Fahrenkamp, Amy J.

AbstractObjectiveYouth with chronic orthostatic intolerance (OI) can experience significant physical, social, and academic functional debilitation. Previous studies have indicated associations among symptom severity, psychosocial factors, and functional disability. However, empirically tested models explaining how different medical and psychosocial factors may contribute to functional disability are lacking. The current cross-sectional study aimed to evaluate mediation, moderation, and additive models of the effect of physical symptoms and psychological distress on functional disability.MethodsOne hundred and sixty-five youth (13–22 years old) undergoing medical evaluation of chronic OI symptoms completed measures of autonomic dysfunction symptom severity, depressive and anxiety symptoms, and functional disability. Models were evaluated using tests of indirect effects and linear and logistic regression analyses.ResultsResults supported the mediation and additive effects models for depressive symptoms. Mediation, moderation, and additive models for hypothesized effects of anxiety symptoms were not supported.ConclusionsResults provide preliminary support for models in which OI symptoms affect functional debility via their effects on mood and in which depressive symptoms have unique and additive effects on functioning. Findings lay the foundation for longitudinal and experimental evaluation of biopsychosocial models of functional disability in youth with chronic OI and related conditions. Implications include the importance of a biopsychosocial conceptualization of OI symptoms and debility as a complex interplay of factors rather than as a purely physiological or psychological process.

Among adolescents with fatigue and postural dizziness, it is unclear how health behaviors and emotional distress relate to the presence of excessive postural tachycardia. We prospectively evaluated adolescents aged 13-22 years presenting with symptoms suggestive of autonomic dysfunction between September 2017 and December 2018. Patients underwent standard 10-minute, 70-degree head-up tilt testing. Clinician diagnoses and recommendations were recorded from the medical record. Patients completed validated self-report measures of lifestyle factors, autonomic symptoms, depression, anxiety, and functional disability. Of 179 patients, 58 were diagnosed with postural orthostatic tachycardia syndrome and 59 had excessive postural tachycardia, with 90.5% concordance between the 2 groups. Presence of excessive postural tachycardia was associated with greater baseline fluid intake and likelihood of medication prescription in their treatment plan. Medication findings were replicated for postural orthostatic tachycardia syndrome diagnosis. Presence of excessive postural tachycardia or postural orthostatic tachycardia syndrome did not differentiate patients on perceived symptom severity, emotional distress, disability, or health behaviors but did appear to determine treatment recommendations.

Food cravings have been associated with problematic eating behaviors, such as emotional eating. Late adolescence is an important developmental period to examine this association, as late adolescents have greater independence in food choices as well as potentially higher demands during a transitional period of their lives. Mechanisms underlying the association between food cravings and problematic eating remain unclear. This study examined whether experiential avoidance (EA) may be one possible mechanism mediating the association between higher levels of food cravings and problematic eating behaviors. Late adolescents (n = 174) completed measures assessing EA, food cravings, and three problematic eating behaviors: emotional eating, cognitive restraint, and uncontrolled eating. Height and weight were measured objectively to calculate body mass index (BMI). Food cravings were positively associated with emotional eating and mediated by EA. EA also significantly mediated the association between greater cognitive restraint and greater food cravings. No significant mediation was detected for food cravings and uncontrolled eating. Future research may consider EA as a treatment target in intervention strategies for late adolescents seeking to decrease emotional or restrained eating behaviors.

Biofeedback is 1 form of complementary therapy commonly used to treat pediatric chronic pain. Given the limited research in biofeedback treatment outcomes with youth experiencing chronic pain, the present study sought to initially examine the potential for heart rate variability (HRV) biofeedback to support self-regulation training for adolescents participating in a chronic pain rehabilitation program. Using a case series design, this study examined changes in HRV and respiration rate for 4 adolescents with chronic pain. Adolescents completed an initial assessment followed by 3–4 biofeedback training sessions. The Nexus 10 biofeedback system (BioTrace+ software) was used to obtain respiration rate and HRV low-frequency percentage. Visual inspection of plotted graphs from adolescents’ HRV biofeedback training demonstrated (a) improved cardiopulmonary functioning across sessions during active training, (b) changed cardiopulmonary functioning across sessions during baseline assessment, and (c) improved functioning without active feedback, suggesting self-regulation of cardiopulmonary functioning. Adolescents using a brief protocol of HRV biofeedback training demonstrated expected changes in cardiopulmonary functioning and self-regulation. Similar to findings in adults, HRV biofeedback yields promise as an intervention to treat children with chronic pain and comorbid symptoms. However, because this is an initial study, additional research with more rigorous methodology is needed to further support the benefit of HRV biofeedback in modifying physiological awareness and self-regulation and the connection of this self-regulation with clinical outcomes. Future clinical research should build on these initial findings to develop and test biofeedback protocols to treat chronic pain in children. Implications for Impact Statement Findings from this case series design showed initial benefits in increasing adolescents’ physiological self-regulation skills. Providers may draw clinical applications from these self-regulation techniques within and outside of a biofeedback context to teach increased awareness, control, and generalization of self-regulatory skills to cope with negative experiences.