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Home > Divisions > Adolescent Medicine > Research > Walker Lab > Recent Publications
Recent Publications

Walker, L. S., Baber, K. F., Garber, J., & Smith, C. A. (2008). A typology of pain coping strategies in pediatric patients with chronic abdominal pain. Pain.

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n = 699) were pediatric patients (ages 8–18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children’s pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n = 311) that replicated in Sample 2 (n = 388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients’ pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications.

Walker, L.S. Treatment for Kids and Teens with Functional GI Disorders. Interview. International Symposium on Functional Gastrointestinal Disorders. April 2007.

In this interview Dr. Walker discusses the need for better understanding, ways to improve existing treatment options, and how the IFFGD symposium, held every 2 years, helps advance understandings in the field.

Walker, L.S. Managing Abdominal Pain in Kids and Teens. Interview. International Symposium on Functional Gastrointestinal Disorders. April 2007.

In this interview Dr. Walker discusses strategies for helping families and children or adolescents deal with managing chronic pain conditions that affect the bowel such as IBS or IBD. Managing pain, going to school, dealing with bathroom issues, and explaining what is wrong to peers are all challenging issues that confront the patient and the family.

Walker, L.S. Treating Adominal Pain in Kids and Teens. Interview. International Symposium on Functional Gastrointestinal Disorders. April 2007.

In this interview Dr. Walker discusses new approaches being investigated to treat recurrent abdominal pain, and the need for wider availability of existing treatment options.

Walker, L. S., Smith, C. A., Garber, J., & Claar, R. L. (2007). Appraisal and coping with daily stressors by pediatric pain patients and well children. Journal of Pediatric Psychology, 32, 206-216.

Objective: To test the hypothesis that pain patients differ from well children in their appraisal and coping with daily stressors and to test a model of the relation of stress appraisal and coping to symptoms and disability. Methods Pediatric patients with chronic abdominal pain (n = 143) and well children (n = 104) completed a 5-day diary study regarding their appraisal and coping with daily stressors. Somatic symptoms, depressive symptoms, and functional disability were assessed 2 months later. Results Compared to well children, pain patients were less confident of their ability either to change or to adapt to stress and were less likely to use accommodative coping strategies. Different patterns of stress appraisal were associated with active, passive, and accommodative coping. Both appraisals and coping were significantly related to symptoms and disability. Conclusions: The relation between stress and symptoms in pediatric pain patients may be explained in part by their appraisal and coping with stressors. The relation between appraisal and coping was consistent with Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.

Little, C. A., Williams, S. E., Puzanovova, M., Rudzinski, E. R., & Walker, L. S. (2007). Multiple somatic symptoms linked to positive screen for depression in pediatric patients with chronic abdominal pain. Journal of Pediatric Gastroenterology and Nutrition, 44, 58-62.

Objectives: Abdominal pain is a frequent childhood complaint, comprising 2% to 4% of all reasons for pediatric office visits. Patients referred for evaluation of chronic abdominal pain (CAP) frequently present with comorbid nonspecific somatic symptoms that may complicate the medical evaluation and lead to unnecessary diagnostic tests and procedures. We tested the hypothesis that multiple nongastrointestinal (GI) symptoms in children presenting with CAP is a marker for clinically significant levels of depressive symptoms.

Methods: Participants were 400 consecutive new patients (ages 8–17 years; 63% female) referred to the pediatric gastroenterology clinic for evaluation of abdominal pain of >3 months’ duration. Patients reported how frequently they experienced 7 non-GI symptoms. Patients were screened for depression with the Children’s Depression Inventory.

Results: On the basis of their Children’s Depression Inventory scores, 58 (15%) patients had a positive screen for clinically significant depressive symptoms. Patients with a positive versus negative depression screen did not differ by sex, pain duration or laboratory evidence of organic disease. Patient report of >3 non-GI symptoms maximized sensitivity (71%) and specificity (75%) in prediction of depression screening results. With each addition of a non-GI symptom, the odds of a positive screen for depression doubled. Conclusions: For patients with and without organic disease findings associated with CAP, the presence of >3 non-GI symptoms should signal the practitioner to evaluate for depression and may be used as an indicator of the likelihood of depression in the absence of specific inquiry into emotional symptoms.

Mulvaney, S., Lambert, E. W., Garger, J., & Walker, L. S. (2006). Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain: A 5-year longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 737-744.

Objective: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain not associated with identifiable organic disease. Method: The Children’s Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6Y18 years old) seen in a pediatric gastroenterology clinic. Individual trajectories were empirically grouped and correlates of trajectory group membership at baseline were evaluated. Results: A model with three unique trajectories was found to adequately fit both symptom and impairment data. Two trajectories indicated relatively long-term improvement and one indicated continued high levels of symptoms and impairment. At baseline, the long-term risk group did not have the most severe pain but had significantly more anxiety, depression, lower perceived self-worth, and more negative life events. Conclusions: These results indicate that several distinct trajectories of relatively long-term outcomes may exist in children with functional abdominal pain. One trajectory indicated long-term risk for a high level of symptoms and impairment. Psychosocial correlates of long-term risk for physical symptoms and impairment, such as child-reported stress and internalizing symptoms, may be useful for treatment planning.

Walker, L. S., Williams, S. E., Smith, C. A., Garber, J., Van Slyke, D. A., & Lipani, T. A. (2006). Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain. Pain, 122, 43-52.

The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominal pain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominal pain (N = 104) and well children (N = 119), ages 8–16 years. Parents were randomly assigned and trained to interact with their children according to one of three conditions: Attention, Distraction, or No Instruction. Children’s symptom complaints and parents’ responses were audiotaped and coded. Children completed a self-report measure of gastrointestinal (GI) symptoms before and after interacting with their parents. Parents’ and children’s perceptions of their interaction were assessed. Compared to the No Instruction condition, symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition. The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children. Findings for self-report GI symptoms were similar to those for audiotaped symptom complaints. Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition. Parents of pain patients rated distraction as having greater potential negative impact on their children than attention. Parents’ responses to children’s symptom complaints can significantly increase or decrease those complaints. Girls with functional abdominal pain are particularly vulnerable to the symptom-reinforcing effects of parental attention.

Walker, L. S., Williams, S. E., Smith, C. A., Garber, J., Van Slyke, D. A., Lipani, T. A., Greene, J. W., Mertz, H., Naliboff, B. D. (2006). Validation of a symptom provocation test for laboratory studies of abdominal pain and discomfort in children and adolescents. Journal of Pediatric Psychology, 31, 703-713.

Objective: Assessed the convergent and discriminant validity of a Water Load Symptom Provocation Test (WL-SPT) in creating visceral sensations similar to the naturally occurring sensations experienced by children with functional abdominal pain.
Methods: Participants were pediatric patients with functional abdominal pain (N = 110) and healthy school children (N = 120) between the ages of 8 and 16 years. Pain patients completed questionnaires describing gastrointestinal (GI) and non-gastrointestinal (Non-GI) symptoms associated with their typical abdominal pain episodes. Weeks later, the WL-SPT was administered to pain patients and well children. Prior to and immediately following the WL-SPT, children rated their symptoms.
Results: The WL-SPT produced (a) significant increases in children’s GI symptoms that were reliably predicted by the children’s naturally occurring GI symptoms, and (b) significantly greater increases in GI symptoms in pain patients than in well children.
Conclusions: The WL-SPT produces clinically relevant symptoms for laboratory studies of children with functional abdominal pain.

Last Edited: June 5, 2009