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Parental factors included emotional distress (SCL-8), health anxiety by proxy (HAPYs), and behavioral responses (Adult Responses to Child Symptoms Monitor and Protect subscales). Youth-reported outcomes included gastrointestinal symptoms (Pediatric Quality of Life Gastrointestinal Symptom Scale (PedsQL-Gastro)), pain intensity (Faces Pain Rating Scale-Revised), quality of life (PedsQL), gastrointestinal-anxiety (Visceral Sensitivity Index-Child adapted short scale), and avoidance\/control behaviors (BRQ-C). Associations were examined using Spearman\u2019s correlations and hierarchical linear regression models, adjusting for all parental factors and youth sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Most parents were mothers, highly educated, employed, cohabiting, with a middle to high household income. They generally reported low emotional distress, moderate health anxiety by proxy (HAPY) and monitoring behavior, and low protective behavior. Parental emotional distress and HAPY were significantly correlated with lower youth-reported quality of life and higher gastrointestinal-specific anxiety, particularly among adolescents. Monitoring behavior correlated with greater pain intensity, especially in children. In adjusted analyses, higher emotional distress remained significantly associated with lower youth-reported quality of life (\u03b2\u2009=\u2009\u20130.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and higher gastrointestinal-specific anxiety (\u03b2\u2009=\u20090.63,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). Monitoring behavior remained significantly associated with greater youth-reported pain intensity (\u03b2\u2009=\u20090.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). HAPY and protective behavior showed no significant independent associations with adverse youth outcomes. However, in age-stratified analyses, protective behavior was associated with fewer gastrointestinal symptoms in adolescents (\u03b2\u2009=\u20092.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). No notable significant sex differences were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Parental emotional distress and monitoring behavior were the most consistent parental factors associated with adverse youth outcomes and may represent key targets in intervention for pediatric FAPDs. The potential protective role of certain parental behaviors in adolescents warrants further exploration. Findings should be replicated in larger, more diverse samples.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562848251383414","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T08:44:18Z","timestamp":1759913058000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Parental distress and symptom severity in referred youths with functional abdominal pain disorders: a cross-sectional study prior to internet-based cognitive behavioral therapy"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0537-7494","authenticated-orcid":false,"given":"Eva","family":"Skovslund Nielsen","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, Aarhus N 8200, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N 8200, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2413-4586","authenticated-orcid":false,"given":"Karen Hansen","family":"Kalles\u00f8e","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6101-2150","authenticated-orcid":false,"given":"Anne Sofie","family":"Hansen","sequence":"additional","affiliation":[{"name":"Research Unit for Child and Adolescent Psychiatry, Psychiatry, Aalborg University Hospital, Aalborg, Denmark"},{"name":"Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9683-7416","authenticated-orcid":false,"given":"Lisbeth","family":"Frostholm","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"},{"name":"Department of Functional Disorders, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6818-8156","authenticated-orcid":false,"given":"Maria","family":"Lalouni","sequence":"additional","affiliation":[{"name":"Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Center for Epidemiology and Community Medicine, Health Care Services, Stockholm County, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0140-773X","authenticated-orcid":false,"given":"Marianne","family":"Bonnert","sequence":"additional","affiliation":[{"name":"Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7426-0353","authenticated-orcid":false,"given":"Charlotte Ulrikka","family":"Rask","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2016.02.032"},{"key":"e_1_3_4_3_2","first-page":"193","article-title":"The pediatric Rome IV criteria: what\u2019s new?","volume":"11","author":"Koppen IJ","year":"2017","unstructured":"Koppen IJ, Nurko S, Saps M, et al. 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