Executive Functioning in Children with Chronic Pain
Date
2020-07-06
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Abstract
Objective: School serves as a crucial site for youth development and the potential consequences of poor school functioning are extensive. Limited school functioning is well documented in youth with chronic pain; however, variables that may explain poor school functioning are not adequately understood. Preliminary research suggests differences in executive functioning (EF) to possibly play a role, yet little research specifically examining EF in youth with chronic pain is available. Given the critical role of EF in learning, problem-solving, school functioning, and coping, the overall aim of this dissertation was to examine potential differences in EF between youth with and without chronic pain. A subsequent aim was to explore associations between EF and school functioning in youth with chronic pain and to investigate relationships between performance-based measures and behaviour ratings of EF in a mixed sample of youth. Method: A series of studies examining school functioning in youth with chronic pain in direct relation to one or more additional variables were synthesized and a preliminary conceptual model of school functioning in youth with chronic pain was proposed. A total of 26 youth with chronic pain (80.8% girls) and their parents were recruited from two tertiary-care pain clinics and a comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a brief measure of general intelligence. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent- and self- report behaviour rating of EF was also administered. Results: Participants with chronic pain had significantly lower scores on performance-based tests of working memory, divided and alternating attention, inhibition, and flexibility compared to the non-chronic pain group. Poorer behaviour ratings of overall emotion and cognitive regulation as well as global EF were also found for youth with chronic pain. Several of these observed group differences remained after controlling for covariates. Performance-based measures of EF were not found to be significant predictors of school functioning. In contrast, parent- and self-report behaviour rating scales of EF showed a statistically significant result; however, subsequent analysis found only the self-report cognitive regulation scale to be a significant predictor of school functioning. Performance-based and parent- and self-report scales evaluating the same EF domains showed some weak correlations and several non-significant associations. Conclusion: This empirical work offers one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behaviour ratings of EF. It offers several novel and pertinent findings, and demonstrates EF differences in youth with chronic pain. It also raises potential implications for the evaluation of EF in youth with chronic pain, lending evidence to the use of both performance-based measures and behaviour ratings when evaluating, remediating, and accommodating EF. This dissertation highlights the need for multidisciplinary healthcare and education teams to achieve collaborative and integrated services within individualized pain management for youth.
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Keywords
adolescents, youth, cognitive function, chronic pain, children, executive functioning, school functioning, assessment, evaluation
Citation
Jones, K. M. (2020). Executive Functioning in Children with Chronic Pain (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.