ADAPTed Cognitive Behavioral Therapy for Pediatric Functional Abdominal Pain in Community-Based Pediatric Care: Mixed Methods Study

Abstract

Background: The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is a blended, digital, and live cognitive behavioral therapy program for children with functional abdominal pain disorder (FAPDs) and anxiety. Initially developed and evaluated in US pediatric gastroenterology settings, a culturally refined version was developed in Swedish, for potential use within community-based pediatric health care settings. Objective: This study aimed to evaluate a modified version of ADAPT as an early intervention for FAPD within a community-based pediatric setting in Sweden, exploring both the potential treatment effect and participants’ treatment experience. Methods: Participants were aged 9‐14 years, and all were diagnosed with FAPD. Using a mixed methods design, the study examined the preliminary effect through a single-arm pre-posttest and treatment experience through semistructured child interviews. Data were analyzed in three steps: nonparametric quantitative analysis of results on pre- and postintervention measures of self-rated pain-related functional disability, pain intensity, and anxiety; thematic qualitative analysis of the interviews; and conversion of qualitative data to enable both datasets to be analyzed and presented together. Results: A total of 13 children (12 girls) participated in ADAPT, all completing the program. In total, 7 of the invited 13 participating children agreed to be interviewed following intervention completion. Quantitative results were analyzed using the Wilcoxon signed rank test, and Pearson r was used to calculate the effect size. Results showed a significant reduction in pain-related functional disability, with a median decrease from 14.00 (IQR 10‐20) preintervention, to 5.00 (IQR 1‐9) postintervention (P=.04), a large effect size, r=−0.58, and 46% (n=6) achieving a clinically meaningful change where a Functional Disability Inventory (FDI) score decrease of ≥7.8 points denoted a clinically meaningful treatment response. Pain intensity also significantly decreased from a median of 6.5 (IQR 5.25‐8) to 4.00 (IQR 2.5‐6.5; P=.02), a large effect size r=−0.70, with 33% (n=4) experiencing at least a 50% reduction. Clinically meaningful change was determined to be present if at least a 50% reduction in self-rated measures of pain intensity was observed. Qualitative thematic analysis identified three themes: “Starting from scratch,” “Experiencing the treatment,” and “Getting on with life.” In terms of treatment experience, the blended live or digital format was perceived as a good fit for youth. Most children described finding some strategy that was effective and reported positive outcomes, such as increased participation in school. Conclusions: As patient experiences were predominantly positive and quantitative results indicative of potential for increased function and reduced pain, our findings suggest that ADAPT may present as a possible early treatment option for FAPD in a Swedish community–based pediatric setting. To draw robust conclusions on effectiveness, further research is required using a larger sample size, as well as research aimed at following up treatment effects over time.