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Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain

Gibler, Robert C., MA*; Beckmann, Emily A., BS*; Lynch-Jordan, Anne M., PhD; Kashikar-Zuck, Susmita, PhD; Mano, Kristen E. Jastrowski, PhD*

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 625–632
doi: 10.1097/AJP.0000000000000720
Original Articles

Objective: School anxiety is a prevalent and debilitating mental health problem among youth with chronic pain. Despite evidence that anxiety in the context of school is associated with significant school-related disability, no studies have examined specific aspects of school anxiety in a pediatric chronic pain population.

Materials and Methods: Adolescents with chronic pain (n=30) and age-matched and sex-matched controls (n=30) and their parents completed questionnaires assessing school anxiety and functioning.

Results: Adolescents with chronic pain reported significantly more cognitive, behavioral, and psychophysiological symptoms of school anxiety relative to healthy controls. Youth with pain also endorsed significantly greater school anxiety in situations involving negative social evaluation and peer aggression. Exploratory analyses indicated that adolescents with chronic pain reporting school refusal behaviors more strongly endorsed behavioral and psychophysiological school anxiety symptoms, and more symptoms in social-evaluative situations. Youth with pain reporting lower school functioning endorsed more cognitive school anxiety symptoms and anxiety in situations involving academic failure relative to those reporting higher functioning.

Discussion: Present results offer a nuanced perspective into the underlying sources of school anxiety among adolescents with chronic pain. Our findings may inform future research efforts and targeted school functioning interventions. In particular, findings suggest that an individualized approach to the assessment of school anxiety which considers the unique sources of anxiety (eg, social vs. academic) may lay the groundwork for the refinement of school functioning interventions in pediatric chronic pain.

*Department of Psychology, University of Cincinnati

Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Supported by a National Science Foundation ADVANCE Institutional Transformation UC LEAF mini grant, Cincinnati, OH [grant number 1010013 I/O# M16929] and a University of Cincinnati University Research Council Faculty Research Award awarded to K.E.J.M, Cincinnati, OH. The authors declare no conflict of interest.

Reprints: Robert C. Gibler, MA, Department of Psychology, University of Cincinnati, 5140K Edwards One Center, Cincinnati, OH 45221 (e-mail:

Received November 19, 2018

Received in revised form April 6, 2019

Accepted April 11, 2019

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