Parental Reinforcement of Recurrent Pain: The Moderating Impact of Child Depression and Anxiety on Functional Disability

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Abstract
Objective To examine whether children's distress moderates the relationship between parental responses to children's pain behaviors and functional disability. Methods Participants were 215 children (ages 8 to 16 years) diagnosed with either headaches, juvenile idiopathic arthritis, or sickle cell disease. Children and parents completed questionnaires assessing sociodemographics, pain, depression, anxiety, parental solicitous responses to pain behaviors, and functional disability. Results Hierarchical linear regressions computed for parental responses to children's pain significantly predicted child functional disability, controlling for children's pain intensity. Significant interactions between parental solicitous behaviors and child depressive symptoms (β =.74, p <.01) and between solicitous behaviors and child anxiety symptoms (β =.91, p <.01) indicated that for children with more psychological distress, parental solicitous behaviors were associated with greater child functional disability. Conclusions Child psychological distress may exacerbate the impact of parental solicitous responses to pain on functioning, suggesting the potential role of family intervention to enhance optimal functioning in children with recurrent pain.