{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T12:01:28Z","timestamp":1789300888140,"version":"build-2803163510"},"reference-count":51,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is a blended, digital, and live cognitive behavioral therapy program for children with functional abdominal pain disorder (FAPDs) and anxiety. Initially developed and evaluated in US pediatric gastroenterology settings, a culturally refined version was developed in Swedish, for potential use within community-based pediatric health care settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate a modified version of ADAPT as an early intervention for FAPD within a community-based pediatric setting in Sweden, exploring both the potential treatment effect and participants\u2019 treatment experience.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Participants were aged 9\u201014 years, and all were diagnosed with FAPD. Using a mixed methods design, the study examined the preliminary effect through a single-arm pre-posttest and treatment experience through semistructured child interviews. Data were analyzed in three steps: nonparametric quantitative analysis of results on pre- and postintervention measures of self-rated pain-related functional disability, pain intensity, and anxiety; thematic qualitative analysis of the interviews; and conversion of qualitative data to enable both datasets to be analyzed and presented together.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 13 children (12 girls) participated in ADAPT, all completing the program. In total, 7 of the invited 13 participating children agreed to be interviewed following intervention completion. Quantitative results were analyzed using the Wilcoxon signed rank test, and Pearson\n r<\/jats:italic>\n was used to calculate the effect size. Results showed a significant reduction in pain-related functional disability, with a median decrease from 14.00 (IQR 10\u201020) preintervention, to 5.00 (IQR 1\u20109) postintervention (\n P<\/jats:italic>\n =.04), a large effect size,\n r<\/jats:italic>\n =\u22120.58, and 46% (n=6) achieving a clinically meaningful change where a Functional Disability Inventory (FDI) score decrease of \u22657.8 points denoted a clinically meaningful treatment response. Pain intensity also significantly decreased from a median of 6.5 (IQR 5.25\u20108) to 4.00 (IQR 2.5\u20106.5;\n P<\/jats:italic>\n =.02), a large effect size\n r<\/jats:italic>\n =\u22120.70, with 33% (n=4) experiencing at least a 50% reduction. Clinically meaningful change was determined to be present if at least a 50% reduction in self-rated measures of pain intensity was observed. Qualitative thematic analysis identified three themes: \u201cStarting from scratch,\u201d \u201cExperiencing the treatment,\u201d and \u201cGetting on with life.\u201d In terms of treatment experience, the blended live or digital format was perceived as a good fit for youth. Most children described finding some strategy that was effective and reported positive outcomes, such as increased participation in school.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n As patient experiences were predominantly positive and quantitative results indicative of potential for increased function and reduced pain, our findings suggest that ADAPT may present as a possible early treatment option for FAPD in a Swedish community\u2013based pediatric setting. To draw robust conclusions on effectiveness, further research is required using a larger sample size, as well as research aimed at following up treatment effects over time.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/67106","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T20:43:30Z","timestamp":1755722610000},"page":"e67106-e67106","source":"Crossref","is-referenced-by-count":4,"title":["ADAPTed Cognitive Behavioral Therapy for Pediatric Functional Abdominal Pain in Community-Based Pediatric Care: Mixed Methods Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9406-0227","authenticated-orcid":false,"given":"Emma","family":"Ramsay Milford","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9866-8436","authenticated-orcid":false,"given":"Sandra","family":"Buratti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1788-7264","authenticated-orcid":false,"given":"Natoshia R","family":"Cunningham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9346-0115","authenticated-orcid":false,"given":"\u00c5sa","family":"Nilses","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4051-7031","authenticated-orcid":false,"given":"Ewa-Lena","family":"Bratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2428-4004","authenticated-orcid":false,"given":"Sandra","family":"Weineland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1038\/s41572-020-00222-5","article-title":"Paediatric functional abdominal pain disorders","volume":"6","author":"Thapar","journal-title":"Nat Rev Dis Primers"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2017.12.012","article-title":"Prevalence of pediatric functional gastrointestinal disorders utilizing the Rome IV criteria","volume":"195","author":"Robin","journal-title":"J Pediatr"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1097\/10.chi.0000214192.57993.06","article-title":"Trajectories of symptoms and impairment for pediatric patients with functional abdominal pain: a 5-year longitudinal study","volume":"45","author":"Mulvaney","journal-title":"J Am Acad of Child Adolesc Psychiatry"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.jpeds.2008.09.047","article-title":"A prospective school-based study of abdominal pain and other common somatic complaints in children","volume":"154","author":"Saps","journal-title":"J Pediatr"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1542\/peds.2012-2191","article-title":"Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders","volume":"132","author":"Shelby","journal-title":"Pediatrics"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.pain.2007.10.032","article-title":"The frequency, trajectories and predictors of adolescent recurrent pain: a population-based approach","volume":"138","author":"Stanford","journal-title":"Pain"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1016\/j.pain.2010.06.018","article-title":"Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood","volume":"150","author":"Walker","journal-title":"Pain"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1111\/j.1365-2214.2010.01087.x","article-title":"Functional disability in paediatric patients with recurrent abdominal pain","volume":"36","author":"Wendland","journal-title":"Child Care Health Dev"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1097\/MPG.0000000000001342","article-title":"Risk categorization predicts disability in pain-associated functional gastrointestinal disorders after 6 months","volume":"64","author":"Cunningham","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.01.018","article-title":"Anxiety adversely impacts response to cognitive behavioral therapy in children with chronic pain","volume":"171","author":"Cunningham","journal-title":"J Pediatr"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/MPG.0b013e31828b3681","article-title":"Importance of addressing anxiety in youth with functional abdominal pain: suggested guidelines for physicians","volume":"56","author":"Cunningham","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-021-05776-5","article-title":"Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders","volume":"14","author":"Moorman","journal-title":"BMC Res Notes"},{"issue":"5","key":"R13","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1016\/j.jpeds.2015.07.058","article-title":"Annual costs of care for pediatric irritable bowel syndrome, functional abdominal pain, and functional abdominal pain syndrome","volume":"167","author":"Hoekman","journal-title":"J Pediatr"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-019-0985-1","article-title":"Economic burden of moderate to severe irritable bowel syndrome with constipation in six European countries","volume":"19","author":"Tack","journal-title":"BMC Gastroenterol"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010973.pub2","article-title":"Pharmacological interventions for recurrent abdominal pain in childhood","volume":"3","author":"Martin","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"R16","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008013.pub3","article-title":"Antidepressants for functional abdominal pain disorders in children and adolescents","volume":"2","author":"de Bruijn","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012849.pub2","article-title":"Probiotics for management of functional abdominal pain disorders in children","volume":"2023","author":"Gordon","journal-title":"Cochrane Database Syst Rev"},{"issue":"6","key":"R18","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1001\/jamapediatrics.2022.0313","article-title":"Psychosocial interventions for the treatment of functional abdominal pain disorders in children: a systematic review and meta-analysis","volume":"176","author":"Gordon","journal-title":"JAMA Pediatr"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2020.10.060","article-title":"Cognitive behavior therapy tailored to anxiety symptoms improves pediatric functional abdominal pain outcomes: a randomized clinical trial","volume":"230","author":"Cunningham","journal-title":"J Pediatr"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1038\/ajg.2016.503","article-title":"Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome: a randomized controlled trial","volume":"112","author":"Bonnert","journal-title":"Am J Gastroenterol"},{"issue":"11","key":"R21","doi-asserted-by":"publisher","first-page":"2236","DOI":"10.1016\/j.cgh.2018.11.043","article-title":"Clinical and cost effectiveness of online cognitive behavioral therapy in children with functional abdominal pain disorders","volume":"17","author":"Lalouni","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/MPG.0000000000001714","article-title":"Development of the aim to decrease anxiety and pain treatment for pediatric functional abdominal pain disorders","volume":"66","author":"Cunningham","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1002\/art.30644","article-title":"Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial","volume":"64","author":"Kashikar-Zuck","journal-title":"Arthritis Rheum"},{"key":"R24","unstructured":"Lyneham HJ Abbott MJ Wignall A Rapee RA . The Cool Kids Anxiety Treatment Program. MUARU, Macquarie University; 2003."},{"issue":"2","key":"R25","doi-asserted-by":"publisher","DOI":"10.3390\/children4020009","article-title":"Evidence-based psychological interventions for the management of pediatric chronic pain: new directions in research and clinical practice","volume":"4","author":"Coakley","journal-title":"Children (Basel)"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1097\/MPG.0000000000000625","article-title":"Concordant parent-child reports of anxiety predict impairment in youth with functional abdominal pain","volume":"60","author":"Cunningham","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"6","key":"R27","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1111\/apt.13738","article-title":"Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study","volume":"44","author":"Koloski","journal-title":"Aliment Pharmacol Ther"},{"issue":"12","key":"R28","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1097\/AJP.0000000000000646","article-title":"Assessment of pain-related disability in pediatric chronic pain: a comparison of the functional disability inventory and the pediatric pain disability index","volume":"34","author":"Stahlschmidt","journal-title":"Clin J Pain"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2018.03.006","article-title":"The role of avoidance behavior in the treatment of adolescents with irritable bowel syndrome: a mediation analysis","volume":"105","author":"Bonnert","journal-title":"Behav Res Ther"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2020.110287","article-title":"Breaking the vicious circle of fear and avoidance in children with abdominal pain: a mediation analysis","volume":"140","author":"Lalouni","journal-title":"J Psychosom Res"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13538","article-title":"The role of psychological factors in pediatric functional abdominal pain disorders","volume":"31","author":"Newton","journal-title":"Neurogastroenterol Motil"},{"issue":"3","key":"R32","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.psc.2010.04.006","article-title":"The empirical status of the \u201cnew wave\u201d of cognitive behavioral therapy","volume":"33","author":"Hofmann","journal-title":"Psychiatr Clin North Am"},{"issue":"6","key":"R33","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1016\/j.cgh.2018.01.033","article-title":"Functional gastrointestinal disorders: all roads lead to prevention","volume":"16","author":"Lu","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"2","key":"R34","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1097\/MPG.0000000000003305","article-title":"Multidisciplinary care for refractory pediatric functional abdominal pain decreases emergency and inpatient utilization","volume":"74","author":"Chu","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2025.1576698","article-title":"Understanding functional abdominal pain disorders among children: a multidisciplinary expert consensus statement","volume":"13","author":"Vandenplas","journal-title":"Front Pediatr"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s40746-023-00288-9","article-title":"The approach to the management of a child with chronic abdominal pain","volume":"10","author":"Farrell","journal-title":"Curr Treat Options Peds"},{"issue":"9","key":"R37","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.1177\/13591053251320600","article-title":"I\u2019m a bit more free\u201d: lived symptom experiences in adolescents with functional abdominal pain disorders after internet-delivered psychological treatment","volume":"30","author":"S\u00f8gaard-Singh","journal-title":"J Health Psychol"},{"key":"R38","unstructured":"Creswell J Vicki LPC . Designing and Conducting Mixed Methods Research. 3rd ed. Sage Publications; 2017."},{"issue":"1-2","key":"R39","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.pain.2005.12.002","article-title":"Functional assessment of pediatric pain patients: psychometric properties of the functional disability inventory","volume":"121","author":"Claar","journal-title":"Pain"},{"issue":"7","key":"R40","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1016\/j.pain.2014.03.005","article-title":"Identifying treatment responders and predictors of improvement after cognitive-behavioral therapy for juvenile fibromyalgia","volume":"155","author":"Sil","journal-title":"Pain"},{"issue":"4","key":"R41","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1097\/00004583-199704000-00018","article-title":"The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics","volume":"36","author":"Birmaher","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.07.049","article-title":"Screening for childhood anxiety: a meta-analysis of the screen for child anxiety related emotional disorders","volume":"240","author":"Runyon","journal-title":"J Affect Disord"},{"issue":"3","key":"R43","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1097\/AJP.0000000000000667","article-title":"Clinical reference points for the screen for child anxiety-related disorders in 2 investigations of youth with chronic pain","volume":"35","author":"Cunningham","journal-title":"Clin J Pain"},{"issue":"9","key":"R44","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14636","article-title":"First study to assess the reliability of commonly used pain scales in children with disorders of gut-brain interaction","volume":"35","author":"Ginton","journal-title":"Neurogastroenterol Motil"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1007\/s10578-017-0746-8","article-title":"The validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and sub-scales in Swedish youth","volume":"49","author":"Ivarsson","journal-title":"Child Psychiatry Hum Dev"},{"issue":"3","key":"R46","doi-asserted-by":"publisher","first-page":"116","DOI":"10.3109\/21679169.2015.1046486","article-title":"Psychometric properties of the Swedish version of the Functional Disability Inventory","volume":"17","author":"Lind","journal-title":"Eur J Physiother"},{"issue":"1","key":"R47","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1080\/00031305.1988.10475524","article-title":"Thirteen ways to look at the correlation coefficient","volume":"42","author":"Lee Rodgers","journal-title":"Am Stat"},{"issue":"2","key":"R48","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jpain.2007.09.005","article-title":"Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations","volume":"9","author":"Dworkin","journal-title":"J Pain"},{"issue":"8","key":"R49","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/j.jaac.2017.05.018","article-title":"Establishing clinical cutoffs for response and remission on the Screen for Child Anxiety Related Emotional Disorders (SCARED)","volume":"56","author":"Caporino","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"R50","unstructured":"Braun V Clarke V . Thematic Analysis: A Practical. Sage Publishing Ltd; 2021. ISBN: 9781473953246"},{"issue":"7","key":"R51","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1016\/j.acap.2021.06.002","article-title":"Addressing pediatric mental health using telehealth during coronavirus disease-2019 and beyond: a narrative review","volume":"21","author":"Cunningham","journal-title":"Acad Pediatr"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e67106","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:12Z","timestamp":1785536892000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e67106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":51,"URL":"https:\/\/doi.org\/10.2196\/67106","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]},"article-number":"v9i1e67106"}}