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Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8-18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showe

Background: Pediatric chronic pain affects between 11 and 38% of all children. Although pain may result from injury or disease, the cause of chronic pain is commonly unclear. The interaction between biological, psychological, and social aspects has been emphasized as key to the understanding of the chronic pain experience, as well as risk and resilience factors. Pediatric chronic pain may result in significant impairment affecting both child and family functioning, and addressing family factors such as parental distress and protective behaviors, are generally considered important to pediatric chronic pain management. However, there is still a need to identify resilience factors that can be targeted in parental support programs, and to develop and evaluate effective parent support interventions. The complexity of the pain experience in pediatric chronic pain is well known with a large number of patients suffering from co-occurring disorders such as depression or insomnia. However, despite a considerable number of clinical observations suggesting an elevated prevalence of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with chronic pain, and similarities in terms of clinical correlates, the empirical support has been scarce. More research on the co-occurrence of pediatric chronic pain, ADHD, and ASD, including relationships with functioning, is therefore warranted. Purpose and aims: The purpose of the present research project was to identify and assess parental and child factors of importance for functioning and treatment effects in pediatric chronic pain. More specifically, the aims of the project were to: validate an instrument for parental psychological flexibility (Study I); evaluate the effects of a brief parental ACTintervention on parent outcomes (Study II); assess the prevalence of clinically significant traits and symptoms of ASD and ADHD in children, and relations to pain- and demographic variables (Study III

Camilla Wiwe Lipsker,1,2 Sven Bölte,3,4 Tatja Hirvikoski,3–5 Mats Lekander,2,6 Linda Holmström,1,7 Rikard K Wicksell1,2 1Functional Area Medical Psychology/Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden; 2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 3Center of Neurodevelopmental Disorders (KIND), Division of Neuropsychiatry, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; 4Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm, Sweden; 5Habilitation and Health, Stockholm County Council, Stockholm, Sweden; 6Stress Research Institute, Stockholm University, Stockholm, Sweden; 7Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden Purpose: Recent research has suggested that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) may be comorbid to pediatric chronic pain, but the empirical support is yet scarce. Therefore, the current study aimed to investigate the occurrence of traits and symptoms consistent with clinically significant ASD and ADHD in a group of children and adolescents with chronic debilitating pain and examine potential differences in pain and demographic variables between children with and without clinically significant traits and symptoms of ASD and ADHD. Patients and methods: This cross-sectional study included 146 parent–child dyads (102 girls, 111 mothers, children 8–17 years) consecutively referred to a tertiary pain clinic. Parents completed the Social Responsiveness Scale to assess autistic traits, and Conners-3 to measure symptoms of ADHD in their children. Children completed the Lübeck Pain Questionnaire to evaluate experienced pain. Results: Among children, 20 (13.7%) received scores consistent with clinically significant ASD and 29