Background & Aims
Pediatric chronic pain is a societal and personal burden. It affects 1 in 4 youth and amasses $19 billion USD in annual health expenditures (Groenewald et al., 2015; King et al., 2011). Childhood chronic pain often develops into a lifelong condition accompanied by mental health issues including PTSD, anxiety, depression, and suicidality (Vinall et al., 2016; Groenewald et al., 2019). There is a growing understanding that pain communication is important in chronic pain development and maintenance. Validation (i.e., confirmation that an individual’s feelings, thoughts, and actions are legitimate) is emerging as a communication strategy that impacts pain experience. Validating, as opposed to invalidating, communication reduces worry, supports life engagement, and leads to more positive affect (Linton et al., 2012). We aimed to investigate a gap in the validation literature: the effects of parental (in)validation in parent-child pain communication on children’s psychological symptoms.
Methods
Forty youth (8 to 18 years old) with migraine and one of their parents were recruited from tertiary headache and neurology clinics. Over a video-conferencing platform, the parent-child dyads completed a narrative elicitation task wherein participants reminisced about two past attacks of migraine (one from the previous month and another salient headache from any point in the child’s life). The narratives were coded using the Validating and Invalidating Behavior Coding Scale (VIBCS), a rigorous coding scheme validated in emotion regulation literature (Shenk & Fruzzetti, 2011) that has been adapted to capture (in)validation in parent-child interactions. Youth completed a 3-month follow-up questionnaire detailing their pain experience, emotion regulation, and sleep.
Results
Higher levels of parental validation during parent-child reminiscing about a migraine from any point in the child’s life were significantly associated with better developed emotion regulation skills in children (r = .47, p < .05). Additionally, validating parental responses were positively related to children’s fear of pain (r = .47, p < .05). In contrast, higher levels of parental invalidation when discussing a migraine attack were significantly correlated with higher levels of children’s posttraumatic stress symptoms (r = .42, p < .05). Children’s subjective sleep was also linked to invalidation, where higher levels of parental invalidation were associated with poorer child sleep outcomes when the dyads reminisced about both headaches from the previous month and from any point in the child’s life (r = -.36, p < .05 and r = -.46, p < .05, respectively).
Conclusions
This study was novel in its demonstration of the psychological benefits of validating pain communication in the parent-child context; namely, our results suggest that parental validation bolsters child emotion regulation skills. Conversely, parental invalidation was associated with increased symptoms of trauma and poorer sleep outcomes in children. Further, significant associations between pain (in)validation and child outcomes were more common during parent-child reminiscing about a migraine from any point in the child’s life (versus a headache from the past month). A migraine recalled from a child’s history is likely more memorable than a recent headache. Thus, validation may be particularly important when discussing salient pain events. Finally, our results revealed an association between child characteristics (e.g., fear of pain) and parental validation. As these findings are preliminary, sequential analysis to clarify the directionality of parent and child variables is needed.
References
Butow, P., & Sharpe, L. (2013). The impact of communication on adherence in pain management. Pain®, 154, S101–S107.
Groenewald, C. B., Law, E. F., Fisher, E., Beals-Erickson, S. E., & Palermo, T. M. (2019). Associations Between Adolescent Chronic Pain and Prescription Opioid Misuse in Adulthood. The Journal of Pain, 20(1), 28–37.
Hudspith, M., & Iorio, A. (2018). Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research. Canadian Journal of Pain, 2(1), 191–204.
Linton, S. J., Boersma, K., Vangronsveld, K., & Fruzzetti, A. (2012). Painfully reassuring? The effects of validation on emotions and adherence in a pain test. European Journal of Pain, 16(4), 592–599. https://doi.org/10.1016/j.ejpain.2011.07.011
Linton, S. J., Flink, I. K., Nilsson, E., & Edlund, S. (2017). Can training in empathetic validation improve medical students’ communication with patients suffering pain? A test of concept. Pain Reports, 2(3).
Shenk, C. E., & Fruzzetti, A. E. (2011). The impact of validating and invalidating responses on emotional reactivity. Journal of Social and Clinical Psychology, 30(2), 163.
Vinall, J., Pavlova, M., Asmundson, G., Rasic, N., & Noel, M. (2016). Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment. Children, 3(4), 40.
Presenting Author
Queenie Li
Poster Authors
Queenie Li
BSc
University of Calgary
Lead Author
Merek Zimmerman
BSc
Lead Author
Atiqa Pirwani
BSc
Lead Author
Anneke Olson
MSc
Lead Author
Chad Shenk
PhD
Lead Author
Melanie N. Noel
PhD
Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
Lead Author
Maria Pavlova
PhD
Lead Author
Serena L. Orr
MD
Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial