Psychosocial Risk Status Impacts Response to a Psychological Treatment for Youth with Functional Abdominal Pain

Functional abdominal pain disorders (FAPD) are common in youth, impacting up to 25% of children worldwide. A subset of youth experience persistent symptoms that impact functioning over the long-term. It has been shown those with clinically elevated levels of concurrent pain, functional disability, and anxiety (a high risk FAPD profile) are at increased risk of persistent disability due to pain. While effective nonpharmacologic treatments such as cognitive behavioral therapy (CBT) are available for FAPD, it is unknown if there are differential treatment effects based on risk status. This study seeks to understand how high risk youth with FAPD respond to ADAPT, a CBT shown to be effective in reducing symptoms for youth with FAPD. Participants diagnosed with FAPD per Rome IV criteria between the ages of 9 and 14 were recruited from GI clinics as part of a larger psychological treatment study and randomized to receive either ADAPT or treatment as usual. Risk factors were calculated based on established clinical cutoffs for validated measures of anxiety, functional disability, and average pain levels. Treatment outcomes by risk categorization and treatment allocation were then compared using a MANCOVA. The results demonstrated a substantial main effect of risk categorization on post-treatment outcomes (F (3,72)=3.304, p=0.025, Wilks' Λ= 0.879) and showed that high risk youth who received ADAPT had higher anxiety, disability, and pain post-treatment compared to lower risk youth. This study suggests that high risk youth with FAPD may require additional support beyond the brief CBT interventions traditionally utilized.