Research Article
Issue Date: March/April 2020
Published Online: February 05, 2020
Updated: April 30, 2020
Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life
Author Affiliations
  • Cate Sinclair, B. App Sci. O.T., M. Art Therapy, PhD, is Director, Allied Services, Pain Specialists Australia, Richmond, Victoria, Australia, and Honorary Member, Murdoch Children’s Research Institute, Parkville, Victoria, Australia; catherine.sinclair@uq.net.au
  • Pamela Meredith, PhD, is Head of Occupational Therapy, School of Health, Medical and Applied Sciences, University of Central Queensland, Rockhampton, Queensland, Australia.
  • Jenny Strong, PhD, is Emeritus Professor, School of Health and Rehabilitation, University of Queensland, Brisbane, Queensland, Australia.
Article Information
Mental Health / Pediatric Evaluation and Intervention / Rehabilitation, Participation, and Disability / Research Articles
Research Article   |   February 05, 2020
Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life
American Journal of Occupational Therapy, February 2020, Vol. 74, 7402205040. https://doi.org/10.5014/ajot.2020.033308
American Journal of Occupational Therapy, February 2020, Vol. 74, 7402205040. https://doi.org/10.5014/ajot.2020.033308
Abstract

Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain.

Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain.

Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires.

Setting: Tertiary pain management clinic.

Participants: Children (ages 8–12 yr) and adolescents (ages 13–18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently.

Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection.

Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL.

Conclusion and Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain.

What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.