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Background: High test anxiety has been associated with poorer academic performance. Test anxiety may affect academic performance by disrupting cognitive processes required for complex academic tasks, such as reading comprehension., Objectives and Method: The objective of this cross-sectional study was to clarify the cognitive pathways through which test anxiety may affect reading comprehension performance using archival clinical data of adults ( n  = 94; M age  = 23.35, SD  = 4.32) referred for a comprehensive psychological assessment for academic difficulties. Serial multiple indirect effects analysis was used to assess for the direct and indirect effects of test anxiety on reading comprehension through cognitive processing speed, working memory, fluid reasoning, and crystallized knowledge. A second serial multiple indirect effects analysis was conducted with trait anxiety as the antecedent., Results: Test anxiety had a significant indirect effect on reading comprehension through fluid reasoning ( B   = -.08, SE  = .04; 95% CI [-.15 to -.01]), while trait anxiety exerted no significant effect., Conclusion: Results suggest that test anxiety and fluid reasoning play unique roles in disrupting academic functioning among individuals referred for academic difficulties. It may be that test anxious adults struggle to reason effectively in testing situations, leading to downstream difficulty comprehending text.

The aim of this review is to heighten awareness of the association between chronic functional abdominal pain (CFAP) and restrictive eating disorders (ED) in adolescents. We describe current diagnostic practices and propose future research efforts to improve the assessment and treatment of comorbid CFAP and restrictive EDs. A narrative review of the literature on CFAP and EDs was performed using PubMed , JSTOR , ScienceDirect , and PsycINFO and the following search terms: 'restrictive eating disorders', 'chronic functional abdominal pain', 'chronic pain' 'treatment' 'diagnosis' and 'adolescents'. Published studies on restrictive EDs and CFAP from May 2008 to March 2023 were included. Ascribable to the overlap in etiology and symptom presentation, adolescents with chronic pain are significantly less likely to have their ED pathology promptly identified by providers compared to adolescents without comorbid chronic pain. This highlights the importance of the time sensitive and accurate identification of EDs in adolescents with CFAP. Overall, assessment methods are limited and EDs take longer to be identified in adolescents with comorbid CFAP. Future efforts should address diagnostic practices in pediatric settings and improve the communication among medical and mental health providers in order to promote the rapid and effective diagnosis and treatment of comorbid CFAP and EDs.

Stress is a commonly reported issue in pediatric populations of chronic and acute pain. Both outpatient and inpatient settings impose time constraints, which decreases opportunities to measure and address patient stress. The aim of these studies was to evaluate the validity of the Stress Numeric Rating Scale-11 (SNRS-11) in both inpatient and outpatient settings. The SNRS-11 is a single item stress measure ranging from 0 to 10 with endpoint anchors: 0 = "No stress" and 10 = "Highest stress possible". Results showed discriminative validity in the inpatient sample and convergent and discriminant validity in both outpatient and inpatient samples. Additionally, approximately 40% to 50% of the sample reported moderate-severe stress on all post-operative days. The SNRS-11 shows promise as a quick, easy, and free stress measure to be used in both inpatient and outpatient settings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: School anxiety is a prevalent mental health concern that drives school-related disability among youth with chronic pain. The only available measure of school anxiety-the School Anxiety Inventory, Short Version (SAI-SV)-lacks content specificity for measuring school anxiety in pediatric pain populations. We aimed to refine the SAI-SV by obtaining qualitative data about unique school situations that are anxiety-provoking for youth with pain and characterizing the nature of symptoms experienced in these situations., Methods: Adolescents with chronic pain (n = 16) completed a semistructured interview focused on experiences with anxiety in school-related academic and social contexts. We employed thematic analysis to extend the empirical understanding of school anxiety from the perspective of patients suffering from pain and to generate new item content. The content was refined with iterative feedback from a separate group of adolescents with chronic pain (n = 5) and a team of expert pain psychologists (n = 3)., Results: We identified six themes within the data and generated new items designed to capture anxiety related to negative interactions with teachers and peers, falling behind with schoolwork, and struggles with concentration and fatigue. Participants and experts rated new item content as highly relevant for use among youth with pain. The updated item bank was named the School Anxiety Inventory for Chronic Pain., Conclusions: Future research is needed to complete the psychometric evaluation of the item bank and finalize items to be included in a measure that can be used in research and clinical settings. Implications for treating school-related anxiety among youth with pain are also discussed., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Youth with chronic pain often report executive functioning difficulties, many of which have been linked to poor treatment adherence and health-related quality of life in adults with chronic pain, as well as in other pediatric chronic health populations. Despite the extensive implications for functional impairment, executive functioning remains understudied in pediatric chronic pain. Measurement approaches have lacked clear theoretical guidance, resulting in only some domains of executive functioning being investigated. To date, the methods used to measure executive functioning have been inconsistent, ranging from self-report measures of everyday executive functioning in home and school contexts to standardized neuropsychological tests. We argue for enhanced measure validation efforts and increased clarity in the approaches chosen to measure executive functioning in pediatric chronic pain to better guide research efforts in this area, thus yielding clearer clinical implications.

Objectives: Chronic pain is a common and debilitating health problem that impacts up to one third of children and adolescents. The pathophysiological mechanisms of chronic pain are complex, but considerable research links dysfunction of the autonomic nervous system (ANS) and chronic pain in adults. No review of ANS functioning has been conducted in pediatric chronic pain. We systematically reviewed studies examining ANS activity among youth with primary chronic pain conditions., Methods: A systematic search of PsycINFO, PubMed, and CINAHL was conducted using specific search terms. Articles were included if studies measured heart rate, blood pressure, heart rate variability, galvanic skin responses, or pupillometry among children or adolescents with a chronic pain condition. Studies examining these factors in the context of a specific disease-related pain condition were excluded., Results: Of the 1304 articles screened, 15 studies met the criteria for inclusion in this review. All included studies were cross-sectional and primarily included youth with abdominal pain. Results revealed preliminary evidence of reduced parasympathetic activity among youth with pain as measured by heart rate variability. However, results were mixed across ANS indices. Measurement and procedural differences, in addition to a lack of control groups in some studies, limit the interpretability of the reviewed findings., Discussion: Additional studies with larger and more diverse samples of youth with various chronic primary pain conditions are needed to delineate possible relationships among ANS functioning and the development and maintenance of chronic pain in children and adolescents. Clinical implications and avenues for future research are discussed., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the ages of 12 and 17 years ( M = 14.57). Thirty participants with chronic musculoskeletal pain and 30 age- and gender-matched healthy controls were recruited from a large Midwestern children's hospital in the United States. Participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF-2) as well as multiple measures of functional impairment across key domains: school, social, emotional (anxiety, depression), and physical. Adolescents with chronic musculoskeletal pain reported significantly greater EF impairment compared to healthy age- and gender-matched peers. Clinically elevated risk levels of impairment were reported across all aspects of EF, with many adolescents in the chronic pain group scoring above the clinical risk cut off for working memory (52%), inhibition (45%), and cognitive flexibility (38%). EF was also significantly related to functional impairment across all domains. Findings suggest that EF may have an impact across several critical domains of functioning for youth with chronic pain.

The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.

Chronic pain is a prevalent and debilitating health problem that often persists in the absence of an identifiable biomedical cause. Uncertainty regarding the origins of a pain problem may lead to pain catastrophizing and unfruitful healthcare seeking behaviors. Individuals with chronic pain often turn to the internet to identify possible causes or sources of their pain symptoms, thus affirming their pain experience. Despite evidence that pain catastrophizing amplifies distress about pain complaints, no studies have investigated whether it is associated with escalations in health anxiety that result from searching for online health information (i.e., cyberchondria). The aim of the present study was to investigate whether pain catastrophizing predicted variance in cyberchondria above and beyond health anxiety. Undergraduate students ( N = 221, 70.6% female) completed questionnaires assessing pain catastrophizing, health anxiety, and cyberchondria. Results from hierarchical regression models indicated that pain catastrophizing predicted unique variance in four dimensions of cyberchondria: compulsion, distress, excessiveness, and reassurance. Findings are consistent with research highlighting the consequences of pain catastrophizing on myriad psychological outcomes. Individuals who catastrophize about pain experiences may be vulnerable to developing severe health anxiety from searching the internet for health information. Implications for research among individuals with chronic pain are discussed.

Background: Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience difficulties in reading and in fluid reasoning (G f ). According to Cattell's Investment Theory (1987), G f is a causal factor in the development of crystallized knowledge (G c ) and academic skills; therefore, the co-occurrence of reading and G f difficulties within ADHD may not be coincidental. Methods: In the present study with children with both ADHD and reading difficulties ( n  = 187; 61% male; M age  = 9.2), we utilized mediation analyses to test direct and indirect (through G c , phonemic awareness, and rapid automatized naming [RAN]) effects of G f on four basic reading skills: untimed word recognition, untimed phonemic decoding, word reading efficiency, and phonemic decoding efficiency. Results: The direct effect of G f on all reading skills was nonsignificant; however, significant indirect effects were observed. Specifically, G f exerted an effect indirectly onto all reading skills through a serial and joint mechanism comprised of G c and phonemic awareness (i.e., G f → G c → phonemic awareness → reading achievement). G f also exerted an effect indirectly onto untimed word recognition and phonemic decoding through phonemic awareness (i.e., G f → phonemic awareness → untimed word recognition/untimed phonemic decoding). Conclusion: Results build upon Cattell's Investment Theory by linking G f with reading difficulties among children with ADHD, suggesting that such difficulties may arise from weaknesses in G f and insufficient investment of G f into reading through G c and phonemic awareness.

Objective: Anxiety is common in pediatric chronic pain and is related to a higher risk for poor outcomes; thus, there is a need for effective clinical screening methods to identify youth with chronic pain and co-occurring anxiety. The Screen for Child Anxiety-related Disorders (SCARED) is a validated measure that defines clinically significant anxiety using the traditional clinical cut-off, but in pain populations, may fail to screen in youth with subclinical anxiety that may also be at increased risk. Two studies aimed to devise a clinically meaningful approach to capture anxiety severity in pediatric chronic pain., Materials and Methods: Study 1 (n=959) and Study 2 (n=207) were completed at 2 separate pediatric pain clinics, where the SCARED was administered along with measures of disability, activity limitations, pain intensity, quality of life, and pain catastrophizing. Groups with different levels of anxiety were compared on clinical outcomes via multivariate analyses of variance or independent samples t tests., Results: A tertile solution suggested the following anxiety groupings based on the SCARED: minimal (0 to 12), subclinical (13 to 24), and clinical (≥25). Across both studies, the tertile solution was generally superior in classifying different levels of pain-related outcomes., Discussion: Future directions include testing the utility of this anxiety classification system to identify youth with subclinical levels of anxiety for early intervention focused on both pain and anxiety management.

Background: Youth with chronic pain are at higher risk for obesity than the general population. In youth with chronic pain, obesity exacerbates pain-specific activity limitations, and in adults with chronic pain, obesity perpetuates a cycle of disability. The current study examined whether weight status predicts functional disability outcomes over time in youth with chronic pain., Methods: Data were obtained from a retrospective chart review of patients who consented to participate in a longitudinal outcomes study. The Child Activity Limitations Questionnaire was used to assess functional disability at intake, 1-, and 3-month follow-up. Height and weight were measured at intake. A linear mixed model was used to test whether weight status and time predicted functional disability. Trend analysis with polynomial contrasts was used to test whether improvements in functional disability showed a linear trend over time., Results: The linear mixed model analysis showed a main effect of weight, suggesting that youth with higher BMI demonstrated less improvement in functional disability over time. The trend analysis suggested that improvements in functional disability were consistent with a linear trend for both healthy weight and overweight participants, but not for obese participants., Conclusion: These findings demonstrate that obesity impedes improvement in functioning for youth with chronic pain. Despite multidisciplinary pain treatment, youth with comorbid chronic pain and obesity demonstrate greater functional disability at follow-up and little improvement over time. These results support the need for interventions specifically tailored to the unique challenges faced by youth with comorbid chronic pain and obesity., Significance: This study shows that obesity impedes improvement in functioning for youth with chronic pain. On the basis of these findings, interventions should be tailored to the unique challenges of this population., (© 2017 European Pain Federation - EFIC®.)

Chronic pain is highly prevalent in youth and often results in significant health care usage and familial distress. Telephone triage nurses in pediatric pain clinics provide support and consultation to families and engage parents of pediatric pain patients in interdisciplinary intervention efforts. Despite evidence of winter predominance in rates of pain-related and psychiatric complaints, seasonal variations have not been examined in terms of the demand placed on pain clinic triage nurses. The present study investigated seasonal patterns in the frequency and type of phone calls made over the course of 1 year to an interdisciplinary outpatient pediatric chronic pain clinic at a large Midwestern children's hospital. Pain complaints, reasons for phone calls, and call outcomes (e.g., medication changes, consultation with medical or mental health providers) were recorded in patient charts and retrospectively reviewed by the clinic registered nurse. A total of 721 calls regarding 253 patients were made over the course of 1 year. Results indicated that overall call volume across pain conditions was more than two times greater in the winter than in the summer (χ 2  = 64.13, p < .001), and the odds of a call involving headache pain were almost twice as likely in the winter as in the summer. The majority of calls required consultation with physicians and/or mental health providers. Present data may be useful for pediatric chronic pain clinics making staffing decisions throughout the year because the winter season appears to place a significantly greater demand on triage nurses., (Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objectives: Reduced pain thresholds have been documented in adult fibromyalgia, but there are no quantitative studies of altered pain sensitivity in adolescents with juvenile fibromyalgia (JFM). The current study examined differences in pressure pain sensitivity between adolescent females with JFM and healthy controls. The relationship between levels of anxiety and pain were also examined., Methods: A total of 34 JFM (15.4±1.4 y old) and 31 controls (14.5±1.3 y old) completed self-report measures of pain and anxiety. Pressure pain threshold was assessed (palm and forehead sites) with a hand-held algometer. Participants indicated the first sensation of pain and then rated the intensity of pain on a Numerical Rating Scale., Results: Adolescents with JFM exhibited greater sensitivity to pressure pain compared with controls. While the difference between JFM and controls was only observed at the forehead, the intensity of pain produced by the pressure algometry at both sites was significantly higher in the JFM participants compared with controls. Correlations between clinical pain and anxiety were significant for the JFM group only. No relationships were observed between anxiety and pressure pain for either group., Discussion: This study is a first step toward investigating mechanisms of altered pain processing in adolescents with JFM. Adolescents with JFM were found be more sensitive to pressure pain than their healthy peers, which suggests a propensity for sensitization of peripheral and/or central nociceptive information often reported in adult fibromyalgia, and which does not appear to be affected by anxiety.

Evidence suggests that higher order linguistic functioning such as text comprehension is particularly vulnerable to emotional modulation. Gender has been identified as an important moderating variable in emotional expression such that girls tend toward internalizing emotions (e.g., sadness, anxiety) whereas boys tend toward externalizing emotions (e.g., anger, combativeness), which may influence the relationship between emotion and text comprehension. The present study examined whether gender moderates the relationship between emotional-behavioral problems and text comprehension among children ( n = 187; boys= 115, girls = 72) with both word reading difficulties (RD) and attention-deficit/hyperactivity disorder (ADHD), a sample widely acknowledged to be at increased risk for developing emotional-behavioral problems such as anxiety, poor academic self-concept, and delinquency. A moderated regression analysis tested for the significance of two separate interaction terms (i.e., gender × externalizing problems, gender × internalizing problems) after controlling for gender, IQ, basic reading skills, cognitive-linguistic processes closely related to reading, attentional problems, internalizing problems, and externalizing problems. Results indicated that gender significantly and uniquely moderates the relationship between emotional-behavioral problems and text comprehension. Specifically, text comprehension was relatively lower among girls with relatively higher externalizing problems, whereas no such association was observed among boys. These results contribute to our understanding of cognition-emotion interactions within reading development and raise important implications.

Anxiety is highly prevalent in pediatric chronic pain. This comorbidity has been explained by the presence of shared mechanisms underlying the development and maintenance of chronic pain and anxiety. Accumulating evidence demonstrates that school is a significant source of anxiety among youth with chronic pain and that anxiety contributes to school-related functional impairment in this population. This article reviews the cooccurrence of pediatric chronic pain and anxiety, identifies unique sources of heightened school anxiety among youth with chronic pain, and describes current approaches for assessing anxiety in pediatric pain settings. Highlighted by this review is the absence of a comprehensive evidence-based approach for assessing school anxiety in pediatric chronic pain. Given the psychometric limitations inherent to gathering data from a single source, recommendations for advancing measurement methods are provided. Novel approaches may be needed to shed more light on the way in which school anxiety is experienced in pediatric chronic pain.

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child's initial appointment; questions addressed parents' perceptions of their child's weight, and their perceptions of multiple aspects of the relationship between their child's weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child's weight; this group of parents was also more concerned ( p < 0.05) about their child's weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child's weight contributed to his/her pain, or that weight was relevant to their child's pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child's pain. Results support the need for addressing parents' perceptions of their child's weight status, and educating parents about the relationship between excessive weight and chronic pain., Competing Interests: The authors declare no conflict of interest.

Purpose: To investigate the effectiveness of a mindfulness meditation intervention on working memory capacity (WMC) in adolescents via a randomized controlled trial comparing mindfulness meditation to hatha yoga and a waitlist control group., Methods: Participants (N = 198 adolescents) were recruited from a large public middle school in southwest United States and randomly assigned to mindfulness meditation, hatha yoga, or a waitlist control condition. Participants completed a computerized measure of WMC (Automated Operational Span Task) and self-report measures of perceived stress (Perceived Stress Scale) and anxiety (Screen for Childhood Anxiety Related Emotional Disorders) at preintervention and postintervention/waitlist. A series of mixed-design analyses of variance were used to examine changes in WMC, stress, and anxiety at preintervention and postintervention., Results: Participants in the mindfulness meditation condition showed significant improvements in WMC, whereas those in the hatha yoga and waitlist control groups did not. No statistically significant between-group differences were found for stress or anxiety., Conclusions: This is the first study to provide support for the benefits of short-term mindfulness practice, specifically mindfulness meditation, in improving WMC in adolescents. Results highlight the importance of investigating the components of mindfulness-based interventions among adolescents given that such interventions may improve cognitive function. More broadly, mindfulness interventions may be delivered in an abridged format, thus increasing their potential for integration into school settings and into existing treatment protocols., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: The relationships among chronic pain, anxiety, and school functioning are complex, and school functioning is often negatively impacted in youth with chronic pain. The objective of this study was to empirically test a model of associations between constructs predicting school functioning in youth with chronic pain to examine the direct effect of anxiety on school attendance and other indicators of school-related disability., Materials and Methods: Participants included 349 youth and their parents (311 mothers and 162 fathers) who attended a multidisciplinary pain clinic. Youth, mothers, fathers, and clinicians completed assessments of clinical outcomes important to family and clinician perceptions of school functioning; youth, mothers, and fathers completed an assessment of youth anxiety. Structural equation modeling was used to examine interrelations among predictors., Results: Measurement and structural models for predicting youth school functioning provided a very good fit of the data to the conceptual model. Anxiety was directly related to problems with school attendance and avoidance, concentration, and keeping up with schoolwork., Discussion: Anxiety was a robust predictor of school functioning across a range of domains. Evaluating anxiety symptoms in pediatric chronic pain will likely facilitate case conceptualization and treatment planning. This study supports a shift in focus from pain to anxiety as the driving force of school impairment in youth with chronic pain.

Objectives: Examine whether anxiety and pain catastrophizing are distinct constructs in relation to functional outcomes in pediatric chronic pain, and whether they differentially predict functional outcomes based on age., Methods: In all, 725 youth (191 children, 534 adolescents) with chronic pain completed measures of pain characteristics, anxiety, pain catastrophizing, functional disability, and health-related quality of life (HRQOL). Structural equation modeling was used to examine interrelationships., Results: Anxiety and pain catastrophizing were distinct. For both children and adolescents, pain catastrophizing predicted pain, functional disability, and HRQOL, and was a stronger predictor of pain intensity. For children, anxiety predicted HRQOL, and pain catastrophizing was a stronger predictor of functional disability. For adolescents, anxiety predicted functional disability and HRQOL, and anxiety was a stronger predictor of HRQOL., Conclusions: There were age-related differences regarding whether anxiety or pain catastrophizing more strongly predicted specific functional outcomes. Assessment and intervention efforts should emphasize both anxiety and pain catastrophizing., (Published by Oxford University Press on behalf of the Society of Pediatric Psychology 2015. This work is written by US Government employees and is in the public domain in the US.)

Context: It is estimated that 1 in 5 children in the United States is affected by chronic pain. Increasing adaptive coping strategies and decreasing stress may be important in treatment. Research has suggested that mindfulness can help alleviate symptoms associated with medical illnesses and increase quality of life. Little is known about the effectiveness of mindfulness-based stress reduction (MBSR) in youth, partly due to insufficient methodological rigor in related studies., Objective: The primary purpose of the present study was to examine the feasibility, acceptability, and effectiveness of MBSR for a treatment-seeking sample of youth with chronic pain., Design: The current study was the first randomized, controlled pilot study of MBSR for pediatric chronic pain. The research team had intended to use block randomization involving a total of five recruitment waves, with each wave consisting of one MBSR group and one psychoeducation group. Due to difficulties with recruitment and attrition before the start of either group, however, only MBSR was conducted at each wave after the first wave., Setting: Participants were recruited from a multidisciplinary pain clinic in a large, Midwestern children's hospital., Participants: The final sample included six adolescents between the ages of 12 and 17 y, four in the MBSR group and two in the psychoeducation group., Intervention: Weekly sessions for the MBSR group were 90 min in length and followed a structured protocol. Sessions included a review of homework, an introduction to and practice of meditation, discussion of the session, and a review of the home practice assignment. The psychoeducation group participated in six group sessions, which were based on a cognitive-behavioral model of pain, and discussion topics included the nature of chronic pain and stress management., Primary Outcome Measures: Health-related quality of life, pain catastrophizing, anxiety, functional disability, mindfulness, and treatment acceptability were all assessed pre- and postintervention as well as at follow-up., Results: Recruitment and retention difficulties were experienced. Qualitative examination of participants' scores suggested increased mindfulness but inconsistent patterns on other outcome measures., Conclusions: The research team highlighted critical challenges faced by potential researchers aiming to investigate MBSR for pediatric chronic pain, and the study provides recommendations for research and implications for clinical practice.

Objectives: The primary objective of this study was to investigate parental attitudes toward acupuncture for their child. No known research has explored how medical providers discuss acupuncture with families or specific concerns parents have about acupuncture. This study examined whether acupuncture attitudes were influenced by (1) the way acupuncture is explained to parents by a physician and (2) parental experience with acupuncture., Design: Parents (N = 240) read vignettes that varied in a 2 (Physician Description of Acupuncture: Traditional Chinese Medicine versus biomedical) x 2 (Gender: male versus female) design and responded to questions assessing their attitudes toward acupuncture., Results: A factor analysis of the vignette questions resulted in two factors: acupuncture acceptability (alpha = 0.88) and information seeking (alpha = 0.70). Previous experience with acupuncture significantly increased acupuncture acceptability and reduced interest in information seeking. Parents with experience were more likely to report wanting to pursue acupuncture for their child. A biomedical explanation led to increased acceptability and interest in pursuing information among parents with experience (d = 0.36), and significantly predicted parental agreement with the vignette item, "I would have my child receive acupuncture treatment." Common acupuncture concerns included fear of needles and acupuncture ineffectiveness., Conclusions: Parents' experience with acupuncture, regardless of its perceived helpfulness, appears to play an important role in their consideration of acupuncture for their child. Additional research is needed to fully understand the importance of the way acupuncture is presented to families, as it appears to impact parental attitudes in subtle ways. Parents have numerous concerns regarding acupuncture. Our findings suggest that providers would benefit from increased awareness of families' interest in and use of complementary and alternative medicine so as to better monitor safety, provide advice, and discuss treatment expectations and misconceptions.

Background: Children with developmental delay are often unable to verbalize pain or advocate for themselves owing to cognitive, motor, or verbal limitations, which puts them at increased risk for poor pain assessment and management. Although patient-controlled analgesia has been shown to be safe, effective, and superior to intermittent opioid dosing, not all children can operate patient-controlled analgesia independently. Parent/nurse-controlled analgesia (PNCA) may be an option for these children. However, the safety and efficacy of PNCA have not been thoroughly evaluated and many practitioners are reluctant to use it., Objectives: The purpose of this study was to evaluate the outcomes associated with PNCA in pediatric patients with identified developmental delay., Methods: A retrospective review of treatment with PNCA was conducted from a convenience sample of charts for 71 children with developmental delay. Data were collected for 72 hours or until the PNCA was discontinued, whichever came first., Results: Mean pain scores were low, as was the amount of opioid required to keep patients comfortable. Side effects, with the exception of oxygen therapy, were similar to previous studies regarding PNCA. Somnolence and respiratory depression leading to the administration of naloxone occurred in 2.8% of patients, and potential causes were identified., Discussion: Pain scores, side effects, and adverse events suggest that PNCA may be an effective method of pain control for children with developmental delay. Diligent monitoring and education are crucial to ensure safety.