Resilience factors in children with Juvenile Idiopathic Arthritis and their parents: the role of child and parent psychological flexibility.

Objective: Chronic pain is central to Juvenile Idiopathic Arthritis (JIA) and is predictive of
impaired functioning. Whereas most work has focused on identifying psychosocial risk factors
for maladaptive outcomes, we explored the idea that child and parental psychological flexibility
(PF) represent resilience factors for adaptive functioning of the child. We also explored
differences between general versus pain-specific PF in contributing to child outcomes.
Methods: Children with JIA (8-18 years) and (one of) their parents were recruited at the
department of pediatric rheumatology at the Ghent University Hospital in Belgium. They
completed questionnaires assessing child and parent general and pain-specific PF and child
psychosocial and emotional functioning, and disability.
Results: The final sample consisted of fifty-nine children and forty-eight parents. Multiple
regression analyses revealed that child PF contributed to better psychosocial functioning and less
negative affect. Child pain acceptance contributed to better psychosocial functioning, lower
levels of disability and lower negative affect, and also buffered against the negative influence of
pain intensity on disability. Bootstrap mediation analyses demonstrated that parental (general) PF
indirectly contributed to child psychosocial functioning and affect via the child’s (general) PF.
Parent pain-specific PF was indirectly linked to child psychosocial functioning, disability, and
negative affect via child pain acceptance.
Conclusion: Our findings indicate that child and parental PF are resilience factors and show that
pain acceptance buffers against the negative impact of pain intensity. Implications for
psychosocial interventions that target (pain-specific) PF in children as well as in parents are
discussed.