Background & Aims

Functional abdominal pain disorders (FAPDs) are common among children[1] and are associated with functional impairment[2], reduced quality of life[3], and psychiatric comorbidity[4]. Internet delivered Cognitive-behavioral therapy (iCBT) has been shown to be effective in treating FAPDs[4,5]. However, to our knowledge no studies have investigated the influence of comorbid psychopathology on treatment effect in children with FAPDs.
The aim of the study was to investigate whether children with FAPDs and a comorbid psychiatric disorder benefit equally well from iCBT compared with children with FAPDs without a comorbid psychiatric disorder. We hypothesized that children with FAPDs and a comorbid psychiatric disorder would benefit less from iCBT compared with children with FAPDs but without a comorbid psychiatric disorder.

Methods

Secondary analysis was done on data from a feasibility trial (n=31)[6] and a randomized controlled trial (n=89)[4] in which children (8-12 years) with FAPDs received iCBT (10 weeks). The sample (n=120) was split into two groups: presence or absence of psychiatric comorbidity, based on a psychiatric assessment (MINI-KID)[7]. The outcomes (self-assessed) were compared between the groups.
Primary outcome was gastrointestinal symptoms (PedsQL Gastro)[8]. Secondary outcomes were health-related quality of life (PedsQL QOL)[9], gastrointestinal-specific anxiety (VSI-C)[10], last week’s worst pain intensity (FACES)[11], anxiety symptoms (SCAS-S)[12], and depressive symptoms (CDI-S)[13].
Multilevel modelling was used to assess differences in slopes of change (growth), from baseline to end of treatment (10 weeks). The primary outcome was assessed on a weekly basis, and secondary outcomes were measured at baseline, at end of treatment.

Results

Of the 120 children included in the study 36 children (30%) had at least one psychiatric comorbid diagnosis. Across groups, a significant treatment effect was observed between baseline to end of treatment for the primary outcome (gastrointestinal symptoms) with an estimated weekly improvement in symptoms of on average 1.07 points per week (p < .001). All secondary outcomes (health-related quality of life, gastrointestinal-specific anxiety, last week’s worst pain intensity, anxiety symptoms, and depressive symptoms) showed significant improvements from baseline to end of treatment. Children with psychiatric comorbidity had higher baseline symptom burden across all measures than children without psychiatric comorbidity, except for last week’s worst pain intensity. There were no differences in treatment effect between children with and without psychiatric comorbidity in the primary measure (p = .159), nor in any of the secondary measures.

Conclusions

These results indicate that iCBT is effective for children with FAPDs, regardless of psychiatric comorbidity.

References

1. Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLOS ONE [Internet] 2015;10(5):e0126982. Available from: https://pubmed.gov/25992621

2. Saps M, Seshadri R, Sztainberg M, Schaffer G, Marshall BM, Lorenzo CD. A prospective school-based study of abdominal pain and other common somatic complaints in children. The Journal of Pediatrics [Internet] 2009;154(3):322–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S002234760800855X

3. Varni JW, Bendo CB, Nurko S, Shulman RJ, Self MM, Franciosi JP, et al. Health-related quality of life in pediatric patients with functional and organic gastrointestinal diseases. The Journal of Pediatrics [Internet] 2015;166(1):85–90. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022347614007483

4. Lalouni M, Ljótsson B, Bonnert M, Ssegonja R, Benninga M, Bjureberg J, et al. Clinical and Cost Effectiveness of Online Cognitive Behavioral Therapy in Children With Functional Abdominal Pain Disorders. Clin Gastroenterol H [Internet] 2019;17(11):2236-2244.e11. Available from: https://linkinghub.elsevier.com/retrieve/pii/S154235651831320X

5. Bonnert M, Olén O, Lalouni M, Benninga MA, Bottai M, Engelbrektsson J, et al. Internet-Delivered Cognitive Behavior Therapy for Adolescents With Irritable Bowel Syndrome: A Randomized Controlled Trial. The American Journal of Gastroenterology [Internet] 2017;112(1):152–62. Available from: https://pubmed.gov/27845338

6. Lalouni M, Ljótsson B, Bonnert M, Hedman-Lagerlöf E, Högström J, Serlachius E, et al. Internet-Delivered Cognitive Behavioral Therapy for Children With Pain-Related Functional Gastrointestinal Disorders: Feasibility Study. Jmir Ment Heal [Internet] 2017;4(3):e32. Available from: https://mental.jmir.org/2017/3/e32/

7. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry [Internet] 1998;59 Suppl 20:22-33-quiz 34–57. Available from: https://pubmed.gov/9881538

8. Varni JW, Lane MM, Burwinkle TM. Health-Related Quality of Life in Pediatric Patients with Irritable Bowel Syndrome:: A Comparative Analysis. Journal of Developmental & Behavioral Pediatrics [Internet] 2006;27(6):451–8. Available from: https://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00004703-200612000-00001

9. Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical care [Internet] 2001;39(8):800–12. Available from: https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id= 11468499&retmode=ref&cmd=prlinks

10. Lalouni M, Olén O, Bjureberg J, Bonnert M, Chalder T, Hedman?Lagerlöf E, et al. Validation of child?adapted short scales for measuring gastrointestinal?specific avoidance and anxiety. Acta Paediatr 2022;

11. Hicks CL, Baeyer CL von, Spafford PA, Korlaar I van, Goodenough B. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain [Internet] 2001;93(2):173–83. Available from: https://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006396-200108000-00011

12. Ahlen J, Vigerland S, Ghaderi A. Development of the Spence Children’s Anxiety Scale – Short Version (SCAS-S). Journal of Psychopathology and Behavioral Assessment [Internet] 2017;46(9):1–17. Available from: https://link-springer-com.proxy.kib.ki.se/article/10.1007/s10862-017-9637-3

13. Allgaier AK, Frühe B, Pietsch K, Saravo B, Baethmann M, Schulte-Körne G. Is the Children’s Depression Inventory Short version a valid screening tool in pediatric care? A comparison to its full-length version. J Psychosom Res [Internet] 2012;73(5):369–74. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022399912002218

Presenting Author

Viktor Vadenmark

Poster Authors

Viktor Vadenmark

Master of Science in Psycholog

Karolinska Institutet

Lead Author

Aleksandra Bujacz (PhD)

Karolinska Institutet

Lead Author

Johan Åhlén (Lic. psychologist

PhD)

Karolinska Institutet

Lead Author

Martin Jonsjö (Lic. psychologist

PhD)

Karolinska Institutet

Lead Author

Jenny Rickardsson (Lic. psychologist

PhD)

Karolinska Institutet

Lead Author

Jörgen Rosén (Lic. psychologist)

Karolinska Institutet

Lead Author

Sarah Vigerland (Lic. psychologist

PhD)

Karolinska Institutet

Lead Author

Karin jensen Jensen (PhD)

Karolinska Institutet

Lead Author

Marianne Bonnert (Lic. psychologist

PhD)

Karolinska Institutet

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies