Functional abdominal pain (FAP) within the context of internalizing disorders in childhood; A randomized controlled cognitive-behavioural family intervention

INTERVENTION: MC: In line with the current practice of pediatricians in treating children with FAP: supportive physician‐patient relationship and empathy for the family with reassurance that no serious disease is present. Dietary advice will be offered (f.i. fiber intake). If necessary pharmacological agents can be prescribed (laxative medication, spasmolytic drugs, H2 blockers or PP‐inhibitors). No referrals to psychotherapist and/or hypnotherapist will take place and no ‘alternative’ medical therapy (such as acupuncture, homeopathy) will be prescribed. MC will be offered in the same frequency as the CBT will take place. CBT: Six treatment sessions with the patient and at least one with the parents that will contain: 1. information about the treatment model (influence of cognitions and behaviour on the pain experience); 2. learning pain management techniques (relaxation, breathing, imagery, physical exercises); 3. discussing dysfunctional cognitions (learning helping thoughts in stead of catastrophizing thoughts) if applicable; 4. changing parent’s dysfunctional behaviour, if applicable; 5. changing children's dysfunctional behaviour, if applicable (f.i., school absence). The content of the modules are described in detail in a protocol ‘CBT for FAP’. During this period no outpatient visit to the pediatrician will take place. Also no other referrals (such as hypnotherapy or ‘alternative’ medical therapy (such as acupuncture, homeopathy) will be initiated. CONDITION: Functional abdominal pain, Functional dyspepsia (FD), Irritable bowel syndrome (IBS), Recurrent abdominal pain, Abdominal migraine ; ; PRIMARY OUTCOME: 1. Abdominal pain, as measured by the Abdominal Pain Index (API; Walker et al., 1997).; ; 2. Abdominal pain, as measured by 1 week diary cards, making use of the Facial Affect Scale (FAS; McGrath et al., 1996). SECONDARY OUTCOME: 1. Anxiety and depression, measured by a structured interview (ADIS‐C/P; Silverman et al., 1988); ; ; 2. Anxious and depressive symptoms, measured by the Revised Child Anxiety and Depression Scale ‐ short version (RCADS; Muris et al., 2002); ; ; 3. Other somatic complaints, measured by the Children's Somatization Inventory (CSI; Walker & Garber, 1992, Ghys & Meesters, 1993); ; ; 4. Functional impairments due to the abdominal pain, as measured by the Functional Disability Inventory (FDI; Walker & Greene, 1991); ; ; 5. Quality of life, as measured by the Kidscreen‐27 (The KIDSCREEN Group, 2004); ; ; 6. School absence; ; ; 7. Health care use. INCLUSION CRITERIA: 1. Age 8‐18; 2. Abdominal pain is main complaint; 3. Abdominal pain is present at least three times a week, 15 minutes a day. On the Facial Affect Scale (McGrath, 1996) ranging from 1‐9, it hurts at least a '5'; 4. At least 8 weeks of abdominal pain in the last twelve months; 5. Has to understand the Dutch language sufficiently to receive treatment and fill out questionnaires in Dutch; 6. Informed consent from both parent and child.