Pain in Youth with Cerebral Palsy: The Impact of Caregiver Mental Health, Parenting Style, and Protectiveness
Creators: name: Mueri, Kendra Arina
Publisher: name: Graduate Studies
Year: 2024
Subjects: subject: Cerebral Palsy
subject: Pain
subject: Parenting
subject: Mental Health
subject: Parenting Style
subject: Protectiveness
subject: Family Functioning
subject: Neurodiversity
subject: Educational Psychology

description: Background: Estimated to affect 2-3 in every 1000 livebirths, Cerebral palsy (CP) is one of the most common neurodevelopmental disabilities (NDDs) and causes of physical disability in childhood. One of the most common secondary conditions associated with CP is pain, which is reported to impact up to 75% of youth with CP. It is well-established that caregivers of youth with CP experience increased levels of stress due to unique caregiving responsibilities. In the general population, parenting elements such as mental health and pain-specific protectiveness have been found to influence youth chronic pain, including pain intensity, chronicity, and interference. Emerging literature in the general population also suggests that parenting style (e.g., authoritarian) may influence the development and maintenance of youth chronic pain. Although it is well known that parents have a profound impact on their children’s development and wellbeing, little is known about the role that parenting, including parenting styles, parent mental health, and pain-specific protectiveness, may have on pain outcomes in children and adolescents with CP. Understanding the associations between these parenting elements and youth pain outcomes provides valuable insight into modifiable factors that influence pain in youth with CP, which could inform targets for future psychoeducation and family-based interventions for these vulnerable youth. Objectives: The present study contributed to the literature on pain in children and adolescents with CP by 1) determining if parental mental health (i.e., depression and anxiety) was associated with child-reported pain (pain severity, pain-interference), 2) determining if parental protectiveness mediated the proposed associations between parent mental health and child pain (pain severity, pain-interference), 3) determining if parenting style (i.e., authoritarian, authoritative, permissive) was associated with child-reported pain (pain severity, pain-interference), and 4) determining if parental protective-responses mediated the proposed associations between parenting styles (i.e., authoritative, authoritarian, permissive) and child-reported pain (pain severity, pain-interference). Methods: Forty-three youth between the ages of 8 and 17 years (M = 11.51, SD = 2.63, 41.02% female) and one of their caregivers completed cross-sectional measures. Caregivers completed measures of caregiver mental health, parenting style, and pain-specific protectiveness, while youth completed measures of pain (e.g., intensity, interference). A series of linear regression analyses were conducted to determine if caregiver mental health (i.e., depression, anxiety) and parenting style (i.e., authoritarian, authoritative, permissive) predicted youth pain outcomes (i.e., pain intensity, pain interference). Lastly, mediation analyses were conducted to examine the mediating role of pain-specific protectiveness in the proposed associations. Results: Youth reported mean pain intensity levels of 3.69/10 (SD = 2.41), and a mean pain interference T-score of 51.75 (SD = 9.66). Most participants reported experiencing pain in their legs (n = 23, 58.97%) and muscles/joints (n = 11, 28.20%). Caregivers reported on the following parenting styles: authoritative parenting style (M = 110.51/135, SD = 9.95, range = 91-131), authoritarian (M = 34.70/100, SD = 6.81, range = 25-52), and permissive (M = 28.49/75, SD = 5.36, range = 18-42). Caregivers reported average anxiety symptoms of 50.60/83.1 (T-score; SD = 8.74, range = 37-67) and average depressive symptoms of 50.74/81.3 (T-score; SD = 8.33, range = 38-69). When controlling for covariates (GMFCS level, youth age, youth sex, and caregiver age), authoritarian parenting style significantly predicted youth pain interference. When controlling for covariates (GMFCS level, youth age, youth sex, and caregiver age), both caregiver anxiety and caregiver depression significantly predicted youth pain interference. The remainder of caregiver variables did not predict youth pain intensity nor pain interference. Conclusions: This study is the first of its kind to examine the influence of key parenting elements (e.g., parenting style, mental health, pain-specific protectiveness) on the pain outcomes of youth with CP. Results demonstrate that higher levels of authoritarian parenting style, caregiver depressive symptoms, and caregiver anxiety symptoms is significantly associated with higher levels of youth pain interference. The findings of this study provide valuable insights into the role that parenting has on the pain experience of youth with CP and can be used to inform psychoeducational targets for family-based interventions to continue supporting and promoting healthy functioning and wellbeing in this vulnerable population.