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Juvenile fibromyalgia (FM) is characterized by chronic musculoskeletal pain and marked reduction in physical activity. Despite recommendations for exercise to manage juvenile FM pain, exercise adherence is poor. Because of pain and activity avoidance, adolescents with juvenile FM are at risk for altered joint mechanics that may make them susceptible to increased pain and reduced tolerance for exercise. The primary aim of this study was to assess functional deficits in patients with juvenile FM compared to healthy controls using objective biomechanical assessment.Female adolescent patients with juvenile FM (n = 17) and healthy controls (n = 14) completed biomechanical assessments, including gait analysis and tests of lower extremity strength (isokinetic knee extension/flexion and hip abduction) and functional performance (drop vertical jump test) along with self-reported measures of disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), and fear of movement (Tampa Scale of Kinesiophobia).Patients with juvenile FM demonstrated mild deficiencies in walking gait and functional performance (P0.05 for both) and significantly lower left knee extension and flexion strength (18-22% deficit) and bilateral hip abduction strength (34-38%) compared with healthy controls (P0.008 for all). Patients with juvenile FM reported significantly higher functional disability, pain intensity, depressive symptoms, and fear of movement relative to controls (P0.01 for all).This study showed that adolescents with juvenile FM exhibited objective alterations in biomechanics and self-reported fear of movement that may have reinforced their activity avoidance. Interventions for juvenile FM should include a focus on correcting functional deficits and instilling greater confidence in adolescents with juvenile FM to engage in exercise to improve functional outcomes.

Little is known about the impact of family environment on the long-term adjustment of patients with juvenile-onset fibromyalgia (JFM). Our objective was to evaluate whether family environment in early adolescence predicted later physical functioning and depressive symptoms of adolescents with JFM as they transitioned to early adulthood in the context of a controlled long-term followup study.Participants consisted of 39 youth (mean age 18.7 years) with JFM and 38 healthy matched controls who completed web-based surveys about their health status (Short Form 36 health survey) and depressive symptoms (Beck Depression Inventory II) ~4 years after a home-based, in-person assessment of child and family functioning. During the initial assessment, parents of the participants (94% mothers) completed the Family Environment Scale and adolescents (mean age 14.8 years) completed self-report questionnaires about pain (visual analog scale) and depressive symptoms (Children's Depression Inventory).The results indicated that family environment during early adolescence significantly predicted greater depressive symptoms in early adulthood for both the JFM group and the healthy controls. In particular, a controlling family environment (use of rules to control the family and allowing little independence) during early adolescence was the driving factor in predicting poorer long-term emotional functioning for patients with JFM. Family environment did not significantly predict longer-term physical impairment for either group.Adolescents with JFM from controlling family environments are at an increased risk for poorer emotional functioning in early adulthood. Behavioral and family interventions should foster independent coping among adolescents with JFM and greater parenting flexibility to enhance successful long-term coping.

This study sought to evaluate the effectiveness of virtual reality (VR) videogame distraction for children experiencing acute pain and clarify the role of coping style and pain coping strategies as moderators of VR distraction effectiveness. Sixty-two children (6-13 years old) underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered with or without a VR helmet in counterbalanced order. As predicted, children demonstrated significant improvement in pain tolerance during both distraction conditions. However, there were no differences in pain tolerance between the distraction conditions. Neither coping style nor pain coping strategies moderated children's responses to distraction. Distraction was effective for both avoiders and approachers.

Children's knowledge of their illness and the possibility of dying from their disease were evaluated in 90 families of pediatric cancer patients 2 months after diagnosis. Maternal protective parenting, affective distress, coping style, and knowledge about the child's illness were evaluated as predictors of illness and prognosis information disclosure. Information disclosure was expected to predict child affective distress. As expected, children who knew they had cancer or simply knew that they were sick had fewer maternal-reported internalizing behaviors than children with minimal knowledge of their illness. No significant difference was found between children with knowledge of cancer and knowledge of being sick. Maternal depression and approach coping style predicted child knowledge of illness and possibility of death, respectively, in elementary-school aged children (6-10-years-old). Mothers' confusion about their child's illness, prognosis,and treatment, predicted less child knowledge of illness, for elementary and middle/high school aged children (6-18-years-old) and knowledge of the possibility of death for elementary school aged children. Results suggest that providing children with meaningful information regarding their illness rather than withholding illness information may help lessen their affective distress. Specific information about the illness as cancer may not provide additional benefit for children with respect to affective distress beyond that provided by the knowledge that they are sick. Mothers may benefit from greater education about their child's illness and more support to manage their depression to facilitate open parent-child communication about the illness and its prognosis and help lessen child affective distress.