Social consequences of children's pain: When do they encourage symptom maintenance?

Objective: To examine the influence of social factors (e.g., attention, relief from responsibility) and children's perceived competence on pediatric symptom maintenance. Methods: Participants were 151 pediatric patients (ages 8-18) with recurrent abdominal pain. They were interviewed at a clinic visit and again 2 weeks later. The Social Consequences of Pain questionnaire assessed four types of social consequences: positive attention, negative attention, activity restriction, and privileges. Results: Two types of social consequences (positive attention and activity restriction) predicted greater symptom maintenance, but this effect was moderated by children's perceived self-worth and academic competence. To the extent that children rated their self-worth and academic competence as low, the impact of social factors on symptom maintenance was stronger. Conclusions: Children's success in their normal social roles may affect the extent to which they identify with the sick role and find it a rewarding alternative to other social roles.