Dimensions of pain-related parent behavior: development and psychometric evaluation of a new measure for children and their parents

Abstract

The development and maintenance of chronic pain are influenced by its social context, and especially by the responses of family members. For children, very few instruments are available that measure pain-related parental behavior. Using the Multidimensional Pain Inventory for adults (MPI; [Kerns RD, Turk DC, Rudy TE. The west haven-yale multidimensional pain inventory (WHYMPI). Pain 1985;23:345-356.]) as a model, we developed and evaluated a child and parent versions of the Pain-related Parent Behavior Inventory (PPBI). Here, we specifically studied maternal pain-related behavior as perceived by the child and self-reported by the mother. As substantiated by exploratory factor analysis in a mixed sample of 193 children and adolescents (8-16 years) either suffering from recurrent pain of different origin or being healthy controls, both PPBI versions entail the identical subscale solicitousness, distracting behaviors and discouraging/ignoring responses. Child and parent PPBI subscales were internally consistent and were not substantially related to age or gender. Validity analyses yielded a pattern of correlations with measures of depression, trait anxiety, pain activity, and pain-related cognitions that is consistent with the psychometric data for the adult MPI and findings on the social context of chronic pain. Child-perceived maternal behavior was significantly related to overall parenting and to mothers' actual behavior as observed during a cold pressor test. Finally, the PPBI was sensitive to differences in mothers' responses depending on the specific nature of the child's pain. Child and parent reports of parental behaviors were modestly correlated and were differentially related to the validity measures, hence supporting the importance of assessing the social context of pediatric pain independently of both the child's and the parent's perspectives.