Children and Recurrent Headaches: Assessment and Treatment Implications for School Psychologists

Adolescent self-perception: associations with chronic musculoskeletal pain and functional disability

Associations among pain, functional disability, and self-perceived competence were examined in a retrospective record review of the initial clinical evaluations of 115 adolescents (ages 13 to 18 years) with chronic musculoskeletal pain not associated with a specific organic cause. Adolescents self-reported on pain intensity, functional disability, and 9 developmentally relevant domains of self-perceived competence, using the Self-Perception Profile for Adolescents (Harter, 1988). Results confirmed a relation between usual pain intensity and functional disability (r = 0.47, P < .001). A series of multiple regression analyses revealed that adolescents' perceptions of global self-worth significantly moderated the relation between pain and disability. These findings extend our understanding of the relations among self-perception, chronic pain, and disability to include adolescents with chronic musculoskeletal pain syndromes and have future research and therapeutic implications.

PERSPECTIVE

Adolescents with chronic pain syndromes can face significant challenges in accomplishing developmental goals with respect to the pain and disability they experience. Perceptions of self-worth appear to play an important role in understanding the relation between pain and functional disability among adolescents with chronic pain.

Behavioral assessment and treatment of pediatric headache

Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are reviewed, as is the evidence base for their use. The article concludes with practical suggestions for headache management.

Adolescent chronic pain problems in the school setting: exploring the experiences and beliefs of selected school personnel through focus group methodology

PURPOSE

To systematically analyze school personnel's understanding of adolescent chronic pain problems and to learn how healthcare and school systems can collaborate more effectively to address these problems.

METHODS

Focus group methodology was employed in middle- and high-school settings. Five groups, comprised of 38 schoolteachers, administrators, school nurses, and guidance/mental health staff participated.

RESULTS

Transcript analyses indicate that focus group members cited many challenges related to working with adolescents with pain in school (including high absence rates, wide individual variation in presentation of symptoms and impairment, the need to balance accommodations with school policies, attending to the needs of other students, and dealing with parents) and identified needs for more information about chronic pain problems and more guidance from healthcare professionals regarding how to manage pain symptoms and pain-related behaviors in the school setting.

CONCLUSIONS

Results indicate that school personnel struggle when they encounter chronic pain problems in the school setting and feel inadequately educated about how to work effectively with students with chronic pain. Improved collaboration between healthcare and school systems is needed and could increase school success (i.e., the ability to attend school and to perform to the best of one's abilities) for adolescents with chronic pain disorders.