# Comparing the treatment effects of online cognitive-behavioral therapy for pediatric functional abdominal pain disorders with and without psychiatric comorbidity

## TL;DR

Online cognitive-behavioral therapy helps children with stomach pain disorders, even if they also have mental health issues.

## Contribution

Demonstrates that iCBT is equally effective for children with and without psychiatric comorbidities.

## Key findings

- Children with psychiatric comorbidity showed similar improvement rates in gastrointestinal symptoms as those without.
- Treatment benefits were sustained six months after therapy.
- iCBT improved quality of life and reduced anxiety in both groups.

## Abstract

Functional abdominal pain disorders (FAPDs) are disorders of the gut-brain interaction. FAPDs are common in children and adolescents (global prevalence 12%) and are associated with psychiatric comorbidity. Internet-delivered cognitive-behavioral therapy (iCBT) is effective for FAPDs, but it’s unclear whether children with psychiatric comorbidities benefit equally from the treatment.

In this study, we assessed whether having a comorbid psychiatric diagnosis results in different rates of change in iCBT for children with FAPDs.

Between-groups design.

Participants were 120 children with FAPDs (age 8–12 years) taking part in one of two clinical trials testing 10 weeks of iCBT. For the analyses, participants were divided into groups: presence or absence of psychiatric disorder. The primary outcome was gastrointestinal symptoms, assessed weekly using the Pediatric Quality of Life Gastrointestinal Symptom Scale. Secondary outcomes included health-related quality of life, gastrointestinal-specific anxiety, and pain intensity. Multilevel modeling was used to assess differences in rates of change between groups from baseline to follow-up directly after treatment, and then to 6-month follow-up.

We observed significant improvements in the rates of change for both groups for the primary outcome (gastrointestinal symptoms) and all secondary outcomes during treatment. Children with psychiatric comorbidity had significantly more severe symptoms at baseline on all measures, but there was no difference in the rates of change for the primary outcome (−0.29, 95% confidence interval (CI): −0.70, 0.11, p = 0.159) or any of the secondary outcomes compared to the non-comorbid group. Treatment benefits were sustained at 6-month follow-up.

ICBT seems to be beneficial for children with FAPDs, also in the presence of psychiatric comorbidity. Given the high prevalence of psychiatric comorbidity in this patient group, the results will aid the clinical assessment and treatment planning for these patients.

Comparing internet treatment for children with functional abdominal pain, with and without psychiatric disorders

This study looked at how well internet-delivered cognitive behavioral therapy (iCBT) works for children with functional abdominal pain disorders (FAPDs), both with and without psychiatric conditions like anxiety or depression. FAPDs are common in children and can cause significant discomfort and reduced quality of life. Many children with FAPDs also have psychiatric conditions. The study included 120 children aged 8-12 years who previously received 10 weeks of iCBT. The children were divided into two groups: those with psychiatric conditions and those without. The results showed that iCBT helped reduce gastrointestinal symptoms and improve quality of life for all children, regardless of whether they had a psychiatric condition. Children with psychiatric conditions started with more severe symptoms but improved at the same rate as those without psychiatric conditions. The benefits of iCBT were sustained at follow-up six months after treatment. This study suggests that iCBT is an effective treatment for children with FAPDs, even if they have psychiatric conditions. This is important because many children with FAPDs have psychiatric conditions, and this treatment can help improve their overall well-being.