ADAPTing CBT for Pediatric Functional Abdominal Pain in Primary Care

• Aim to Decrease Anxiety and Pain Treatment (ADAPT) (Behavioral): Cognitive behavioral intervention for management of pediatric functional abdominal pain, stratified to 4- or 6- sessions depending on presence of anxiety symptoms, offered through primary care

Primary outcomes

• Recruitment [At enrollment]: >50% agreement to participate
• Retention rates [From baseline to post assessment (8 weeks)]: >80% retention
• Feasibility of intervention [at 8 week post assessment]: responses to semi-structured qualitative post assessment interview

Secondary outcomes

• Change in functional disability, measured using the Functional Disability Inventory (FDI) [From baseline to post assessment (8 weeks)]: The 15-item FDI assesses youths' difficulty performing tasks across home, school, recreational, and social settings over the "past few days" due to physical symptoms. Items are rated from 0 ("no trouble") to 4 ("impossible") and summed, yielding total scores of 0-60 with scores ≥7 suggesting greater than minimal disability. Youth will complete a self-report version, and parents will complete an additional version reporting on their child.
• Changes in pain, as measured by the Pain Visual Analog Scale (VAS) [From baseline to post assessment (8 weeks)]: Youth and parents will each report the youth's average pain intensity over the past week using a Visual Analog Scale (VAS). Responses range from 0 (no pain) to 10 (worst imaginable pain), with ratings ≥3 indicating moderate pain.
• Change in anxiety symptoms, measured using the Screen for Child Anxiety Related Disorders (SCARED) [From baseline to post assessment (8 weeks)]: The 41-item Screen for Child Anxiety Related Disorders (SCARED) assesses past 3-month anxiety symptoms. Items are scored on a 3-point Likert-style scale (0 = not true or hardly ever true, 2=very true or often true), and summed to yield total scores of 0-82 with higher scores indicating greater anxiety and scores ≥25 suggesting clinical significance. Youth will complete a self-report version, and parents will complete an additional version reporting on their child.

Other outcomes

• Eating behavior, measured by the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) [From baseline to post-assessment (8 weeks)]: The Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) is a self-report questionnaire used to assess symptoms of avoidant/restrictive eating, including picky eating, low appetite, and fear of negative consequences of eating. Items are rated on a Likert-type scale and summed to yield a total score ranging from 0 to 45, with higher scores indicating greater severity of avoidant/restrictive eating symptoms. Youth will complete this measure.
• Eating behavior, as measured by the Children's Eating Attitudes Test (ChEAT) [From baseline to post assessment (8 weeks)]: The Children's Eating Attitudes Test (ChEAT) is a self-report questionnaire used to assess disordered eating attitudes and behaviors in youth, including dieting, food preoccupation, and concerns about weight. Items are rated on a Likert-type scale and summed to yield a total score ranging from 0 to 78, with higher scores indicating more problematic eating attitudes and greater eating-related concerns. Youth will complete this measure.

Sex: All, ages: 9 Years to 14 Years

Inclusion Criteria:

* FAPD diagnosis
* Ages 9-14 years
* Functional disability score of 7 or greater

Exclusion Criteria:

* <9 years or >14 years
* Known developmental disability, sensory, or cognitive impairments that limit youths' ability to engage with behavioral programming
* Unmanaged psychiatric illness (e.g., psychosis, active suicidal ideation, severe depression as indicated in electronic medical records)
* Symptoms directly attributable to a physical health concern (e.g., cancer, cystic fibrosis, inflammatory bowel disease).
* Lack of English proficiency