A multi-method dyadic investigation of child and parent pain catastrophizing and family functioning in child pain
Birnie, Kathryn A
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Families play a critical role in children’s pain. Theoretical and empirical work has explored individual child and parent, dyadic (parent-child interaction), and family-level factors; however, prior research has largely examined their influence on child pain in isolation from one another. This dissertation used a multi-informant multi-method design and dyadic analysis to advance our understanding of child and parent catastrophizing (Paper 1) and family functioning (Paper 2) in children’s pain, as modeled using experimental pain. Participants included 171 community-based dyads comprised of one child 8-12 years old (89 girls) and one parent (135 mothers). Parent-child dyads completed two lab-based interaction tasks together in randomized counterbalanced order, including the child’s completion of a cold pressor task (CPT) and a conflict discussion task. Children and parents reported on their trait and state pain catastrophizing about the child’s pain, trait anxiety, situational distress, family functioning, and ratings of child pain intensity and unpleasantness. Child pain tolerance was also recorded. Micro-observational coding of parent and child verbalizations during the CPT captured parent attending, non-attending, and other talk, and child symptom complaints and other talk. Macro-observational coding during the conflict discussion task assessed aspects of family functioning. The actor-partner interdependence model and hierarchical multiple regressions explored intra- and inter-personal contributions to child pain. Paper 1: Results indicated that higher parent and child trait and/or state pain catastrophizing predicted their own ratings of greater child pain, with child state pain catastrophizing additionally influencing parent ratings. Parent and child state pain catastrophizing interacted significantly to influence child symptom complaints, including more child symptom complaints in dyads with low child and high parent pain catastrophizing. Paper 2: Results indicated no relation between family functioning and child pain outcomes. Poorer reported family functioning predicted greater child and parent trait anxiety and pain catastrophizing, and parent situational distress. Aspects of observed family functioning predicted child symptom complaints and other talk. The use of observational methodology and dyadic analysis revealed newly identified interpersonal influences of parent and family factors on children’s verbal pain behaviours, and on parent perceptions of child pain and parent trait and state coping with child pain.