symptoms is associated with functional disabilities and alexithymic facets in school-aged children.

Brain substrates of reward processing and the μ-opioid receptor: a pathway into pain?

The processing of reward and reinforcement learning seems to be important determinants of pain chronicity. However, reward processing is already altered early in life and if this is related to the development of pain symptoms later on is not known. The aim of this study was first to examine whether behavioural and brain-related indicators of reward processing at the age of 14 to 15 years are significant predictors of pain complaints 2 years later, at 16 to 17 years. Second, we investigated the contribution of genetic variations in the opioidergic system, which is linked to the processing of both, reward and pain, to this prediction. We used the monetary incentive delay task to assess reward processing, the Children's Somatization Inventory as measure of pain complaints and tested the effects of 2 single nucleotide polymorphisms (rs1799971/rs563649) of the human μ-opioid receptor gene. We found a significant prediction of pain complaints by responses in the dorsal striatum during reward feedback, independent of genetic predisposition. The relationship of pain complaints and activation in the periaqueductal gray and ventral striatum depended on the T-allele of rs563649. Carriers of this allele also showed more pain complaints than CC-allele carriers. Therefore, brain responses to reward outcomes and higher sensitivity to pain might be related already early in life and may thus set the course for pain complaints later in life, partly depending on a specific opioidergic genetic predisposition.

Validity and Reliability of the Turkish Version of DSM-5 Level 2 Somatic Symptom Scale (Child Form for 11-17 Years and Parent Form for 6-17 Years)

Introduction: This study aimed to assess the validity and reliability of the Turkish Version of DSM-5 Level 2 Somatic Symptom Scale’s child and parent forms. Method: The scale was constructed by carrying out the translation and back translation of DSM-5 Level 2 Somatic Symptom Scale. The study group consisted of a community and clinical sample. The scale was applied to 120 parents and 186 adolescents that represented the clinical and community sample. During the assessment process, Child Somatization Inventory was also used. Results: Reliability analyses indicated a high internal consistency regarding Level 2 Somatic Symptom Scales, for parent forms and acceptable internal consistency for child forms. In the meantime, it was shown that both child and parents form for Level 2 Somatization Symptom Scale were significantly correlated with Child Somatization Inventory. As for the content validity, five factors for child forms and three factors for parent forms were obtained and was observed to be consistent with the original construct of the scale. Conclusion: It was concluded that Turkish version of DSM-V Level 2 Somatic Symptom Scale was a valid and reliable tool to be utilized both for clinical practice and research purposes.

History of Somatization Is Associated with Prolonged Recovery from Concussion

To determine the association between a history of somatization and prolonged concussion symptoms, including sex differences in recovery. A prospective cohort study of 10- to 18-year-olds with an acute concussion was conducted from July 2014 to April 2015 at a tertiary care pediatric emergency department. One hundred twenty subjects completed the validated Children's Somatization Inventory (CSI) for pre-injury somatization assessment and Postconcussion Symptoms Scale (PCSS) at diagnosis. PCSS was re-assessed by phone at 2 and 4weeks. CSI was assessed in quartiles with a generalized estimating equation model to determine relationship of CSI to PCSS over time. The median age of our study participants was 13.8years (IQR 11.5, 15.8), 60% male, with separate analyses for each sex. Our model showed a positive interaction between total CSI score, PCSS and time from concussion for females P<.01, and a statistical trend for males, P=.058. Females in the highest quartile of somatization had higher PCSS than the other 3 CSI quartiles at each time point (B -26.7 to -41.1, P values<.015). Patients with higher pre-injury somatization had higher concussion symptom scores over time. Females in the highest somatization quartile had prolonged concussion recovery with persistently high symptom scores at 4weeks. Somatization may contribute to sex differences in recovery, and assessment at the time of concussion may help guide management and target therapy.

(106) Children's Somatization Inventory: factor structure and clinical reference points in pediatric chronic pain

(106) Children's Somatization Inventory: factor structure and clinical reference points in pediatric chronic pain

Relationships among depression, anxiety, anxiety sensitivity, and perceived social support in adolescents with conversion disorder

Objective: This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD). Methods: Fifty outpatients, aged 8–18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires. Results: Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects. Conclusions: This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.

Impact of Psychological Covariates on Experimental Pain Sensitivity in Children and Adolescents with SCD

Background: Children with Sickle Cell Disease (SCD) have increased sensitivity to heat and cold pain (Brandow et al) during steady state. However, the role of psychological factors such as anxiety, depressive symptoms and catastrophizing on pain sensitivity is not known in SCD. Characterization of these factors may provide an insight into the study of their possible roles in the transition to chronic pain.Aim: To determine if psychological factors impact pain sensitivity in patients with SCD.Methods: Patients with SCD were offered quantitative sensory testing (QST) when at steady state (at least 2 weeks following a VOE). QST procedures included estimation of pressure, mechanical and thermal pain thresholds (minimum intensity of stimulus which is first perceived as painful) and tolerances (maximum intensity of a pain-producing stimulus that a participant is willing to accept in a given situation) as well as windup values (increased pain perception to repetitive painful stimuli). At each time point, participants completed the PROMIS measures of pain intensity, pain interference, anxiety, depressive symptoms, sleep, fatigue and peer relationships. Participants also completed the Pain Catastrophizing Scale ((PCS)-Sullivan et al), Child Somatization Inventory (Walker et al), Pain Coping Inventory (Varni et al)* as well as Peds QL Generic and SCD specific measures of Quality of life*.Results: We determined the experimental pain phenotype (sensitivity to pressure, mechanical and thermal pain) of 29 patients with SCD during steady state (> 2 weeks from a vaso-occlusive episode). These participants were not receiving long-term opioids or adjunctive medications for pain. The median age of participants was 15 (IQR 10-19) and majority (69%) were female. Approximately half of the study sample had HbSS. Three quarters of the study sample were prescribed hydroxyurea. The median Hb level was 11.1 (IQR 10.2-11.6). The median number of VOC's in the year prior to testing was 1(IQR 0-2) and in 3 years prior to testing was 3 (IQR 2-5). The median PROMIS pain intensity T-score was 37.8, PROMIS pain interference T-score was 48.75, PROMIS Depressive symptom T-score was 44.35 and PROMIS anxiety was 43.9; these scores were not higher than the average T-score of 50 described in the pediatric population. High catastrophizing scores were reported on the PCS, with median score being 29. The median cold pain threshold was 23.6 degrees C (IQR 15.8-26.7) and median heat pain threshold was 39.1 degrees C (IQR 37.5-40.9).We noted that increase in scores on PROMIS depressive symptoms was associated with lower heat (Spearman's rho= -0.55), cold (Spearman's rho= 0.57) and mechanical (Spearman's rho= -0.4) pain thresholds. Scores on PROMIS depressive symptoms predicted heat and cold pain thresholds independent of age and VOC's in the past 3 years. Increased PROMIS anxiety scores were associated with lower mechanical pain thresholds (Spearman's rho= -0.43) and lower cold detection thresholds (Spearman's rho= 0.46). Increased scores on PCS were associated with lower heat detection thresholds (Spearman's' rho= -0.39). (All p-values were<0.05) Table 1OutcomeDepressive symptomsVOCs in 3 years prior to studyAge (years)Model signCoeffp-valueCoeffp-valueCoeffp-valueCold Pain Threshold0.40.003-0.190.6-0.410.16<0.0127Heat Pain Threshold-0.120.0130.380.0120.20.068<0.00128Conclusions: Depressive symptoms and anxiety are associated with lower experimental pain thresholds in patients with SCD. Higher scores on PROMIS depressive symptoms predict increased sensitivity to heat and cold pain independent of age and number of VOCs experienced in the past 3 years. Further studies are needed to determine the contribution of psychological factors in the transition to chronic pain in SCD.Acknowledgments: 1-Sickle Cell Disease Association of America 2- *PedsQL™ contact information and permission to use: Mapi Research Trust, Lyon, France. E-mail: PROinformation@mapi-trust.org - Internet: www.Mapi-trust.org and http://www.pedsql.org/index.html DisclosuresNo relevant conflicts of interest to declare.

OP‐20 THE ASSOCIATION BETWEEN ADVERSE LIFE EVENTS AND ABDOMINAL PAIN‐PREDOMINANT FUNCTIONAL GASTROINTESTINAL DISORDERS

Background:Abdominal pain‐predominant functional gastrointestinal disorders (AP‐FGIDs) are a common public health problem in children. The precise aetiology of AP‐FGIDs is far from clear. Psychological stress and all forms of child abuse are known predisposing factors to develop AP‐FGIDs. The main objective of this study is to study the association between adverse life events (ALEs) and development of AP‐FGIDs.Methods:A cross sectional, school based study was conducted in Gampaha district of Sri Lanka. All children aged 13–18 years were recruited from four randomly selected semi‐urban schools in the district after obtaining consent from parents, school administration and children themselves. A translated and validated, self‐administered questionnaire consisting of four parts was used for data collection. Part I was the Rome III questionnaire for functional gastrointestinal disorders, self‐report form for children above 10 years. Part II was a questionnaire on exposure to adverse life events. Part III was the Sinhala (the native language) version of the PedsQL, Pediatric Quality of Life Inventory 4.0 (Generic Core Scales). Part IV was the Child Somatization Inventory. The questionnaire was administered under examination setting to ensure confidentiality and privacy. Research assistant were present during filling the questionnaire for provide assistance and verifications. AP‐FGIDs were defined using the Rome III criteria.Results:A total of 1792 children were included in the analysis (males 975 [54.4%], mean age 14.4 years, SD 1.3 years years). Out of them, 305 (17.0%) had AP‐FGIDs. ALEs that showed a significant association with AP‐FGIDs include, parental substance abuse (25.1% vs. 16.0% in controls, p = 0.015) and domestic violence (28.5% vs. 16.1%, p = 0.02). Children with AP‐FGIDs exposed to ALEs have a higher somatization index compared to children not exposed to ALEs (16.9 vs. 13.4, p = 0.003), and a lower overall health‐related quality of life (HRQoL) score (81.8 vs. 85.1, p = 0.02). The scores they obtained for psycho‐social (86.4 vs. 92.4, p &lt; 0.0001) and emotional (72.5 vs. 77.7, p = 0.03) domains of the HRQoL were also lower than that of children with no such experiences.Conclusions:Exposure to ALEs predispose children to develop AP‐FGIDs. Experience of childhood ALEs deleteriously affects the HRQoL and somatization of children with AP‐FGIDs.

Relationships Among Depression, Anxiety, Anxiety Sensitivity, and Perceived Social Support in Adolescents with Conversion Disorder

Introduction Only a limited number of studies have examined the association of conversion disorder (CD) with depression and anxiety in adolescents. Furthermore, no data regarding the association of CD with anxiety sensitivity and perceived social support are available. This study aimed to assess the relationships among psychological characteristics and conversion symptoms in adolescents. Methods We assessed 50 outpatients, aged 8–18 years, who had been diagnosed with CD and members of a control group using the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI), and Multidimensional Scale of Perceived Social Support (MSPSS). Symptoms of CD were assessed using the Somatoform Dissociation Questionnaire (SDQ) and Children's Somatization Inventory (CSI). Results Compared with controls, adolescents with CD scored higher on the CDI, SCARED, CASI total, CASI physical and cognitive subscales, and MSPSS total and MSPSS family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the SDQ scores and that CDI and CASI total scores predicted the CSI scores of subjects. Conclusion This study suggest that adolescents with CD had poor psychosocial well-being, and depression and global AS and AS cognitive concerns may play a role in the development of conversion symptoms.