(819) Procedure-related distress in children with autism spec-trum disorders

D. Harrison, J. Koh, T. Palermo, P. Michels, P. Lax; Oregon Health & ScienceUniversity / Doernbecher Children’s Hospital, Portland, ORBehavioral and communication deficits in children with autism spectrumdisorders (ASD) can complicate the management of procedural pain anddistress. Research has shown that children with ASD have significantbehavioral changes in response to painful stimuli (e.g., venipuncture);however, specific management strategies for reducing procedure-re-lated distress have not yet been developed and tested in these children.The goals of this two-phase pilot study are: 1) to identify child proce-dure-related behaviors and management strategies used by parents,and 2) to develop individualized behavioral interventions (based onparent input) for children with ASD. Thus far in phase-1, parents of 22children (mean child age � 10.5 years, 77% male) with ASD attending adental clinic completed a survey about their child’s behavior related tomedical procedures. Survey items included open-ended questions aboutchildren’s behavior during and after procedures, and ratings of chil-dren’s difficulty with varying medical stimuli (e.g., unfamiliar people).Parents reported significant behavioral difficulties in most children(96%) and 27% of the children were non-verbal. On ratings of medicalstimuli, parents rated their children as having moderate difficulty withunfamiliar people (78%) and increased sensitivity to sounds (77%), tex-tures in mouth (60%), textures on skin (55%), touch (41%), and painfulsensations (36%). Many parents (47%) identified increased child anxietyand behavioral agitation at the time of a procedure and 55% notedongoing behavioral changes following a procedure including anxiety,fatigue, and lethargy. Parents used several management strategies forhelping their child cope with procedures including rewards (e.g., money,treats) (41%), verbal/physical comforting (26%), distraction (23%), andexplaining the procedure (14%). Phase 2 of our study will focus ondeveloping behavioral interventions that can be individualized to thespecific behaviors and procedural stimuli that are difficult for a childwith ASD, with a goal of reducing distress related to a medical proce-dure.

(820) Adolescent self-perception: Associations with pain andfunctional disability

J. Guite, D. Logan, J. Rose, D. Sherry, H. Roggenkamp; The Children’s Hospitalof Philadelphia, Philadelphia, PA

Adolescents with chronic pain syndromes can encounter significant chal-lenges within social, academic, athletic and other developmentally sa-lient domains of competence. Self-perceived competence has been iden-tified as a factor that moderates the relationship between painsymptoms and functional disability for some adolescents, and as a factorthat influences the maintenance of somatic symptoms. However, theexisting pain-related research is limited to a few domains of self-percep-tion and incorporates only adolescents with recurrent abdominal pain.The present study extends our understanding of relationships betweenself-perception and chronic pain/disability by examining self-perceivedcompetence across a range of domains among adolescents with muscu-loskeletal pain syndromes. A retrospective record review of approxi-mately 90 adolescents (13-18 years of age) presenting at a tertiary caremultidisciplinary pain clinic will include demographic information, painhistory and diagnosis, the Functional Disability Inventory (FDI), and theSelf-Perception Profile for Adolescents (SPPA). Consistent with prior re-search, we predict that adolescent perceived competence will moderatea relationship between pain and functional disability. Within an prelim-inary sample of adolescents (n�20; 14 females/6 males; mean age�14.9,SD�1.3; modal school grade�9), self-reports of pain were significantlycorrelated with functional disability (r�.58, p�.01). A significant nega-tive relationship was found between reports of pain and the SPPA closefriendships scale (r��.46, p�.05). Although not significant in prelimi-nary analyses, other negative relationships occurred between adoles-cents’ reports of pain and SPPA social acceptance, athletic competence,and physical appearance scales. Similarly, correlations between SPPAscales and functional disability were primarily negative and strongestfor SPPA social scales (close friendships r�.35, p�.14; social acceptancer��.32, p�.17). We will test the extent to which individual SPPA scalesmoderate the relationship between pain and functional disability in thefull sample. Findings will be discussed with respect to a biopsychosocialmodel of adolescent development and implications for intervention.

(821) Parenting stress and parent-adolescent relationships infamilies of adolescents with chronic pain syndromes

D. Logan, J. Guite, J. Rose, D. Sherry, H. Roggenkamp; Children’s Hospital ofPhiladelphia, Philadelphia, PAThis study explores parenting stress and perceptions of the adolescent-parent relationship in the context of adolescent chronic pain syndromes.We hypothesize that (1) parents of adolescents with chronic pain syn-dromes will report elevated levels of parenting stress relative to norma-tive data; (2) parents of adolescents with chronic pain will report pooreradolescent-parent relationships compared to normative data; and (3)higher levels of parenting stress will associate with greater pain severityand duration and higher levels of pain-related disability (by adolescentreport). A retrospective record review will include approximately 100adolescents (13-18 years of age) evaluated at a tertiary care pediatricpain management clinic. Information includes demographic data, painhistory and diagnosis, the Stress Index for Parents of Adolescents andthe Functional Disability Inventory. Preliminary analyses involving a sub-sample of participants (n � 21; 15 females/6 males, mean age � 15.0,sd � 1.3) indicate that pain and pain-related functional impairmentassociate with parenting stress and quality of the parent adolescentrelationship. For example, functional disability correlates with parentalperceptions of adolescent distress (r � .58, p�.01), situational life stres-sors (r � .63, p�.01), and total parenting stress (r � .40, p�.10). Al-though not approaching statistical significance in preliminary analyses,correlations between functional disability and parental perceptions ofthe adolescent-parent relationship are in the hypothesized direction. Apreliminary linear regression analysis shows that across levels of painseverity, parenting stress (total score) significantly predicts pain-relatedfunctional disability (r2 � .51; F (2,18) � 11.3, p�.001), with parentingstress accounting for an r2 change of .22 (p �.01). In the full sample, wewill compare the chronic pain group to normative data and explorethese relationships more comprehensively. Study findings have implica-tions for the development of parent-focused intervention approachesto improve functional abilities among adolescents with chronic pain.

(822) Children’s experience of treatment for recurrent pain: Anarrative-based study

M. Meldrum, M. Nutkiewicz, M. Katz, R. Guillen, I. Clemente, M. Jacob; UCLA,Los Angeles, CAThirty children ages 10-17 with recurrent pain were interviewed, using asemi-structured, long interview format, prior to entering a pain clinicwhich uses a biopsychosocial treatment model and at six months post-intake. The authors use a combination of methods drawn from the socialsciences, including thematic coding and grounded theory analysis, toidentify narrative themes and statements indicative of changes in thepatient’s perceptions, attitudes, sense of self-efficacy, and ability to self-manage the pain. The analysis will test the hypothesis: are narrativethemes of improved self-efficacy and self-management associated withself-reports of reductions in pain intensity and/or frequency? Narrativeswill also be analyzed to correlate treatment outcomes with specifictreatment modalities (medications, psychological counseling, physicaltherapy, behavioral training in self-management techniques); and withsignificant treatment factors, as perceived by the child, such as: physi-cian’s listening to child, physician’s acceptance of child’s statements,physician’s redefinition of pain problem in terms clear to child. Theposter will demonstrate the methodologies employed and use specificexamples to illustrate how they are used to test the hypothesis andevaluate the treatment factors.

S63Abstracts