Factor Structure of the Adult Responses to Children's Symptoms: Validation in Children and Adolescents With Diverse Chronic Pain Conditions

Objective: To examine how the Adult Responses to Children's Symptoms (ARCS) does in a sample of children and adolescents with a variety of complex chronic pain conditions and to further validate the ARCS by examining associations among the subscale scores and patients' functional disability and depressive symptoms. Methods: A retrospective chart review was conducted for patients from multidisciplinary pain clinics in 2 large urban children's hospitals. Patients completed self-report measures of their pain, functional disability, and symptoms of depression. Their parents completed a self-report measure assessing adult responses to children's pain complaints (ARCS). Results: Confirmatory factor analysis was used to establish a model that included the original 3 factors (Protect, Minimize, and Encourage/Monitor) and provided good fit to the data, with minor modifications to the original measure. As expected, parental protective behavior was associated with increased child disability. Parental protective behaviors also were linked to higher levels of child depressive symptoms and longer pain duration. Discussion: This study provides the first-known examination of the factor structure of the ARCS in a large sample of pediatric patients with diverse chronic pain conditions. Confirmatory factor analyses indicate that the ARCS is a valid measure for use with children and adolescents presenting to outpatient pain clinics with a variety of chronic pain complaints.