These data demonstrate that mothers’ reports of the extent to which they are usually protective in response to their children’s pain complaints, assessed by the ARCS questionnaire, are strongly associated with their reports of protective responses to specific instances of their children’s pain complaints during a month of daily diary assessments. Furthermore, mothers who obtained high scores on the Protect scale of the ARCS made significantly more HMO clinic visits and had higher health care costs for their children’s abdominal symptoms during the subsequent year than mothers who obtained low scores on the Protect Scale of the ARCS. These findings demonstrate the stability of parental responses to their children’s abdominal pain over time and support the validity of the ARCS questionnaire.
The child report version of the ARCS showed a significant but modest correlation with the parent report ARCS (ρ = 0.338, P = 0.007), but did not correlate significantly with the parent-report ARCS-diary (ρ = 0.141, NS). We conclude that the parent report version of the ARCS more accurately reflects the behaviors of parents in response to children’s somatic complaints. We speculate that children, especially young children, may have difficulty critically evaluating the behavior of their parents and/or they may have difficulty with the level of abstraction demanded by the ARCS.
When the demographic characteristics of the mothers in the High and Low Protect groups were compared, we observed that the mothers in the High Protect groups were more likely to come from ethnic minorities (especially Asian and Hispanic), and they tended to be younger and to have terminated their education earlier. These differences suggest that there are cultural differences in the ways parents respond to the somatic complaints of their children, including what behaviors they consider to be normal and appropriate. The data also suggest that there may be socioeconomic differences in the ways mothers respond to their children’s somatic complaints. These demographic differences must be considered when interpreting observed differences between parents in their responses to somatic complaints. Further research is needed to understand these cultural and socioeconomic associations.
The use of small samples is a limitation of this study. The sample size was sufficient to achieve the primary aim of testing the agreement between parent responses on the ARCS questionnaire and their subsequent responses on a daily diary. However, larger samples, including children with more frequent pain, would have made it possible to explore the relation of ARCS responses to child characteristics including sex and pain frequency. A second limitation was the relatively long interval between the completion of the ARCS questionnaire and the diary study. Changes in parent behavior or in the child’s health status between these 2 intervals may have contributed to measurement error. However, this long interval has the advantage of showing that behaviors of mothers toward their children’s abdominal pain complaints are relatively stable over time.
In addition to the support it provides for the validity of the parent report version of the ARCS, the study makes 2 important substantive contributions to the empirical literature on parental responses to children’s pain. First, the study is based on daily reports of behavior from a community sample of mothers who reported their responses to a pain complaint that is common even among healthy schoolchildren.16
Previous research in this area has been conducted in clinical settings with pediatric patients with chronic or acute procedural pain. Thus, results of this study suggest that it is possible to make meaningful discriminations between parents with different levels of protective responding to children’s everyday pain complaints in a nonclinical setting, and that this behavior is relatively stable during the course of a year.
Second, the study showed that mothers’ reports of protective responding to their children’s abdominal complaints at home predicted subsequent health service utilization when their children had abdominal complaints. This finding underscores that the tendency to respond in a protective way to children’s pain may be associated with a variety of parent behaviors ranging from relieving the child from chores at home, to taking the child to a medical clinic. Additional work is needed to extend this research to examine the effects of culture and sex on parents’ protective behavior.