title: A developmental analysis of the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms in children versus adolescents with chronic pain or pain-related chronic illness.
abstract: The widely used Adult Responses to Children's Symptoms measures parental responses to child symptom complaints among youth aged 7 to 18 years with recurrent/chronic pain. Given developmental differences between children and adolescents and the impact of developmental stage on parenting, the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms with a pain-specific stem was examined separately in 743 parents of 281 children (7-11 years) and 462 adolescents (12-18 years) with chronic pain or pain-related chronic illness. Factor structures of the Adult Responses to Children's Symptoms beyond the original 3-factor model were also examined. Exploratory factor analysis with oblique rotation was conducted on a randomly chosen half of the sample of children and adolescents as well as the 2 groups combined to assess underlying factor structure. Confirmatory factor analysis was conducted on the other randomly chosen half of the sample to cross-validate factor structure revealed by exploratory factor analyses and compare it to other model variants. Poor loading and high cross-loading items were removed. A 4-factor model (Protect, Minimize, Monitor, and Distract) for children and the combined (child and adolescent) sample and a 5-factor model (Protect, Minimize, Monitor, Distract, and Solicitousness) for adolescents was superior to the 3-factor model proposed in previous literature. Future research should examine the validity of derived subscales and developmental differences in their relationships with parent and child functioning.
  
  
  CONCLUSIONS
  This article examined developmental differences in the structure of a widely used measure of caregiver responses to chronic pain or pain-related chronic illness in youth. Results suggest that revised structures that differ across developmental groups can be used with youth with a range of clinical pain-related conditions.
authors.affiliation: Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington. Electronic address: melanie.noel@seattlechildrens.org.
authors.forename: Melanie
authors.initials: M
authors.lastname: Noel
authors.affiliation: Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
authors.affiliation: Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Essner
authors.affiliation: Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Rona L
authors.initials: RL
authors.lastname: Levy
authors.affiliation: School of Social Work, University of Washington, Seattle, Washington.
authors.forename: Shelby L
authors.initials: SL
authors.lastname: Langer
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Sherman
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D002648:Child; D002657:Child Development; D002908:Chronic Disease; D059350:Chronic Pain; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology*; D011594:Psychometrics
keywords: Adult Responses to Children's Symptoms; Pediatric pain; adolescents; children; chronic pain; factor analysis; parental behaviors