The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study
Background: Both medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations. Objective: This study aimed to identify themes in the clinical narratives of adolescents with chronic...
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| Veröffentlicht in: | Child abuse & neglect 2022-10, Vol.132, p.105788-105788, Article 105788 |
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| container_title | Child abuse & neglect |
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| creator | Johnson, Katie L. Wilkins, Stephanie N. Brown, Emily C.B. Tham, See Wan Walco, Gary A. Feldman, Kenneth W. Wiester, Rebecca Qu, Pingping Campbell, Kristine A. |
| description | Background: Both medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations. Objective: This study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. Participants and setting: Participants were 28 adolescents (ages 13–18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively. Methods: This was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence. Results: Several themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care. Conclusions: This exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup. |
| doi_str_mv | 10.1016/j.chiabu.2022.105788 |
| format | Article |
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Objective: This study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. Participants and setting: Participants were 28 adolescents (ages 13–18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively. Methods: This was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence. Results: Several themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care. Conclusions: This exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup.</description><identifier>ISSN: 0145-2134</identifier><identifier>EISSN: 1873-7757</identifier><identifier>DOI: 10.1016/j.chiabu.2022.105788</identifier><language>eng</language><publisher>Oxford: Elsevier Science Ltd</publisher><subject>Adolescents ; Caregivers ; Catastrophic reactions ; Child Abuse ; Child abuse & neglect ; Children ; Chronic pain ; Coding ; Content analysis ; Convergence ; Disability ; Health care ; Health services ; Health services utilization ; Health status ; Help seeking behavior ; Home education ; Interdisciplinary aspects ; Maternal characteristics ; Medical referrals ; Medical Services ; Medicine ; Mental disorders ; Mental health ; Misrepresentation ; Mothers ; Narratives ; Pain ; Pediatrics ; Qualitative research ; Scripts ; Sensitization ; Teams ; Teenagers</subject><ispartof>Child abuse & neglect, 2022-10, Vol.132, p.105788-105788, Article 105788</ispartof><rights>Copyright Elsevier Science Ltd. Oct 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c312t-8ccb32f0f2d6bd167332d79a93bd6893bcc57a5e0cfe01fdeac541ada088d4eb3</citedby><cites>FETCH-LOGICAL-c312t-8ccb32f0f2d6bd167332d79a93bd6893bcc57a5e0cfe01fdeac541ada088d4eb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902,30976,33751</link.rule.ids></links><search><creatorcontrib>Johnson, Katie L.</creatorcontrib><creatorcontrib>Wilkins, Stephanie N.</creatorcontrib><creatorcontrib>Brown, Emily C.B.</creatorcontrib><creatorcontrib>Tham, See Wan</creatorcontrib><creatorcontrib>Walco, Gary A.</creatorcontrib><creatorcontrib>Feldman, Kenneth W.</creatorcontrib><creatorcontrib>Wiester, Rebecca</creatorcontrib><creatorcontrib>Qu, Pingping</creatorcontrib><creatorcontrib>Campbell, Kristine A.</creatorcontrib><title>The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study</title><title>Child abuse & neglect</title><description>Background: Both medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations. Objective: This study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. Participants and setting: Participants were 28 adolescents (ages 13–18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively. Methods: This was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence. Results: Several themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care. Conclusions: This exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup.</description><subject>Adolescents</subject><subject>Caregivers</subject><subject>Catastrophic reactions</subject><subject>Child Abuse</subject><subject>Child abuse & neglect</subject><subject>Children</subject><subject>Chronic pain</subject><subject>Coding</subject><subject>Content analysis</subject><subject>Convergence</subject><subject>Disability</subject><subject>Health care</subject><subject>Health services</subject><subject>Health services utilization</subject><subject>Health status</subject><subject>Help seeking behavior</subject><subject>Home education</subject><subject>Interdisciplinary aspects</subject><subject>Maternal characteristics</subject><subject>Medical referrals</subject><subject>Medical Services</subject><subject>Medicine</subject><subject>Mental disorders</subject><subject>Mental health</subject><subject>Misrepresentation</subject><subject>Mothers</subject><subject>Narratives</subject><subject>Pain</subject><subject>Pediatrics</subject><subject>Qualitative research</subject><subject>Scripts</subject><subject>Sensitization</subject><subject>Teams</subject><subject>Teenagers</subject><issn>0145-2134</issn><issn>1873-7757</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><sourceid>BHHNA</sourceid><recordid>eNpdkUtLAzEUhYMoWKv_wEXAjZupeUwmqTspvqDgRtchk9zBlHQyJjPF-utNqSvv4l449-Nw4CB0TcmCEtrcbRb205t2WjDCWJGEVOoEzaiSvJJSyFM0I7QWFaO8PkcXOW9IGSHFDG3fPwHHHaRgBhw7vAXnrQm4GAaHi2cGbHqHLfRjKnqGPvvR_5jRxx77HhsXA-TDO9_jhx7D9xBiMmNMe_w1meDHgu4A53Fy-0t01pmQ4ervztHH0-P76qVavz2_rh7WleWUjZWytuWsIx1zTetoIzlnTi7NkreuUWVbK6QRQGwHhHYOjBU1Nc4QpVwNLZ-j26PvkOLXBHnUW18yhmB6iFPWrFnWNRVkqQp68w_dxCn1JZ1mkjKlJCGyUPWRsinmnKDTQ_Jbk_aaEn3oQG_0sQN96EAfO-C_-sl-pQ</recordid><startdate>20221001</startdate><enddate>20221001</enddate><creator>Johnson, Katie L.</creator><creator>Wilkins, Stephanie N.</creator><creator>Brown, Emily C.B.</creator><creator>Tham, See Wan</creator><creator>Walco, Gary A.</creator><creator>Feldman, Kenneth W.</creator><creator>Wiester, Rebecca</creator><creator>Qu, Pingping</creator><creator>Campbell, Kristine A.</creator><general>Elsevier Science Ltd</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7U3</scope><scope>7U4</scope><scope>BHHNA</scope><scope>DWI</scope><scope>K7.</scope><scope>K9.</scope><scope>WZK</scope><scope>7X8</scope></search><sort><creationdate>20221001</creationdate><title>The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study</title><author>Johnson, Katie L. ; Wilkins, Stephanie N. ; Brown, Emily C.B. ; Tham, See Wan ; Walco, Gary A. ; Feldman, Kenneth W. ; Wiester, Rebecca ; Qu, Pingping ; Campbell, Kristine A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c312t-8ccb32f0f2d6bd167332d79a93bd6893bcc57a5e0cfe01fdeac541ada088d4eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adolescents</topic><topic>Caregivers</topic><topic>Catastrophic reactions</topic><topic>Child Abuse</topic><topic>Child abuse & neglect</topic><topic>Children</topic><topic>Chronic pain</topic><topic>Coding</topic><topic>Content analysis</topic><topic>Convergence</topic><topic>Disability</topic><topic>Health care</topic><topic>Health services</topic><topic>Health services utilization</topic><topic>Health status</topic><topic>Help seeking behavior</topic><topic>Home education</topic><topic>Interdisciplinary aspects</topic><topic>Maternal characteristics</topic><topic>Medical referrals</topic><topic>Medical Services</topic><topic>Medicine</topic><topic>Mental disorders</topic><topic>Mental health</topic><topic>Misrepresentation</topic><topic>Mothers</topic><topic>Narratives</topic><topic>Pain</topic><topic>Pediatrics</topic><topic>Qualitative research</topic><topic>Scripts</topic><topic>Sensitization</topic><topic>Teams</topic><topic>Teenagers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Johnson, Katie L.</creatorcontrib><creatorcontrib>Wilkins, Stephanie N.</creatorcontrib><creatorcontrib>Brown, Emily C.B.</creatorcontrib><creatorcontrib>Tham, See Wan</creatorcontrib><creatorcontrib>Walco, Gary A.</creatorcontrib><creatorcontrib>Feldman, Kenneth W.</creatorcontrib><creatorcontrib>Wiester, Rebecca</creatorcontrib><creatorcontrib>Qu, Pingping</creatorcontrib><creatorcontrib>Campbell, Kristine A.</creatorcontrib><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Social Services Abstracts</collection><collection>Sociological Abstracts (pre-2017)</collection><collection>Sociological Abstracts</collection><collection>Sociological Abstracts</collection><collection>ProQuest Criminal Justice (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Sociological Abstracts (Ovid)</collection><collection>MEDLINE - Academic</collection><jtitle>Child abuse & neglect</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Johnson, Katie L.</au><au>Wilkins, Stephanie N.</au><au>Brown, Emily C.B.</au><au>Tham, See Wan</au><au>Walco, Gary A.</au><au>Feldman, Kenneth W.</au><au>Wiester, Rebecca</au><au>Qu, Pingping</au><au>Campbell, Kristine A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study</atitle><jtitle>Child abuse & neglect</jtitle><date>2022-10-01</date><risdate>2022</risdate><volume>132</volume><spage>105788</spage><epage>105788</epage><pages>105788-105788</pages><artnum>105788</artnum><issn>0145-2134</issn><eissn>1873-7757</eissn><abstract>Background: Both medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations. Objective: This study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. Participants and setting: Participants were 28 adolescents (ages 13–18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively. Methods: This was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence. Results: Several themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care. Conclusions: This exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup.</abstract><cop>Oxford</cop><pub>Elsevier Science Ltd</pub><doi>10.1016/j.chiabu.2022.105788</doi><tpages>1</tpages></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Elsevier ScienceDirect Journals; Sociological Abstracts |
| subjects | Adolescents Caregivers Catastrophic reactions Child Abuse Child abuse & neglect Children Chronic pain Coding Content analysis Convergence Disability Health care Health services Health services utilization Health status Help seeking behavior Home education Interdisciplinary aspects Maternal characteristics Medical referrals Medical Services Medicine Mental disorders Mental health Misrepresentation Mothers Narratives Pain Pediatrics Qualitative research Scripts Sensitization Teams Teenagers |
| title | The overlap of medical child abuse and central sensitization in adolescents: An exploratory qualitative study |
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