Journal of Abnormal Child Psychology

, Volume 41, Issue 1, pp 151–163

Functional Gastrointestinal Symptoms in Children with Anxiety Disorders

  • Allison M. Waters
  • Elizabeth Schilpzand
  • Clare Bell
  • Lynn S. Walker
  • Kari Baber
Article

Abstract

This study examined the incidence and correlates of functional gastrointestinal symptoms in children with anxiety disorders. Participants were 6–13 year old children diagnosed with one or more anxiety disorders (n = 54) and non-clinical control children (n = 51). Telephone diagnostic interviews were performed with parents to determine the presence and absence of anxiety disorders in children. Parents completed a questionnaire that elicited information about their child’s gastrointestinal symptoms associated with functional gastrointestinal disorders in children, as specified by the paediatric Rome criteria (Caplan et al., Journal of Pediatric Gastroenterology & Nutrition, 41, 296–304, 2005a). Parents and children also completed a symptom severity measure of anxiety. As expected, children with anxiety disorders were significantly more likely to have symptoms of functional gastrointestinal disorders (FGID), compared to children without anxiety disorders. That is, 40.7 % of anxious children had symptoms of a FGID compared to 5.9 % of non-anxious control children. Children with anxiety disorders were significantly more likely to have symptoms of functional constipation, and showed a trend for a higher incidence of irritable bowel syndrome symptoms compared to non-anxious control children. Furthermore, higher anxiety symptom severity was characteristic of anxious children with symptoms of FGID, compared to anxious children without FGID symptoms and non-anxious control children. Also, children with anxiety disorders, regardless of FGID symptoms, were more likely to have a biological family member, particularly a parent or grandparent, with a gastrointestinal problem, compared to non-anxious control children. The high incidence of FGID symptoms in children with anxiety disorders warrants further research on whether gastrointestinal symptoms reduce following psychological treatments for childhood anxiety disorders, such as cognitive behavioural therapy.

Keywords

Anxiety disorders Functional gastrointestinal symptoms 

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  2. Apley, J. (1976). The child with abdominal pains (2nd ed.). Oxford: Blackwell Scientific.Google Scholar
  3. Apley, J., & Naish, N. (1958). Recurrent abdominal pains: a field survey of 1,000 school children. Archives of Disease in Children, 33, 165–170.CrossRefGoogle Scholar
  4. Baber, K. F., Anderson, J., Puzanovova, M., & Walker, L. S. (2008). Rome II versus Rome III classification of functional gastrointestinal disorders in pediatric chronic abdominal pain. Journal of Pediatric Gastroenterology and Nutrition, 47, 299–302.PubMedCrossRefGoogle Scholar
  5. Baker, S. S., Liptak, G. S., Colletti, R. B., Croffie, J. M., Di Lorenzo, C., et al. (1999). Constipation in infants and children: evaluation and treatment. Journal of Pediatric Gastroenterology and Nutrition, 29(5), 612–626.PubMedCrossRefGoogle Scholar
  6. Ball, T., & Weydert, J. (2003). Methodological challenges to treatment trials for recurrent abdominal pain in children. Archives of Pediatric & Adolescent Medicine, 157, 112–117.CrossRefGoogle Scholar
  7. Beidel, D. C., Christ, M. G., & Long, P. J. (1991). Somatic complaints in anxious children. Journal of Abnormal Child Psychology, 19, 659–670.PubMedCrossRefGoogle Scholar
  8. Bernstein, G. A., Massie, E. D., Thuras, P. D., Perwien, A. R., Borchardt, C. M., & Crosby, R. D. (1997). Somatic symptoms in anxious-depressed school refusers. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 661–668.PubMedCrossRefGoogle Scholar
  9. Bittner, A., Egger, H., Erkanli, A., Costello, E., Foley, D., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48, 1174–1183.PubMedCrossRefGoogle Scholar
  10. Bögels, S. M., & Zigterman, D. (2000). Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized anxiety disorder. Journal of Abnormal Child Psychology, 28(2), 205–211.PubMedCrossRefGoogle Scholar
  11. Campo, J. V., Comer, D., Jansen-McWilliams, L., Gardner, W., & Kelleher, K. J. (2002). Recurrent pain, emotional distress, and health service use in childhood. Journal of Pediatrics, 141, 76–83.PubMedCrossRefGoogle Scholar
  12. Campo, J. V., Perel, J., Lucas, A., Bridge, J., Ehmann, M., Kalas, C., et al. (2004). Citalopram treatment of pediatric recurrent abdominal pain and comorbid internalizing disorders: An exploratory study. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1234–1242.CrossRefGoogle Scholar
  13. Caplan, A., Lambrette, P., Joly, L., Bouin, M., Boivin, M., & Rasquin, A. (2003). Intergenerational transmission of functional gastrointestinal disorders: children of IBS patients versus parents of children with IBS, functional dyspepsia, and functional abdominal pain. Gastroenterology, 124(4, Suppl 1), A533–A533.CrossRefGoogle Scholar
  14. Caplan, A., Walker, L., & Rasquin, A. (2005a). Development and preliminary validation of the questionnaire on pediatric gastrointestinal symptoms to assess gastrointestinal disorders in children and adolescents. Journal of Pediatric Gastroenterology & Nutrition, 41, 296–304.CrossRefGoogle Scholar
  15. Caplan, A., Walker, L., & Rasquin, A. (2005b). Validation of the pediatric Rome II criteria for functional gastrointestinal disorders using the questionnaire on pediatric gastrointestinal symptoms. Journal of Pediatric Gastroenterology & Nutrition, 41, 305–316.CrossRefGoogle Scholar
  16. Cartwright-Hatton, S., McNicol, K., & Doubleday, E. (2006). Anxiety in a neglected population: prevalence of anxiety in pre-adolescent children. Clinical Psychology Review, 26, 817–833.PubMedCrossRefGoogle Scholar
  17. Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting Clinical Psychology, 66, 893–905.CrossRefGoogle Scholar
  18. Cobham, V. E., Dadds, M. R., Spence, S. H., & McDermott, B. (2010). Parental anxiety in the treatment of childhood anxiety: a different story three years later. Journal of Clinical Child & Adolescent Psychology, 39(3), 410–420.Google Scholar
  19. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
  20. Creswell, C., Schniering, C. A., & Rapee, R. M. (2005). Threat interpretation in anxious children and their mothers: comparison with non-clinical children and the effects of treatment. Behaviour Research & Therapy, 43, 1375–1381.CrossRefGoogle Scholar
  21. Daniel, A. E. (1983). Power, privilege and prestige. Melbourne: Longman Cheshire.Google Scholar
  22. Dorn, L. D., Campo, J. C., Thato, S., Dahl, R. E., Lewin, D., Chandra, R., et al. (2003). Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 66–75.CrossRefGoogle Scholar
  23. Dufton, L. M., Dunn, M. J., & Compas, B. E. (2009). Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety. Journal of Pediatric Psychology, 34, 176–186.PubMedCrossRefGoogle Scholar
  24. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129–136.PubMedCrossRefGoogle Scholar
  25. Garber, J., Zeman, J., & Walker, L. S. (1990). Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 648–656.CrossRefGoogle Scholar
  26. Hotopf, M., Carr, S., Mayou, R., Wadsworth, M., & Wessely, S. (1998). Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. British Medical Journal, 316(7139), 1196–1200.PubMedCrossRefGoogle Scholar
  27. Huang, R., Palmer, L., & Forbes, D. (2000). Prevalence & pattern of childhood abdominal pain in an Australian general practice. Journal of Pediatrics & Child Health, 36, 349–353.CrossRefGoogle Scholar
  28. Hudson, J. L., Gradisar, M., Gamble, A., Schniering, C. A., & Rebelo, I. (2009). The sleep patterns and problems of clinically anxious children. Behaviour Research & Therapy, 47, 339–344.CrossRefGoogle Scholar
  29. Hughes, A. A., Lourea-Waddell, B., & Kendall, P. C. (2008). Somatic complaints in children with anxiety disorders and their unique prediction of poorer academic performance. Child Psychiatry and Human Development, 39, 211–220.PubMedCrossRefGoogle Scholar
  30. Hyams, J. S., Treem, W. R., Justinich, C. J., Davis, P., Shoup, M., & Burke, G. (1995). Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome. Journal of Pediatric Gastroenterology & Nutrition, 20, 209–214.CrossRefGoogle Scholar
  31. Hyams, J. S., Burke, G., Davis, P. M., Rzepski, B., & Andrulonis, P. A. (1996). Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. The Journal of Pediatrics, 129, 220–226.PubMedCrossRefGoogle Scholar
  32. Kaminsky, L., Robertson, M., & Dewey, D. (2006). Psychological correlates of depression in children with recurrent abdominal pain. Journal of Pediatric Psychology, 31, 956–966.PubMedCrossRefGoogle Scholar
  33. Last, C. G. (1991). Somatic complaints in anxiety disordered children. Journal of Anxiety Disorders, 5, 125–138.CrossRefGoogle Scholar
  34. Levy, R. L., Whitehead, W., Walker, R., Von Korff, M., Feld, A., Garner, M., et al. (2004). Increased somatic complaints & health-care utilization in children: effects of parental IBS status and parent response to gastrointestinal symptoms. American Journal of Gastroenterology, 99, 2442–2451.PubMedCrossRefGoogle Scholar
  35. Levy, R., Olden, K., Naliboff, B., Bradley, L., Francisconi, C., Drossman, D., et al. (2006). Psychosocial aspects of functional gastrointestinal disorders. Gastroenterology, 130, 1447–1458.PubMedCrossRefGoogle Scholar
  36. Levy, R. L., Langer, S. L., Walker, L. S., Romano, J. M., Christie, D. L., et al. (2010). Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. American Journal of Gastroenterology, 105, 946–956.PubMedCrossRefGoogle Scholar
  37. Liakopoulou-Kairis, M., Alifieraki, T., Protagora, D., Korpa, T., Kondyli, K., Dimosthenous, E., et al. (2002). Recurrent abdominal pain and headache. European Child and Adolescent Psychiatry, 11, 115–122.PubMedCrossRefGoogle Scholar
  38. Liberman, L. C., Lipp, O. V., Spence, S. H., & March, S. (2006). Evidence for retarded extinction of aversive learning in anxious children. Behaviour Research and Therapy, 44, 1491–1502.PubMedCrossRefGoogle Scholar
  39. Lindley, K. J., Glaser, D., & Milla, P. J. (2005). Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain. Archives of Disease in Childhood, 90, 335–337.PubMedCrossRefGoogle Scholar
  40. Logan, D., & Scharff, L. (2005). Relationships between family and parent characteristics and functional abilities in children with recurrent pain: an investigation of moderating effects on the pathway from pain to disability. Journal of Pediatric Psychology, 30(8), 698–707.PubMedCrossRefGoogle Scholar
  41. Lyneham, H. J., & Rapee, R. M. (2005). Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 274–282.CrossRefGoogle Scholar
  42. Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist-supported parent- implemented CBT for anxiety disorders in rural children. Behaviour Research and Therapy, 44, 1287–1300.PubMedCrossRefGoogle Scholar
  43. Masi, G., Favilla, L., Millepiedi, S., & Mucci, M. (2000). Somatic symptoms in children and adolescents referred for emotional and behavioral disorders. Psychiatry: Interpersonal, Biological Processes, 63, 140–149.Google Scholar
  44. Messer, S. C., & Beidel, D. C. (1994). Psychosocial correlates of childhood anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 33, 975–983.CrossRefGoogle Scholar
  45. Murray, L., Creswell, C., & Cooper, P. (2009). The development of anxiety disorders in childhood: an integrative review. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 39, 1413–1423.CrossRefGoogle Scholar
  46. Mussell, M., Kroenke, K., Spitzer, R. L., Williams, J. B. W., Herzog, W., & Löwe, B. (2008). Gastrointestinal symptoms in primary care: prevalence and association with depression and anxiety. Journal of Psychosomatic Research, 64, 605–612.PubMedCrossRefGoogle Scholar
  47. Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. M. (2004). A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behaviour Research and Therapy, 42, 813–839.PubMedCrossRefGoogle Scholar
  48. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64.PubMedCrossRefGoogle Scholar
  49. Ramchandani, P. G., Stein, A., Hotopf, M., & Wiles, N. (2006). Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study. Journal of the American Academy of Child and Adolescent Psychiatry, 45(6), 729–736.PubMedCrossRefGoogle Scholar
  50. Rapee, R. M., Barrett, P., Dadds, M., & Evans, L. (1994). Reliability of DSM-III-R child anxiety disorders using structured interview: inter-rater and parent-child agreement. Journal of American Academy of Child & Adolescent Psychiatry, 33, 984–992.CrossRefGoogle Scholar
  51. Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, E., Hyams, J. S., Staiano, A., et al. (2006). Childhood functional gastrointestinal disorders. Gastroenterology, 130, 1527–1537.PubMedCrossRefGoogle Scholar
  52. Rasquin-Weber, A., Hyman, P. E., Cucchiara, S., Fleisher, D. R., Hyams, J. S., Milla, P. J., et al. (1999). Childhood functional gastrointestinal disorders. Gut, 45(Suppl 2), II60–68.PubMedCrossRefGoogle Scholar
  53. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM–IV, child and parent versions. Albany: Graywind.Google Scholar
  54. Silverman, W. K., Saavedra, L. M., & Pina, A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 937–944.CrossRefGoogle Scholar
  55. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566.PubMedCrossRefGoogle Scholar
  56. Spence, S. H., Holmes, J. M., March, S., & Lipp, O. V. (2006). The feasibility and outcome of clinic plus internet delivery of cognitive–behavior therapy for childhood anxiety. Journal of Consulting and Clinical Psychology, 74, 614–621.PubMedCrossRefGoogle Scholar
  57. Strauss, C. C., Frame, C. L., & Forehand, R. (1987). Psychosocial impairment associated with anxiety in children. Journal of Clinical Child Psychology, 16, 235–239.CrossRefGoogle Scholar
  58. Thompson, W. G. (2008). Understanding the irritable gut: The functional gastrointestinal disorders. Virginia: Degnon Associates.Google Scholar
  59. Walker, L. S., & Greene, J. W. (1989). Children with recurrent abdominal pain and their parents: more somatic complaints, anxiety, and depression than other patient families? Journal of Pediatric Psychology, 14(2), 231–243.PubMedCrossRefGoogle Scholar
  60. Walker, L. S., Garber, J., & Greene, J. (1993). Psychosocial correlates of recurrent childhood pain: comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders. Journal of Abnormal Psychology, 102, 248–258.PubMedCrossRefGoogle Scholar
  61. Waters, A. M., Craske, M. G., Bergman, R. L., & Treanor, M. (2008a). Threat interpretation bias as a vulnerability factor in childhood anxiety disorders. Behaviour Research & Therapy., 46, 39–47.CrossRefGoogle Scholar
  62. Waters, A. M., Wharton, T. A., Zimmer-Gembeck, M. J., & Craske, M. G. (2008b). Threat-based cognitive biases in anxious children: comparison with non-anxious children before and after cognitive-behavioural treatment. Behaviour Research & Therapy., 46(3), 358–374.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Allison M. Waters
    • 1
  • Elizabeth Schilpzand
    • 1
  • Clare Bell
    • 1
  • Lynn S. Walker
    • 2
  • Kari Baber
    • 2
  1. 1.School of PsychologyGriffith UniversityBrisbaneAustralia
  2. 2.Division of Adolescent MedicineVanderbilt UniversityNashvilleUSA

Personalised recommendations