title: Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain.
abstract: BACKGROUND
  Recurrent pain symptoms in children are associated with psychiatric comorbidities that could complicate treatment. We investigated the prevalence of psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain and evaluated the screening potential of the Strength and Difficulties Questionnaire compared with the Development and Well-Being Assessment (DAWBA).
  
  
  METHODS
  Eighty-three outpatients aged 5-17 years attending a tertiary medical center for a primary diagnosis of migraine (n = 32), tension-type headache (n = 32), or recurrent abdominal pain (n = 19), and 33 healthy matched controls completed the brief self-reporting Strength and Difficulties Questionnaire followed by the Development and Well-Being Assessment. Findings were compared among groups and between instruments.
  
  
  RESULTS
  The pain groups were characterized by a significantly higher number of Development and Well-Being Assessment diagnoses (range 0-11) than controls and a significantly greater prevalence (by category) of Development and Well-Being Assessment diagnoses (P < 0.001 for both). Anxiety and depression were the most prevalent Development and Well-Being Assessment diagnoses. Comorbidities were more severe in the headache groups than the controls (P < 0.001). In general, any diagnosis by the Development and Well-Being Assessment was associated with a significantly higher Strength and Difficulties Questionnaire score (P < 0.001). Abnormal scores on the emotional, conduct, and hyperactivity Strength and Difficulties Questionnaire scales were significantly predictive of a Development and Well-Being Assessment diagnosis (P < 0.003).
  
  
  CONCLUSIONS
  Children referred to specialized outpatient pediatric units for evaluation of recurrent pain are at high risk of psychopathology. The Strength and Difficulties Questionnaire may serve as a rapid cost-effective tool for initial screening of these patients.
authors.affiliation: Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ditti
authors.initials: D
authors.lastname: Machnes-Maayan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Maya
authors.initials: M
authors.lastname: Elazar
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ambulatory Day Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Zeharia
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
authors.forename: Orit
authors.initials: O
authors.lastname: Krispin
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ambulatory Day Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. Electronic address: eidlitz@post.tau.ac.il.
authors.forename: Tal
authors.initials: T
authors.lastname: Eidlitz-Markus
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008881:Migraine Disorders / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: Development and Well-Being Assessment (DAWBA); Strength and Difficulties Questionnaire (SDQ); children; psychiatric comorbidity; recurrent abdominal pain; recurrent headache