ARTICLES
Trajectories of Symptoms and Impairment for Pediatric Patients With Functional Abdominal Pain: A 5-Year Longitudinal Study

https://doi.org/10.1097/10.chi.0000214192.57993.06Get rights and content

ABSTRACT

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 (6-18 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.

Section snippets

Sample

The sample was consecutive new pediatric patients evaluated at a tertiary care center for abdominal pain and followed for 5 years. Patients between the ages of 6 and 18 years were eligible if, by parental report, they had no other chronic illness or handicapping condition. Of 302 subjects initially contacted, 16 declined, 50 did not meet eligibility, and 31 had incomplete medical examinations, resulting in a sample of 205. Only patients without evidence of organic disease (132/205; 66%) were

Descriptive Statistics

Table 1 reports the characteristics of all of the study variables for the entire sample at baseline. Sample sizes for dependent variables varied by measure and time point. For the CSI, the baseline sample was 132. Subsequent time points each had smaller sample sizes because of an inability to locate families. At time 2, the CSI sample was 124; at time 3, it was 131; and at time 4, it was 112. For the FDI, the sample size at each time point was 118, 123, 128, and 111, respectively.

Reliability of Measures

Baseline

DISCUSSION

This study identified relatively long-term trajectories of symptoms and impairment in pediatric patients with abdominal pain without identifiable organic disease. Three distinct trajectories of change described the course of symptoms and functional impairment. The majority of patients fell into a group labeled low risk. Children and adolescents in this group initially showed relatively low levels of symptoms and impairment, improved within 2 months, and maintained those gains 1 and 5 years

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    Research was supported by the National Institute of Child Health and Human Development to Lynn S. Walker (R01 HD23264) and by the Vanderbilt Kennedy Center (P30 HD15052).

    Disclosure: The authors have no financial relationships to disclose.

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