ADAPTed Cognitive Behavioral Therapy for Pediatric Functional Abdominal Pain in Community-Based Pediatric Care: Mixed Methods Study
Bibliographic record
Abstract
Background: The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is a blended, digital, and live cognitive behavioral therapy program for children with functional abdominal pain disorder (FAPDs) and anxiety. Initially developed and evaluated in US pediatric gastroenterology settings, a culturally refined version was developed in Swedish, for potential use within community-based pediatric health care settings. Objective: This study aimed to evaluate a modified version of ADAPT as an early intervention for FAPD within a community-based pediatric setting in Sweden, exploring both the potential treatment effect and participants' treatment experience. Methods: Participants were aged 9-14 years, and all were diagnosed with FAPD. Using a mixed methods design, the study examined the preliminary effect through a single-arm pre-posttest and treatment experience through semistructured child interviews. Data were analyzed in three steps: nonparametric quantitative analysis of results on pre- and postintervention measures of self-rated pain-related functional disability, pain intensity, and anxiety; thematic qualitative analysis of the interviews; and conversion of qualitative data to enable both datasets to be analyzed and presented together. Results: A total of 13 children (12 girls) participated in ADAPT, all completing the program. In total, 7 of the invited 13 participating children agreed to be interviewed following intervention completion. Quantitative results were analyzed using the Wilcoxon signed rank test, and Pearson r was used to calculate the effect size. Results showed a significant reduction in pain-related functional disability, with a median decrease from 14.00 (IQR 10-20) preintervention, to 5.00 (IQR 1-9) postintervention (P=.04), a large effect size, r=-0.58, and 46% (n=6) achieving a clinically meaningful change where a Functional Disability Inventory (FDI) score decrease of ≥7.8 points denoted a clinically meaningful treatment response. Pain intensity also significantly decreased from a median of 6.5 (IQR 5.25-8) to 4.00 (IQR 2.5-6.5; P=.02), a large effect size r=-0.70, with 33% (n=4) experiencing at least a 50% reduction. Clinically meaningful change was determined to be present if at least a 50% reduction in self-rated measures of pain intensity was observed. Qualitative thematic analysis identified three themes: "Starting from scratch," "Experiencing the treatment," and "Getting on with life." In terms of treatment experience, the blended live or digital format was perceived as a good fit for youth. Most children described finding some strategy that was effective and reported positive outcomes, such as increased participation in school. Conclusions: As patient experiences were predominantly positive and quantitative results indicative of potential for increased function and reduced pain, our findings suggest that ADAPT may present as a possible early treatment option for FAPD in a Swedish community-based pediatric setting. To draw robust conclusions on effectiveness, further research is required using a larger sample size, as well as research aimed at following up treatment effects over time.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".