Understanding Psychosocial Treatment Non-Response in Children with Functional Abdominal Pain

Functional abdominal pain (FAP) is a commonly occurring gastrointestinal disorder in children and adolescents. It is associated with significant distress and impairment for both children and caregivers. Psychosocial treatments have been shown to effectively treat FAP and related outcomes. However, not all children respond to treatment. Using data from a randomized controlled trial for childhood FAP, the present study aimed to clarify what factors predicted treatment non-response, how and for whom treatments worked, and why some children’s pain worsened. Participants were randomized to undergo one of two 10-week interventions—either caregiver education or a novel, acceptance- and interoceptive exposure-based intervention. They completed pain diaries and interviews assessing both child and caregiver report of the intensity, frequency, and duration of their pain; questionnaires about therapeutic alliance, somatic sensitivities, and psychological factors; and interviews about coping strategies and treatment at various time points before, during, and after treatment.Results revealed that higher levels of baseline anxiety sensitivity were associated with lower probability of treatment response to the caregiver education intervention but not the novel intervention. Anxiety and depressive symptoms emerged as marginally significant predictors of changes in functional impairment across both treatment arms. In-depth examination of quantitative and qualitative data for children whose pain worsened suggested that neither their pain nor related impairment were at clinically significant levels following intervention, despite statistical significance. Study implications, limitations, and directions for future research are discussed.