Abstract
Objectives
The current project examines parenting style and common psychological stressors specific to parenting behavior reported among parents of an adolescent with chronic pain. Parents provide crucial pragmatic and emotional supports for adolescents’ engagement in healthcare behaviors and may also experience significant emotional distress around caring for adolescents with chronic pain. Families coping with pediatric chronic health conditions often report more negative family dynamics, characterized by simultaneously unresponsive and demanding parenting behaviors, than families with healthy children.
Methods
Participating parents completed the “Parents as Coping Coaches (PaCC),” 3-session, group intervention developed to directly support parent individual needs and parenting behavior.
Results
Findings suggest that parent participation in the newly developed PaCC intervention was significantly related to reductions in parenting experiences associated with caring for the adolescent and parent-reported authoritarian parenting style.
Conclusions
Significant differences seen pre- to post-intervention suggest that parent experiences and parenting behaviors are amenable intervention targets.
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References
Anderson, B. J., & Coyne, J. C. (1993). Family context and compliance behavior in chronically ill children. In N. A. Krasnegor, L. H. Epstein, S. B. Johnson & S. J. Yaffe (Eds), Developmental aspects of health compliance behavior (pp. 77–89). Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc.
Anestis, M. D., Selby, E. A., Fink, E. L., & Joiner, T. E. (2007). The multifaceted role of distress tolerance in dysregulated eating behaviors. International Journal of Eating Disorders, 40, 718–726. https://doi.org/10.1002/eat.20471.
Baumrind, D. (2005). Patterns of parental authority and adolescent autonomy. New Directions for Child and Adolescent Development, 108, 580–589. https://doi.org/10.1002/cd.128.
Baumrind, D. (2012). Differentiating between confrontive and coercive kinds of parental power-assertive disciplinary practices. Human Development, 55, 35–51. https://doi.org/10.1159/000337962.
Beveridge, J., Neville, A., Wilson, A., & Noel, M. (2018). Intergenerational examination of pain and posttraumatic stress disorder symptoms among youth with chronic pain and their parents. Pain Reports, 3(7), e667 https://doi.org/10.1097/PR9.0000000000000667.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Aronson.
Bradshaw, S. R., Shaw, K., Bem, D., & Cummins, C. (2017). Improving health, well-being and parenting skills in parents of children with medical complexity: a scoping review protocol. BMJ Open, 7, e015242.
Brehaut, J. C., Garner, R. E., Miller, A. R., Lach, L. M., Klassen, A. F., Rosenbaum, P. L., & Kohen, D. E. (2011). Changes over time in the health of caregivers of children with health problems: growth-curve findings from a 10-year Canadian population-based study. American Journal of Public Health, 101, 2308–2316. https://doi.org/10.2105/AJPH.2011.300298.
Buckner, J. D., Keough, M. E., & Schmidt, N. B. (2007). Problematic alcohol and cannabis use among young adults: the roles of depression and discomfort and distress tolerance. Addictive Behaviors, 32, 1957–1963. https://doi.org/10.1016/j.addbeh.2006.12.019.
Burgdorf, V., Szabó, M., & Abbott, M. J. (2019). The effect of mindfulness interventions for parents on parenting stress and youth psychological outcomes: a systematic review and meta-analysis. Frontiers in Psychology, 10, 1336. https://doi.org/10.3389/fpsyg.2019.01336.
Caes, L., Vervoort, T., Eccleston, C., Vandenhende, M., & Goubert, L. (2011). Parental catastrophizing about child’s pain and its relationship with activity restriction: the mediating role of parental distress. Pain, 152, 212–222. https://doi.org/10.1016/j.pain.2010.10.037.
Cicchetti, D. (2010). Resilience under conditions fo extreme stress: a multilevel perspective. World Psychiatry, 9, 145–154.
Coatsworth, J. D., Duncan, L. G., Greenberg, M. T., & Nix, R. L. (2010). Changing parent’s mindfulness, child management skills and relationship quality with their youth: results from a randomized pilot intervention trial. Journal of Child and Family Studies, 19, 203–217. https://doi.org/10.1007/s10826-009-9304-.
Cohen, L. L., Vowles, K. E., & Eccleston, C. (2010). Parenting an adolescent with chronic pain: an investigation of how a taxonomy of adolescent functioning relates to parent distress. Journal of Pediatric Psychology, 35, 748–757. https://doi.org/10.1093/jpepsy/jsp103.
Crandell, J. L., Sandelowski, M., Leeman, J., Havill, N. L., & Knafl, K. (2018). Parenting behaviors and the well-being of children with a chronic physical condition. Families, Sysetms and Health, 36, 45–61.
Daughters, S. B., Ross, T. J., Bell, R. P., Yi, J. Y., Ryan, J., & Stein, E. A. (2016). Distress tolerance among substance users is associated with functional connectivity between prefrontal regions during a distress tolerance task. Addiction Biology, 22, 1378–1390. https://doi.org/10.1111/adb.12396.
Day, M. A., Jensen, M. P., Ehde, D. M., & Thorne, B. E. (2014). Toward a theoretical model for mindfulness-based pain management. The Journal of Pain, 15, 691–703.
Eccleston, C., & Crombez, G. (2007). Worry and chronic pain: a misdirected problem solving model. Pain, 132, 233–236. https://doi.org/10.1016/j.pain.2007.09.014.
Eccleston, C., Crombez, G., Scotford, A., Clinch, J., & Connell, H. (2004). Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents. Pain, 108, 221–229.
Eccleston, C., Wastell, S., Crombez, G., & Jordan, A. (2008). Adolescent social development and chronic pain. European Journal of Pain, 12, 765–774. https://doi.org/10.1016/j.ejpain.2007.11.002.
Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535–544.
Grolnick, W. S. (2012). The relations among parental power assertion, control, and structure. Human Development, 55, 57–74. https://doi.org/10.1159/000338533.
Gratz, K. L., Weiss, N. H., & Tull, M. T. (2015). Examining emotion regulation as an outcome, mechanism, or target of psychological treatments. Current Opinion in Psychology, 3, 85–90. https://doi.org/10.1016/j.copsyc.2015.02.010.
Guite, J. W., Logan, D. E., McCue, R. L., Sherry, D. D., & Rose, J. B. (2009). Parental beliefs and worries regarding adolescent chronic pain. The Clinical Journal of Pain, 25, 223–232.
Guite, J. W., McCue, R. L., Sherker, J. L., Sherry, D. D., & Rose, J. B. (2011). Relationships among pain, protective parental responses and disability for adolescents with chronic musculoskeletal pain: the mediating role of pain catastrophizing. The Clinical Journal of Pain, 27, 775–781.
Guite, J., Russell, B., Homan, K., Tepe, R., & Williams, S. (2018a). Parenting in the context of children’s chronic pain: balancing care and burden. Children, 5. https://doi.org/10.3390/children5120161.
Guite, J., Russell, B. S., Pantaleao, A., Heller, A. T., Donohue, E., Galica, J., Zempsky, W., & Ohanessian, C. M. (2018b). Parents as coping coaches for adolescents with chronic pain: promoting caregiver self-regulation. Clinical Practice in Pediatric Psychology, 6, 223–237. https://doi.org/10.1037/cpp0000244.
Guyatt, G. H., Osoba, D., Wu, A. W., Wyrwich, K. W., & Norman, G. R. (2002). Methods to explain the clinical significance of health status measures. Mayo Clinic Procedures, 77, 371–383.
Haeffner, J. (2014). An application of bowen family systems theory. Issues in Mental Health Nursing, 35, 835–841.
Harnett, P. H., & Dawe, S. (2012). The contribution of mindfulness-based therapies for children and families and proposed conceptual integration. Child and Adolescent Mental Health, 17, 195–208. https://doi.org/10.1111/j.1475-3588.2011.00643.x.
Hatchette, J. E., McGrath, P. J., Murray, M., & Finley, G. A. (2006). Maternal influences in adolescents’ pain self-management: a qualitative investigation. Vulnerable Children and Youth Studies, 1, 159–169. https://doi.org/10.1080/17450120600872332.
Hatzmann, J., Maurice-Stam, H., Heymans, H. S. A., & Grootenhuis, M. A. (2009). A predictive model of health related quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system. Health and Quality of Life Outcomes, 7, 72. https://doi.org/10.1186/1477-7525-7-72.
Hatzmann, J., Peek, N., Heymans, H., Maurice-Stam, H., & Grootenhuis, M. (2014). Consequences of caring for a child with a chronic disease: employment and leisure time of parents. Journal Of Child Health Care, 18, 346–357. https://doi.org/10.1177/1367493513496668.
Hostinar, C. E. (2015). Recent developments in the study of social relationships, stress responses, and physical health. Current Opinion in Psychology, 5, 90–95. https://doi.org/10.1016/j.copsyc.2015.05.004.
Jordan, A. L., Eccleston, C., McCracken, L. M., Connell, H., & Clinch, J. (2008). The Bath Adolescent Pain—Parental Impact Questionnaire (BAP-PIQ): development and preliminary psychometric evaluation of an instrument to assess the impact of parenting an adolescent with chronic pain. Pain, 137, 478–487. https://doi.org/10.1016/j.pain.2007.10.007.
Jordan, A. L., Eccleston, C., & Osborn, M. (2007). Being a parent of the adolescent with complex chronic pain: an interpretative phenomenological analysis. European Journal of Pain, 11, 49–56. https://doi.org/10.1016/j.ejpain.2005.12.012.
King, S., Chambers, C. T., Huguet, A., MacNevin, R. C., McGrath, P. J., Parker, L., & MacDonald, A. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain, 152, 2729–2738.
Knafl, K. A., Havill, N. L., Leeman, J., Crandell, J. L., & Sandelowski, M. (2017). The nature of family engagement in interventions for children with chronic conditions. Western Journal of Nursing Research, 39, 690–723.
Kraemer, K. M., Luberto, C. M., & McLeish, A. C. (2013). The moderating role of distress tolerance in the association between anxiety sensitivity, physical concerns, and panic and PTSD-related re-experiencing symptoms. Anxiety, Stress & Coping, 26, 330–342. https://doi.org/10.1080/10615806.2012.693604.
Law, E. F., Fales, J. L., Beals-Erickson, S. E., Failo, A., Logan, D., Randall, E., & Palermo, T. M. (2016). A single-arm feasibility trial of problem-solving skills training for parents of children with idiopathic chronic pain conditions receiving intensive pain rehabilitation. Journal of Pediatric Psychology, 42, 422–433. https://doi.org/10.1093/jpepsy/jsw087.
Lewandowski, A. S., & Palermo, T. M. (2009). Parent–teen interactions as predictors of depressive symptoms in adolescents with headache. Journal of Clinical Psychology in Medical Settings, 16, 331–338. https://doi.org/10.1007/s10880-009-9173-8.
Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97–110.
Logan, D. E., Guite, J. W., Sherry, D. D., & Rose, J. B. (2006). Adolescent-parent relationships in the context of adolescent chronic pain conditions. Clinical Journal of Pain, 22(6), 576–583.
Lansing, A. H., & Berg, C. A. (2014). Adolescent self-regulation as a foundation for chronic illness self-management. Journal of Pediatric Psychology, 39, 1091–1096. https://doi.org/10.1093/jpepsy/jsu067.
Leyro, T. M., Bernstein, A., Vujanovic, A. A., McLeish, A. C., & Zvolensky, M. J. (2011). Distress tolerance scale: a confirmatory factor analysis among daily cigarette smokers. Journal of Psychopathology and Behaviorial Assessment, 33, 47–57. https://doi.org/10.1007/s10862-010-9197-2.
Logan, D. E., & Scharff, L. (2005). Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: an investigation of moderating effects on the pathway from pain to disability. Journal of Pediatric Psychology, 30, 698–707. https://doi.org/10.1093/jpepsy/jsj060.
Lynch, A. M., Kashikar-Zuck, S., Goldschneider, K. R., & Jones, B. A. (2006). Psychosocial risks for disability in children with chronic back pain. Journal of Pain, 7, 244–251.
Manor-Binyamini, I. (2011). Mothers of children with developmental disorders in the Bedouin community in Israel: family functioning, caregiver burden, and coping abilities. Journal of Autism and Developmental Disorders, 41, 610–617.
McHugh, R. K., Weiss, R. D., Cornelius, M., Martel, M. O., Jamison, R. N., & Edwards, R. R. (2016). Distress intolerance and prescription opioid misuse among patients with chronic pain. The Journal of Pain, 17, 806–814. https://doi.org/10.1016/j.jpain.2016.03.004.
Melzack, R., & Wall, P. D. (1965). Pain mechanisms: a new theory. Science, 150, 971–979.
Murray, D. W., & Rosanbalm, K. (2017). Current gaps and future directions for self-regulation intervention research: a research brief. OPRE Report #2017-93. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.
O’Cleirigh, C., Ironson, G., & Smits, J. A. (2007). Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV? Behavior Therapy, 38, 314–323. https://doi.org/10.1016/j.beth.2006.11.001.
O’Connell, L. K., Davis, M. M., & Bauer, N. S. (2015). Assessing parenting behaviors to improve child outcomes. Pediatrics, 135, e286. https://doi.org/10.1542/peds.2014-2497.
Olivari, M. G. (2013). Parenting Style and Dimensions Questionaire: a review of reliability and validity. Marriage & Family Review, 49, 465–490. https://doi.org/10.1080/01494929.2013.770812.
Onder, A., & Guylay, H. (2009). Reliability and validity of the Parenting Styles and Dimensions Questionaire. Procedia–social and behavioral sciences, 1, 508–514. https://doi.org/10.1016/j.sbspro.2009.01.092.
Palermo, T. M., & Chambers, C. T. (2005). Topical review: parent and family factors in pediatric chronic pain and disability: an integrative approach. Pain, 119, 1–4. https://doi.org/10.1016/j.pain.2005.10.027.
Palermo, T. M., & Eccleston, C. (2009). Topical review: parents of children and adolescents with chronic pain. Pain, 146, 15–17. https://doi.org/10.1016/j.pain.2009.05.009.
Palermo, T. M., & Holley, A. (2013). The importance of the family environment in pediatric chronic pain. JAMA Pediatrics, 167, 93–94. https://doi.org/10.1001/jamapediatrics.2013.428.
Palermo, T. M., Law, E. F., Essner, B., Jessen-Fiddick, T., & Eccleston, C. (2014). Adaptation of problem-solving skills training (PSST) for parent caregivers of youth with chronic pain. Clinical Practice in Pediatric Psychology, 2, 212–223. https://doi.org/10.1037/cpp0000067.
Palermo, T. M., Law, E. F., Bromberg, M., Fales, J., Eccleston, C., & Wilson, A. C. (2016). Problem-solving skills training for parents of children with chronic pain: a pilot randomized controlled trial. Pain, 157, 1213–1223. https://doi.org/10.1097/j.pain.0000000000000508.
Pereira, A. I., Barros, L., Mendonça, D., & Muris, P. (2014). The relationships among parental anxiety, parenting, and children’s anxiety: the mediating effects of children’s cognitive vulnerabilities. Journal of Child and Family Studies, 23, 399–409. https://doi.org/10.1007/s10826-013-9767-5.
Pinquart, M. (2013). Do the parent–child relationship and parenting behaviors differ between families with a child with and without chronic illness? A meta-analysis. Journal of Pediatric Psychology, 38, 708–721. https://doi.org/10.1093/jpepsy/jst020.
Poppert Cordts, K. M., Stone, A. L., Beveridge, J. K., Wilson, A. C., & Noel, M. (2019). The (parental) whole is greater than the sum of its parts: a multifactorial model of parent factors in pediatric chronic pain. The Journal of Pain. https://doi.org/10.1016/j.jpain.2019.01.004.
Powers, T. G. (2013). Parenting dimensions and styles: a brief history and recommendations for future research. Childhood Obesity, 9, 14–21. https://doi.org/10.1089/chi.2013.0034.
Robbins, C. J., Keng, S. L., Ekbald, A. G., & Brantley, J. G. (2012). Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial. Journal of Clinical Psychology, 68, 117–131.
Robinson, C. C., Mandleco, B., Olsen, S. F., & Hart, C. H. (1995). Authoritative, authoritarian, and permissive parenting practices: development of a new measure. Psychological Reports, 77, 819–830.
Robinson, C., Mandleco, B., Olsen, F., & Hart, C. (2001). The parenting styles and dimensions questionnaire (PSDQ). In B. F. Perlmutter, J. Touliatos & M. A. Straus (Eds), Handbook of family measures techniques. Vol 3 (pp. 319–321). Thousand Oaks, CA: Sage Publications.
Roth-Isigkeit, A., Thyen, U., Stoven, H., Schwartzenberger, J., & Schmucker, P. (2005). Pain among children and adolescents: restrictions in daily living and triggering factors. Pediatrics, 115, e152–e62. https://doi.org/10.1542/peds.2004-0682.
Russell, B. S., Lincoln, C. R., & Starkweather, A. (2018). Distress tolerance as a theoretical mechanism of action for the self-management of chronic conditions. Journal of Holistic Nursing, https://doi.org/10.1177/0898010118777327.
Russell, B. S. & Park, C. L. (2018). The role of emotion regulation in chronic pain self-management. Topics in Pain Management, 33(6), 1–10.
Saletsky, R. D., Trief, P. M., Anderson, B. J., Rosenbaum, P., & Weinstock, R. S. (2014). Parenting style, parent−youth conflict, and medication adherence in youth with type 2 diabetes participating in an intensive lifestyle change intervention. Families, Systems, & Health, 32, 176–85. https://doi.org/10.1037/fsh0000008.
Santos, S., Crespo, C., Canavarro, M. C., & Kazak, A. E. (2015). Family rituals and quality of life in children with cancer and their parents: the role of family cohesion and hope. Journal of Pediatric Psychology, 40, 664–671. https://doi.org/10.1093/jpepsy/jsv013.
Sieberg, C. B., Smith, A., White, M., Manganella, J., Sethna, N., & Logan, D. E. (2016). Changes in maternal and paternal pain-related attitudes, behaviors, and perceptions across pediatric pain rehabilitation treatment: a multilevel modeling approach. Journal of Pediatric Psychology, 42, 52–64. https://doi.org/10.1093/jpepsy/jsw046.
Sieberg, C. B., Williams, S., & Simons, L. E. (2011). Do parent protective responses mediate the relation between parent distress and child functional disability among children with chronic pain? Journal of Pediatric Psychology, 36, 1043–1051. https://doi.org/10.1093/jpepsy/jsr043.
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83–102. https://doi.org/10.1007/s11031-005-7955-3.
Simons, L. E., Sieberg, C. B., Pielech, M., Conroy, C., & Logan, D. E. (2013). What does it take? Comparing intensive rehabilitation to outpatient treatment for children with significant pain-related disability. Journal of Pediatric Psychology, 38, 213–223. https://doi.org/10.1093/jpepsy/jss109.
Steinberg, L. (2001). We know some things: parent-adolescent relationships in retrospect and prospect. Journal of Research on Adolescence, 11, 1–19. https://doi.org/10.1111/1532-7795.00001.
Steinberg, L., Darling, N. E., & Fletcher, A. C. (1995). Authoritative parenting and adolescent adjustment: an ecological journey. In P. Moen, G. H. Elder, K. Luscher & U. Bronfenbrenner (Eds), Examining lives in context: perspectives on the ecology of lives in context: perspectives on the ecology of human development. Washington, DC: American Psychological Association.
Steinberg, L., & Silk, J. (2002). Parenting adolescents. In M. Bornstein (Ed.), Handbook of parenting: vol. 1. Children and parenting. 2nd ed. (pp. 103–133). Mahwah, NJ: Earlbaum.
Vowles, K. E., Cohen, L. L., McCracken, L. M., & Eccleston, C. (2010). Disentangling the complex relations among caregiver and adolescent responses to adolescent chronic pain. Pain, 151, 680–686. https://doi.org/10.1016/j.pain.2010.08.031.
Welkom, J. S., Hwang, W. T., & Guite, J. W. (2013). Adolescent pain catastrophizing mediates the relationship between protective parental responses to pain and disability over time. The Journal of Pediatric Psychology, 38(5), 541–550.
Wilson, A. C., & Fales, J. L. (2015). Parenting in the context of chronic pain: a controlled study of parents with chronic pain. Clinical Journal of Pain, 31, 689–698. https://doi.org/10.1097/AJP.0000000000000157.
Wong, J. J., Gonzales, N. A., Montaño, Z., Dumka, L., & Millsap, R. E. (2014). Parenting intervention effects on parental depressive symptoms: examining the role of parenting and child behavior. Journal of Family Psychology, 28, 267–277. https://doi.org/10.1037/a0036622.
Zvolensky, M., & Hogan, J. (2013). Distress tolerance and its role in psychopathology. Cognitive Therapy & Research, 37, 419–420. https://doi.org/10.1007/s10608-013-9533-4.
Acknowledgements
We are deeply grateful to the families who participated in PaCC and kindly gave their time, energy, and opinions to this effort. We also thank the research team members at both partner institutions, including Christine Ohannessian, PhD, and William Zempsky, MD, for their support, and Anne Thompson Heller, LMFT, and Ruth Freeman, LCSW, for their facilitation efforts. This project was supported by a 2015 University of Connecticut Institute for Collaboration in Health Intervention & Policy—Connecticut Children’s Medical Center dual-Principal Investigator Seed Grant.
Author Contributions
B.S.R. designed and executed the study in full partnership with all coauthors, completed the data analyses, and wrote the paper. J.W.G. designed and executed the study in full partnership with all coauthors, collaborated on the analysis and writing of the paper.
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Institutional Review Boards at the University of Connecticut and CT Children’s Medical Center approved all study materials.
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Russell, B.S., Guite, J.W. Parenting Impacts from a Mindfulness-Based Pilot Intervention for Families Facing Pediatric Chronic Pain. J Child Fam Stud 29, 1861–1872 (2020). https://doi.org/10.1007/s10826-019-01635-x
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DOI: https://doi.org/10.1007/s10826-019-01635-x