Stability of Anxiety Ratings and Parent-Child Concordance in a Pediatric Chronic Pain PopulationTran, S.T.,1 Hainsworth, K.R.,2,3 Anderson Khan, K.,2,3 Ladwig, R.,3 Rusy, L.,2,3 Varadarajan, J.,2,3 Guastello, A.D.,4 Davies, W.H.,1 & Weisman, S.J.2,3

1University of Wisconsin-Milwaukee, 2Medical College of WI, 3Children’s Hospital of Wisconsin, 4Marquette University

Stability of Anxiety Ratings

• Repeated-measures ANOVAs were conducted for each respondent in order to assess the stability of anxiety scores over time.

• Results indicated no differences in individual total anxiety scores over the 3 time points (see Table 2).

• Individual reports for youth, mother, and father reported child anxiety appear to be stable over time.

Parent-Child Concordance of Anxiety Ratings

• At intake, concordance between child and mother report of total anxiety was r = .55, and between child and father report was r = 0.44, both p < 0.01.

• At one- and three-month follow-ups, concordance between child and mother report of total anxiety was r = 0.61 and 0.62 respectively, and father report was r = 0.60 and 0.66 respectively (all p < 0.01).

• At all time points, concordance between child and parent report of child anxiety on all five subscales was moderate to high (ranging from r = 0.32 to r = 0.86; see Table 3).

• At all 3 time points, the strongest concordance occurred on the separation anxiety subscale.

• Stability in respondents’ reports of anxiety over time may translate to persistent problems in pain and functioning.

• Unlike previous reports, this study shows strong correlations between child and parent reports of child anxiety over time.

• Future studies should examine clusters (e.g. pain problem, treatment modality) within the population to determine whether level of anxiety moderates treatment outcomes.

• Given the complex interplay between anxiety and chronic pain, it is critical that future studies continue to investigate relationships between anxiety and treatment outcomes for youth with chronic pain.

References• Birmaher, B., et al. (1999). Psychometric properties of the Screen for Child Anxiety

Related Emotional Disorders (SCARED): a replication study. Journal of the American Academy of Child & Adolescent Psychiatry, 38(10), 1230-1236.

doi:10.1097/00004583-199910000-00011• Klein, R.G. (1991). Parent-child agreement in clinical assessment of anxiety and other

psychopathology: A review. Journal of Anxiety Disorders, 5 (2), 187-198. doi: 10.1016/0887-6185(91)90028-R

• This data was collected as part of a larger Clinical Outcomes registry in a multidisciplinary pain clinic.

• Participant characteristics: • Youth between 8 and 18 years old (n = 425)• 69% Female• 77% Caucasian

•Mothers (n = 382)• Fathers (n= 200)

See Table 1 for sample size at each time point.

•Measures:• Demographic information• Screen for Child Anxiety Related Disorders

(Birmaher, et al., 1999)• Based on DSM-IV classification• Provides total score and 5 subscales• Clinical cutoff total score ≥ 25

• Completed at:• Intake• 1 month after initial appointment • 3 months after initial appointment

PURPOSE/BACKGROUND

METHODS

RESULTS

CONCLUSIONS

For more information, please contact Susan Tran, stheinze@uwm.edu.Presented at the 2012 Midwest Regional Conference on Pediatric Psychology

• Our understanding of the role played by anxiety in pediatric pain is hindered by the limited information available on how anxiety levels change over the course of treatment.

• Studies report poor parent-child agreement regarding child anxiety symptoms, which is true for several different assessment tools, and modes of administration (Klein, 1991).

• However, no studies have examined parent-child concordance in reporting anxiety over time in the pediatric pain population.

• The aim of this study is to examine concordance between reporters and to determine whether anxiety remains stable or decreases over time.

• Particular interests include changes between the intake appointment and 3-month follow-up assessment.

Intake 1 mo. Follow-up

3 mo. Follow-up

Youth 425 87 51

Mothers 382 86 51

Fathers 200 59 33

TABLE 1. SAMPLE SIZE ACROSS TIMEPOINTS

M SD F df p

Youth Intake 20.64 2.19 0.56 1, 41 0.14

1 mo. 21.83 2.68

3 mo. 19.19 2.52

Mother Intake 15.00 2.02 0.47 1, 34 0.42

1 mo. 16.71 1.82

3 mo. 16.31 2.18

Father Intake 14.82 3.04 1.58 1, 21 0.31

1 mo. 15.23 3.44

3 mo. 12.46 2.64

TABLE 3. CORRELATIONS MEASURING PARENT-CHILD CONCORDANCE OF ANXIETY RATINGS

TABLE 2. REPEATED MEASURES ANOVA COMPARING ANXIETY OVER 3 TIME POINTS

Mother-Child Concordance

Father-Child Concordance

Intake 1 mo. 3 mo. Intake 1 mo. 3 mo.

Total 0.55* 0.61* 0.62* 0.44* 0.60* 0.66*

Panic 0.52* 0.59* 0.68* 0.32* 0.58* 0.60*

General 0.49* 0.55* 0.47* 0.46* 0.51* 0.54*

Separation 0.63* 0.60* 0.70* 0.57* 0.52* 0.86*

Social 0.48* 0.53* 0.36* 0.46* 0.45* 0.42*

School 0.52* 0.59* 0.59* 0.48* 0.52* 0.43*

* p < .01