Matching treatment with recurrent abdominal pain symptoms: an evaluation of dietary fiber and relaxation treatments

Abstract

Several etiological models of recurrent abdominal pain (RAP) in children have been proposed but no one model has been able to adequately account for the symptoms of all children with RAP. The present study proposed that symptom presentation may provide a basis for treatment selection. Two etiological models were tested in the present study: the constipation model and the operant learning model. Subjects were assigned to either model based upon whether or not they presented with symptoms of constipation. The treatments derived from these two models were: daily dietary fiber supplements, and teaching children relaxation skills and teaching parents to respond to their child’s pain complaints by encouraging their child to cope with pain through relaxation. Thirteen subjects between the ages of six and 12 years of age were treated in a nonconcurrent multiple baseline A-B or A-B-C design. To control for nonspecific effects, some subjects in each model received the treatment suggested by the alternative model first. All four subjects in the constipation model showed substantial reductions in stomachache activity following the introduction of the dietary fiber treatment. Of the nine subjects in the operant learning model, one showed substantial reductions in stomachache activity following the introduction of the relaxation and parent instruction treatment, two showed reductions during both treatments, four responded to the dietary fiber treatment, and two showed no response to treatment. Results support the effectiveness of a dietary fiber treatment for children with RAP with symptoms of constipation. Minimal support was obtained for the effectiveness of a relaxation and parent instruction treatment for children with RAP without symptoms of constipation. Limitations, implications and directions for future research are discussed.