Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Associated With Greater Pain Interference and Depression, and Reduced Health-Related Quality of Life in Children With Chronic Pain
Open accessAbstract
Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain (n = 146, 8–17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents (n = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.
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Various studies have shown that psychological flexibility correlates significantly with psychological health problems ranging from r = 0.2 to r = 0.8.
“various studies have shown that psychological flexibility correlates significantly with psychological health problems ranging from r = 0.2 to r = 0.8 [47,48]”
From The Psychological Flexibility in Epilepsy Questionnaire (PFEQ): Psychometric properties of the Persian version (2022) · cites this paper as [48]
Table 1 in Results > Descriptive Statistics and Bivariate Correlations reports significant correlations between pain-related psychological inflexibility and depression (r = 0.634), pain interference (r = 0.720), and health-related quality of life (r = −0.682). These support the general association, but this is one study of children with chronic pain; it does not establish a range across various studies from r = 0.2 to r = 0.8. (LLM, conf=0.87)
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References 100 · Cited by 12
Research works printed but not linked: 3
- Conners C. K. (2008). Conners third edition (Conners 3). Los Angeles, CA: Western Psychological Services.
- Sparrow E. P. (2010). Essentials of Conners behavior assessments. Hoboken: John Wiley & Sons.
- Thorell L. Hammar M. Berggren S. Zander E. Bölte S. (2015). Conners 3 Manual. Stockholm: Pearson.
- Authors
- Wiwe Lipsker, C., Hirvikoski, T., Balter, L. J. T., Bölte, S., Lekander, M., Holmström, L., & Wicksell, R. K.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Curtin University (AU)
- Karolinska University Hospital (SE)
- ORCID
- Venue
- Frontiers in Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2021-11-01
- Volume
- 15
- Pages
- 716887-716887
- ISSN
- 1662-453X (ISSN-L)
- PMC
- PMC8591303
- OpenAlex
- W3210545232
- Cited by
- 12
- References
- 100
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 2
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Karolinska Institutet
- Stiftelsen Sven Jerrings Fond
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Keywords
- autistic traits, attention deficit hyperactivity disorder, chronic pain, children, pain interference, depression, health-related quality of life, insomnia, psychological inflexibility, neurodevelopmental disorders, mediation
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