title: Adolescent autonomy and family functioning are associated with headache-related disability.
abstract: OBJECTIVE
  The aims of this study were to examine the relationships between a range of family factors, including autonomy and general family functioning, on headache outcomes (ie, pain and functional impairment) in adolescents with recurrent headaches.
  
  
  METHODS
  Forty nine adolescents, ages 11 to 16 years, (mean age=13.5 y, 63% female) receiving treatment through pediatric neurology for recurrent headaches were enrolled. Adolescents and their parents completed measures of pubertal status, pain, functional impairment, parental solicitousness, behavioral autonomy, depressive symptoms, and family functioning.
  
  
  RESULTS
  Lower levels of adolescent autonomy (r=0.53, P<0.01) and less healthy family functioning (r=0.32, P<0.01) were significantly related to higher levels of functional impairment. In multivariate regression analyses controlling for pain intensity, pubertal status, and depressive symptoms, parent and family variables added significant variance in the prediction of functional impairment (r change=0.21, P<0.05). Both adolescent autonomy (beta=0.38, P<0.05) and general family functioning (beta=0.34, P<0.05) were significant individual predictors of adolescent functional impairment.
  
  
  CONCLUSIONS
  This study extends research on family factors and adolescent headache-related pain and disability. Future research is needed to discover whether family based interventions helping adolescents to acquire appropriate and supportive levels of autonomy may be useful in reducing headache-related disability.
authors.affiliation: Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. palermot@ohsu.edu
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
authors.forename: Janel
authors.initials: J
authors.lastname: Putnam
authors.forename: Geniel
authors.initials: G
authors.lastname: Armstrong
authors.forename: Sarah
authors.initials: S
authors.lastname: Daily
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D003863:Depression / Q000523:psychology; D004185:Disability Evaluation; D005190:Family / Q000523:psychology*; D005260:Female; D020773:Headache Disorders / Q000523:psychology*; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000523:psychology; D010290:Parents / Q000523:psychology; D026684:Personal Autonomy; D011594:Psychometrics; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome