Emotion awareness and coping in children with functional abdominal pain: A controlled study

Alexithymia in children with medically unexplained symptoms: a systematic review

OBJECTIVE

Adult research investigating the link between alexithymia and medically unexplained symptoms (MUS) has found a significant relationship between increased alexithymia and MUS. This difficulty in expressing emotions is likely to begin in childhood so the objective of this paper is to present a quantitative review of studies focussing on the association between MUS and alexithymia in children.

METHODS

Databases were searched with predefined terms relating to alexithymia and MUS in children (0-17 years). Two reviewers independently assessed abstracts, extracted data and undertook quality analyses. Systematic review methods were used in accordance with Cochrane guidelines.

RESULTS

Ten studies met the criteria for inclusion in the review. Seven of the eight studies which focused on a comparison between children with MUS and healthy controls, found higher levels of self-reported alexithymia in the children with MUS. However, in the two studies where children were asked to complete tasks that objectively measure alexithymia, significant differences were not found. Results of studies comparing alexithymia in children with MUS and children with medical/psychiatric controls were inconsistent; there was some evidence of increased anxiety and depression in young people with alexithymia and MUS but inconsistency of measures across studies makes drawing conclusions difficult.

CONCLUSION

There is preliminary evidence that children with MUS have significantly higher levels of alexithymia than controls based on self-report measures; however, this finding was not replicated in objective tasks of alexithymia. Future studies should include validated tasks that objectively measure emotion recognition abilities and focus on possible mediating factors such as neurodevelopmental and mental health difficulties.

The role of psychological factors in pediatric functional abdominal pain disorders

BACKGROUND

Pediatric functional abdominal pain disorders (FAPDs) are disorders of brain-gut dysregulation. Psychological factors are known to be related to etiology, maintenance, and exacerbation of pediatric FAPDs. With the evolving literature in the past two decades, a better understanding has emerged of precisely which psychological factors are associated with childhood FAPDs.

PURPOSE

This narrative literature review summarizes the literature of both child and parent psychological factors in pediatric FAPD. Where anxiety and depression were major targets in the older literature, present-day focus is increasingly on pain-specific cognitions and coping strategies including disease threat and catastrophizing. In addition, parental reaction to a child's pain is increasingly recognized as an important moderator of a child's outcomes and has become an area for clinical intervention. Screening for these factors and integrative treatment approaches are recommended in childhood FAPD.

Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome

BACKGROUND

Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing.

METHODS

We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity.

KEY RESULTS

We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [β] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized β 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized β 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized β 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized β 0.19, CI 0.04-0.19).

CONCLUSIONS AND INFERENCES

Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes.

The role of avoidance behavior in the treatment of adolescents with irritable bowel syndrome: A mediation analysis

Irritable bowel syndrome (IBS) is common in adolescents with a pronounced negative impact on quality of life. A pattern of avoidance behavior is commonly seen in the IBS population, which is associated with more gastrointestinal (GI) symptoms. Exposure-based cognitive behavior therapy (CBT) targets the avoidance behavior to reduce symptoms, but it is unknown whether reduced avoidance is a mediator of symptom improvement in adolescent IBS. Stress has been suggested to play a key role in worsening GI symptoms and is also a potential mediator of the treatment effect in IBS. This study was based on data from a randomized controlled trial (N = 101) that evaluated exposure-based internet-delivered CBT (Internet-CBT) compared with a wait-list for adolescents with IBS. We investigated whether avoidance behavior and perceived stress mediated the improvement in global GI symptoms due to treatment. We found that a change in avoidance behavior, but not perceived stress, mediated the effect of exposure-based Internet-CBT on GI symptoms. The decrease in avoidance behavior explained a large portion (67%) of the total treatment effect. Moreover, a unidirectional relationship over time was observed between avoidance behavior and GI symptoms. Our conclusion is that exposure-based CBT in adolescent IBS reduces avoidance and, consequently, reduces GI symptoms.

Bodily maps of emotions across child development

Different basic emotions (anger, fear, disgust, happiness, sadness, and surprise) are consistently associated with distinct bodily sensation maps, which may underlie subjectively felt emotions. Here we investigated the development of bodily sensations associated with basic emotions in 6- to 17-year-old children and adolescents (n = 331). Children as young as 6 years of age associated statistically discernible, discrete patterns of bodily sensations with happiness, fear, and surprise, as well as with emotional neutrality. The bodily sensation maps changed from less to more specific, adult-like patterns as a function of age. We conclude that emotion-related bodily sensations become increasingly discrete over child development. Developing awareness of their emotion-related bodily sensations may shape the way children perceive, label, and interpret emotions.

Validation of the Abdominal Pain Index using a revised scoring method

OBJECTIVE

Evaluate the psychometric properties of child- and parent-report versions of the four-item Abdominal Pain Index (API) in children with functional abdominal pain (FAP) and healthy controls, using a revised scoring method that facilitates comparisons of scores across samples and time.

METHODS

Pediatric patients aged 8-18 years with FAP and controls completed the API at baseline (N = 1,967); a subset of their parents (N = 290) completed the API regarding the child's pain. Subsets of patients completed follow-up assessments at 2 weeks (N = 231), 3 months (N = 330), and 6 months (N = 107). Subsets of both patients (N = 389) and healthy controls (N = 172) completed a long-term follow-up assessment (mean age at follow-up = 20.21 years, SD = 3.75).

RESULTS

The API demonstrated good concurrent, discriminant, and construct validity, as well as good internal consistency.

CONCLUSION

We conclude that the API, using the revised scoring method, is a useful, reliable, and valid measure of abdominal pain severity.

IBS and FAPS in children: a comparison of psychological and clinical characteristics

OBJECTIVES

It has been suggested that different subcategories of childhood abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) are not separate clinical entities, but represent variable expressions of the same FGID. The aim of the present study was to compare clinical and psychological characteristics of children with irritable bowel syndrome (IBS), functional abdominal pain (FAP), and functional abdominal pain syndrome (FAPS).

METHODS

A total of 259 children, ages 8 to 18 years, fulfilling Rome III criteria for IBS or FAPS were included in a randomized controlled trial evaluating the effect of hypnotherapy. At inclusion, questionnaires assessed demographics, clinical features, abdominal pain frequency and intensity, depression and anxiety, somatization, health-related quality of life, pain beliefs, and coping strategies.

RESULTS

No differences were found between children with IBS and those with FAPS with respect to the main outcomes: frequency and intensity of abdominal pain, symptoms of depression and anxiety, somatization, health-related quality of life, pain beliefs, and coping strategies. A significantly higher percentage of patients with IBS had a positive family history for AP-FGIDs (56.8% vs 37.8%; P = 0.00). Characteristics of patients with IBS subtypes did not differ. Patients with FAP or FAPS differed only with respect to problem-focused coping strategy (2.21 ± 0.61 vs 2.52 ± 0.49; P = 0.00).

CONCLUSIONS

Pediatric patients with IBS and those with FAPS have similar psychosocial profiles. These results may explain why treatment response of psychological therapies in these AP-FGIDs is similar. These results may indicate that pediatric IBS and FAPS are different expressions of 1 underlying functional disorder, but similarities in psychosocial characteristics do not exclude the possibility that these disorders are different entities, because these similarities can exist between disorders of various causes. Therefore, future research is required on the role of other (physiological) factors in pediatric IBS and FAPS.

The role of emotion awareness and mood: somatic complaints and social adjustment in late childhood

Emotion awareness is a key concept related to different child adjustment outcomes. This relationship, influenced by mood, has been found in the preadolescent and adolescent population for somatic complaints. However, little is known in the case of younger children and when other adjustment outcomes are included. The objective of this work is to analyze the contribution of emotion awareness and mood upon different adjustment outcomes (somatic complaints, maladjustment, and peer sociometric status), in children aged 8-12 years old. Self-reported questionnaires and peer-nomination scales were administered to 1423 children (mean age = 9.8 years old). Results support the influence of emotion awareness reinforced by mood, not only upon somatic complaints, but also upon new indicators of personal and social maladjustment, within an age bracket that has not been considered previously. These results stress the importance of emotional abilities and the corresponding affective moods in children's daily life.

[Somatic complaints, emotional awareness and maladjustment in schoolchildren]

INTRODUCTION

Somatic complaints are common in childhood. Research has shown their relationship with emotional awareness and maladjustment. The study had three objectives: 1) to analyze the prevalence of somatic complaints; 2) To explore the relationships between the variables evaluated: somatic complaints, differentiating emotions, verbal sharing of emotions, not hiding emotions, body awareness, attending to others' emotions, analysis of emotions, and personal, social, family, and school maladjustments; and 3) To identify predictors of somatic complaints.

PATIENTS AND METHODS

The study included a total of 1,134 randomly selected schoolchildren of both sexes between 10-12 years old (M=10.99; SD=0.88). The Somatic Complaint List, Emotional Awareness Questionnaire, and Self-reported Multifactor Test of Childhood Adaptation were used to gather information.

RESULTS

The results showed that the prevalence of somatic complaints was 90.2%, with fatigue, headache and stomachache being the most frequently. Dizziness and headache were more common in girls, and the frequency of complaints decreases with age. Somatic complaints are negatively related to emotional awareness, and positively related to maladjustment. The variables that contribute the most to the prediction of somatic complaints are personal maladjustment (25.1%) and differentiating emotions (2.5%).

CONCLUSIONS

The study shows that personal maladjustment is the best predictor of somatic complaints; the more emotional awareness and better adapted the child, the fewer somatic complaints they lodge. Childhood is a stage with significant physical discomfort.

[Relationship between self-evaluation of their emotions and subjective adaptation to school among junior high school students]

The effect of self-evaluation of emotions on subjective adaption to school was investigated among junior high school students (n = 217: 112 boys, 105 girls) who participated in a questionnaire survey. Hierarchical multiple regression analysis indicated that for boys "Infringement and maladjustment" differed based on their self-evaluation of anger and anxiety. For girls, on the other hand, the self-evaluation of anger alleviated psychological stress, worsened the "Relationship with the teacher" and the "Relationship with the class", whereas self-evaluation of anxiety played a role in increasing psychological stress and deteriorating the "Relationship with the class." Furthermore, negatively evaluating either anger or anxiety heightened the "Motivation for learning" in girls. These results suggest that the evaluation of emotions is different in boys and girls and for different emotions.

[Development of the Japanese version of the Emotion Awareness Questionnaire for junior high school students]

This study reports about the development of the Japanese version of the Emotion Awareness Questionnaire for junior high school students. Emotion Awareness Questionnaire (EAQ; Rieffe, Oosterveld, Miers, Meerum Terwogt, & Ly, 2008) for children and adolescents aims not only to monitor and differentiate emotions but also to measure attitudes about emotions. It consists of six factors: differentiating emotions, verbal sharing of emotions, not hiding emotion, bodily awareness, attending to others' emotion, analyses of emotions. To examine the reliability and validity of the Japanese version of the EAQ, junior high school students (7th to 9th grades) were requested to complete the questionnaires (n = 535 in time 1, n = 537 in time 2, n = 330 in time 3). The results showed that the Japanese version of the EAQ had almost the same six-factor structure as the original one. It also had moderate internal consistency and test-retest reliability (three weeks). The validity of the scale was examined in relation to emotional intelligence, social anxiety, depression, psychological stress responses, evaluation of emotions, self esteem and sense of authenticity. The results confirmed that the Japanese version of the EAQ had good validity.

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7-18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N = 617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.