Patterns of Anxiety Symptoms in Pediatric Chronic Pain as Reported by Youth,Mothers,and Fathers

Pediatric chronic pain and anxiety often co-occur. Youth with chronic pain are at risk for heightened functional impairment related to anxiety. Research suggests the importance of screening for anxiety and the possibility that different clinical presentations may warrant modified treatment options. The aims of the current study were to comprehensively examine the nature and prevalence of anxiety disorder symptoms in a heterogeneous pediatric chronic pain sample, concordance of mother-proxy/father-proxy and child reports of anxiety, patient characteristics associated with increased anxiety, and the relationship between different anxiety presentations and quality of life outcomes. Participants included 423 children and adolescents ages 8–18 (M = 14.12, SD = 2.53) and their parents (380 mothers and 200 fathers) who presented at an interdisciplinary chronic pain clinic. Families completed questionnaires before beginning treatment, including pain information and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Thirty-one percent of youth had total scores exceeding the clinical cutoff indicating a possible anxiety disorder; 46% had clinical elevations on at least 1 anxiety subscale. Female youth reported higher anxiety than males. Youth with abdominal pain reported higher overall anxiety and more panic/somatic symptoms relative to other pain groups. Among youth who self-reported clinically elevated anxiety, 59% of mothers and 64% of fathers rated their child’s anxiety as nonclinical. A considerable number of youth with chronic pain reported clinically elevated anxiety symptoms. Reliance on parent-proxy reports may systematically underrepresent the range and severity of anxiety symptoms. Limitations and implications for practice are discussed.