Wiwe Lipsker Camilla, Hirvikoski Tatja, Balter Leonie J T, Bölte Sven, Lekander Mats, Holmström Linda, Wicksell Rikard K
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.
Front Neurosci. 2021 Nov 1;15:716887. doi: 10.3389/fnins.2021.716887. eCollection 2021.
Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain ( = 146, 8-17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents ( = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.
先前的研究表明，慢性疼痛儿童中自闭症谱系障碍以及注意缺陷多动障碍（ADHD）具有临床意义的特征和症状水平升高，但与功能和抑郁之间的关联尚不清楚。本研究调查了慢性疼痛儿童（n = 146，8 - 17岁，102名女孩）中自闭症特征和ADHD症状与疼痛干扰、抑郁及健康相关生活质量的关系，以及失眠和心理灵活性的中介作用，这些儿童在一家三级疼痛诊所就诊。儿童完成了疼痛强度、抑郁、疼痛干扰、健康相关生活质量、失眠和心理灵活性的测量。家长（n = 146，111名母亲）完成了评估其子女自闭症特征和ADHD症状的测量。与其他儿童相比，具有临床意义的自闭症特征和ADHD症状的儿童表现出显著更高水平的抑郁症状和疼痛干扰，以及显著更低的健康相关生活质量。自闭症特征和ADHD症状对疼痛干扰、抑郁症状以及健康相关生活质量的预测有显著贡献。心理灵活性一方面在ADHD症状与自闭症特征之间起中介作用，另一方面在与抑郁、疼痛干扰和健康相关生活质量之间起中介作用，而失眠在ADHD症状与抑郁、疼痛干扰和健康相关生活质量之间起中介作用。所有分析均对人口统计学特征和疼痛强度进行了校正。结果表明，对慢性疼痛儿童进行神经发育障碍筛查具有实用价值。此外，研究结果可能表明，失眠和与心理灵活性相关的技能是旨在改善慢性疼痛儿童以及伴有神经发育障碍共病症状儿童的功能和健康相关生活质量的干预措施中的潜在治疗靶点。
