Brain mediators of negative affect-induced physical symptom reporting in patients with functional somatic syndromes.

Functional somatic syndromes (FSS) include fibromyalgia, irritable bowel syndrome (IBS), and others. In FSS patients, merely viewing negative affective pictures can elicit increased physical symptoms. Our aim was to investigate the neural mechanisms underlying such negative affect-induced physical symptoms in FSS patients. Thirty patients with fibromyalgia and/or IBS and 30 healthy controls (all women) watched neutral, positive and negative affective picture blocks during functional MRI scanning and rated negative affect and physical symptoms after every block. We compared brain-wide activation during negative versus neutral picture viewing in FSS patients versus controls using robust general linear model analysis. Further, we compared neurologic pain signature (NPS), stimulus intensity-independent pain signature (SIIPS) and picture-induced negative emotion signature (PINES) responses to the negative versus neutral affect contrast and investigated whether they mediated between-group differences in affective picture-induced physical symptom reporting. More physical symptoms were reported after viewing negative compared to neutral pictures, and this effect was larger in patients than controls (p = 0.025). Accordingly, patients showed stronger activation in somatosensory regions during negative versus neutral picture viewing. NPS, but not SIIPS nor PINES, responses were higher in patients than controls during negative versus neutral pictures (p = 0.026). These differential NPS responses partially mediated between-group differences in physical symptoms. In conclusion, picture-induced negative affect elicits physical symptoms in FSS patients as a result of activation of somatosensory and nociceptive brain patterns, supporting the idea that affect-driven alterations in processing of somatic signals is a critical mechanism underlying FSS.

The Effects of Age, Biological Maturation and Sex on the Development of Executive Functions in Adolescents.

The development of executive functions (EF) has been widely investigated and is associated with various domains of expertise, such as academic achievement and sports performance. Multiple factors are assumed to influence the development of EF, among them biological maturation. Currently the effect of biological maturation on EF performance is largely unexplored, in contrast to other domains like physical development or sports performance. Therefore, this study aimed (a) to explore the effect of chronological age on EF performance and (b) to investigate to what extent age-related changes found in EF are affected by biological maturation on both sexes. To this end, EF performance and degree of maturity, indexed by percentage of predicted adult height (%PAH), of 90 adolescents (11-16 years old, 54% males) were measured on three occasions in a time frame of 12 months. A Generalized Estimating Equation (GEE) approach was used to examine the association between chronological age and %PAH and the weighted sum scores for each EF component (i.e., inhibition, planning, working memory, shifting). All models were run separately for both sexes. The males' results indicated that EF performance improved with age and degree of maturity on all four components. Interaction effects between age and %PAH on inhibition showed that at a younger age, males with a higher %PAH had a lower chance of performing well on inhibition, whereas at later ages, males with a higher %PAH had a higher chance to have a good inhibition performance. For working memory, it seems that there is no maturity effect at a younger age, while at later ages, a disadvantage for later maturing peers compared to on-time and earlier maturing male adolescents emerged. Females showed slightly different results. Here, age positively influenced EF performance, whereas maturity only influenced inhibition. Interaction effects emerged for working memory only, with opposite results from the males. At younger ages, females with lower %PAH values seem to be scoring higher, whereas at later ages, no maturity effect is observed. This study is one of the first to investigate the effect of biological maturation on EF performance, and shows that distinct components of EF are influenced by maturational status, although the effects are different in both sexes. Further research is warranted to unravel the implications for maturation-driven effects on EF that might significantly affect domains of human functioning like academic achievement and social development.

Validation of a Motor Competence Assessment Tool for Children and Adolescents (KTK3+) With Normative Values for 6- to 19-Year-Olds.

The use of the short form of the Körperkoordinationstest für Kinder (KTK3) to evaluate children's and adolescents' motor competence (MC) is increasing. When combined with an alternating one-handed catching and throwing ball task, assessing eye-hand coordination (EHC), it has been shown that the different aspects of motor skills are adequately covered in one compact KTK3+ test battery, studied in 6- to 10-year-old children. The present study aimed to validate the KTK3+ test battery and to provide contemporary MC normative values for boys and girls from 6- to 19-year-olds. A total of 2,271 children and adolescents (1,112 boys, 1,159 girls) participated in this study and were evaluated on the four included test items: jumping sideways (JS), moving sideways (MS), balancing backwards (BB), supplemented by an EHC task. Children's participation in organised sport was registered using a demographic questionnaire. For the first objective, a factor analysis with multidimensional scaling demonstrated that the one-dimensional model provided the best fit, with all test items correlating to the same latent construct: "MC". This was further supported with moderate to good correlations between all four test items (r = 0.453-0.799). Construct validity was investigated with a three-way MANOVA, demonstrating a significant multivariate interaction effect between sex and age group (p = 0.001) as well as a multivariate main effect of sex, age group, and organised sport participation (p < 0.001). Boys outperformed girls on two out of the four tests (JS and EHC, p < 0.005), while girls were better than boys on the BB test (p < 0.005). Performance scores increased across age groups on all tests (p < 0.001). Only for the BB test score, a plateau effect was noted around the age of 12 years. Children and adolescents participating in sports generally outperformed their peers who were not involved in organised sports, on the present KTK3+ test battery. For the second objective, raw score normative values are provided separately for both sexes between 6- to 19-year-olds. In combination with the one-factor structure confirmation, these sex, age, and sport participation effects demonstrate the validity of the test battery. The provided normative values are useful to evaluate MC in children and adolescents from 6 to 19 years old. The use of only four test items that are identical across all ages makes the KTK3+ test battery a practical instrument to assess and compare MC development.

Differences in Weight Status and Autonomous Motivation towards Sports among Children with Various Profiles of Motor Competence and Organized Sports Participation.

This study aimed (1) to identify profiles in children based on actual motor competence (AMC), perceived motor competence (PMC), and organized sports participation (OSP), and (2) to examine differences among these profiles in weight status as well as autonomous motivation towards sports. Children's (N = 206; 112 boys; Mage = 10.83 ± 0.92 years) AMC, PMC, OSP, weight status, and autonomous motivation towards sports were measured using validated assessment tools. Cluster analyses identified three profiles with completely convergent levels of AMC, PMC, and OSP and three profiles with partially convergent levels. Children in the convergent profiles with average to high levels of AMC, PMC, and OSP had the most optimal profile, as they combined a healthier weight status with elevated levels of autonomous motivation, while the opposite was true for children with low levels on all three cluster-variables. Partially convergent profiles showed that AMC and PMC appear crucial for weight status, as profiles with relatively low levels of AMC and PMC had the highest weight status, independent of their OSP levels. Overall, the findings highlight the importance of promoting AMC, PMC, and OSP simultaneously to help children in achieving a healthy weight status and being autonomously motivated towards OSP.

Long-term effectiveness of a fundamental motor skill intervention in Belgian children: A 6-year follow-up.

The aim of this study was (1) to examine the long-term effectiveness of the "Multimove for Kids" program, a 30-week fundamental motor skill intervention (approximately 1 hour per week) for typically developing children between 3 and 8 years, and (2) to determine the influence of participation in organized sports on motor competence (MC) six years after the intervention. Of the 992 children who took part in the "Multimove" program, 399 (intervention group: N = 228, control group: N = 171) were tested again at 6-year follow-up. MC was measured with the Test of Gross Motor Development, 2nd Edition. To examine the long-term impact of "Multimove" on MC, and the effect of participation in organized sports a latent growth curve analysis was conducted. After the 30-week intervention, the intervention group outperformed the control group (ß = 5.57, P < .001). However, when the entire study period, including the 6-year follow-up, was considered, the intervention group made less progress in MC than the control group (ß = -0.41, P < .05). Looking at the engagement in organized sports, it was found that years of experience before the intervention had no significant influence on the evolution of MC over time, whereas a positive effect was observed for children's average sports participation (h/week) during the 6-year retention period (ß = 0.14, P < .001). Finally, children practicing predominantly object control-oriented sports during retention obtained slightly better MC scores at follow-up (ß = 0.01, P < .01). The "Multimove" intervention does not have a long-term effect on the development of MC. However, participation in organized sports has a positive influence on MC evolution over time.

Developmental Change in Motor Competence: A Latent Growth Curve Analysis.

BACKGROUND: The development of childhood motor competence demonstrates a high degree of inter-individual variation. Some children's competence levels increase whilst others' competence levels remain unchanged or even decrease over time. However, few studies have examined this developmental change in motor competence across childhood and little is known on influencing factors. AIM: Using latent growth curve modeling (LGCM), the present longitudinal study aimed to investigate children's change in motor competence across a 2-year timespan and to examine the potential influence of baseline weight status and physical fitness on their trajectory of change in motor competence. METHODS: 558 children (52.5% boys) aged between 6 and 9 years participated in this study. Baseline measurements included weight status, motor competence (i.e., Körperkoördinationstest für Kinder; KTK) and physical fitness (i.e., sit and reach, standing long jump and the 20 m shuttle run test). Motor competence assessment took place three times across a 2-year timespan. LGCM was conducted to examine change in motor competence over time. RESULTS: The analyses showed a positive linear change in motor competence across 2 years (ß = 28.48, p < 0.001) with significant variability in children's individual trajectories (p < 0.001). Girls made less progress than boys (ß = -2.12, p = 0.01). Children who were older at baseline demonstrated less change in motor competence (ß = -0.33, p < 0.001). Weight status at baseline was negatively associated with change in motor competence over time (ß = -1.418, p = 0.002). None of the physical fitness components, measured at baseline, were significantly associated with change in motor competence over time. CONCLUSION AND IMPLICATIONS: This longitudinal study reveals that weight status significantly influences children's motor competence trajectories whilst physical fitness demonstrated no significant influence on motor competence trajectories. Future studies should further explore children's differential trajectories over time and potential factors influencing that change.

Cortisol and Subjective Stress Responses to Acute Psychosocial Stress in Fibromyalgia Patients and Control Participants.

OBJECTIVE: Hypothalamic-pituitary-adrenal axis dysfunction may play a role in fibromyalgia (FM) pathogenesis but it remains understudied in this disorder. Furthermore, early childhood adversities (ECA) are common in FM, but whether they moderate stress reactivity is unknown. Hence, we investigated cortisol and subjective responses to acute psychosocial stress in FM and controls, while adjusting for ECA. METHODS: Twenty-seven female FM patients and 24 age-matched female controls were recruited in a tertiary care center and through advertisements, respectively. The Childhood Trauma Questionnaire was used to measure ECA history. Salivary cortisol levels and subjective stress ratings were measured at multiple time points before and after the Trier Social Stress Test (TSST) was administered. RESULTS: Significant main effects of group [F(1,43) = 7.04, p = .011, lower in FM] and ECA [F(1,43) = 5.18, p = .028, higher in participants with ECA] were found for cortisol responses. When excluding controls with ECA (n = 5), a significant group-by-time interaction was found [F(6,39) = 2.60, p = .032], driven by a blunted response to the stressor in FM compared with controls (p = .037). For subjective stress responses, a significant main effect of group [F(1,45) = 10.69, p = .002, higher in FM] and a trend toward a group-by-time interaction effect [F(6,45) = 2.05, p = .078, higher in FM 30 minutes before and 30 and 75 minutes after the TSST, and impaired recovery (difference immediately after - 30 minutes after the TSST) in FM] were found. CONCLUSIONS: Blunted cortisol responsivity to the TSST was observed in FM patients compared with controls without ECA. FM patients had higher subjective stress levels compared with controls, particularly at baseline and during recovery from the TSST. In FM patients, ECA history was not associated with cortisol or subjective stress levels or with responsivity to the TSST. Future research should investigate the mechanisms underlying hypothalamic-pituitary-adrenal axis dysregulation in FM.

Self-critical perfectionism predicts outcome in multidisciplinary treatment for chronic pain.

BACKGROUND: Self-critical perfectionistic personality features have been shown to influence the onset and perpetuation of pain symptoms. However, no study to date has investigated whether these personality features are associated with treatment response in chronic pain. METHODS: Using a naturalistic pre-post design, the present study examined the effect of self-critical perfectionism on treatment outcome in terms of self-reported pain. The study was conducted in a sample of 53 chronic non-cancer pain patients who followed Multidisciplinary Pain Education Program (MPEP), a brief, 2-week cognitive-behaviorally based psycho-educational intervention for chronic pain that was recently found to be effective in reducing pain severity. Pre- and post-treatment pain intensity levels were assessed with the visual analog scale of the McGill Pain Questionnaire-Short Form. RESULTS: Pretreatment self-critical perfectionism was significantly associated with negative treatment outcome, even after taking into account pretreatment levels of depression. CONCLUSION: Results suggest that self-critical perfectionistic personality features may negatively interfere with treatment response in patients with chronic pain. Thus, findings indicate that chronic pain patients with high levels of self-critical perfectionism may benefit less from brief interventions such as MPEP, and therefore may need more intensive and tailored treatment.

A multidimensional model of psychobiological interactions in functional dyspepsia: a structural equation modelling approach.

OBJECTIVE: Gastric sensorimotor function, abuse history, 'trait' and 'state' psychological factors and 'somatisation' all play a role in functional dyspepsia (FD) and its associated impaired quality of life (QoL), but their interplay remains poorly understood. We aimed to test a comprehensive, a priori hypothesised model of interactions between these dimensions in FD. DESIGN: In 259 FD patients, we studied gastric sensitivity with a barostat. We measured abuse history (sexual/physical, childhood/adulthood), 'trait' (alexithymia, trait anxiety) and 'state' (positive/negative affect, depression, panic disorder) psychological factors, somatic symptom reporting (somatic symptom count, dyspepsia, irritable bowel syndrome and fatigue symptoms) and QoL (physical, mental) using validated questionnaires. Confirmatory factor analysis (CFA) was used to assess whether four a priori hypothesised latent variables ('abuse', 'trait affectivity', 'state affect' and 'somatic symptom reporting') were adequately supported by the data. Structural equation modelling (SEM) was used to test the a priori hypothesised relationships between these latent variables and the observed variables gastric sensitivity and QoL. RESULTS: Both the CFA and SEM models fitted the data adequately. Abuse exerted its effect directly on 'somatic symptom reporting', rather than indirectly through psychological factors. A reciprocal relationship between 'somatic symptom reporting' and 'state affect' was found. Gastric sensitivity influences 'somatic symptom reporting' but not vice versa. 'Somatic symptom reporting' and 'trait affectivity' are the main determinants of physical and mental QoL, respectively. CONCLUSIONS: We present the first comprehensive model elucidating the complex interactions between multiple dimensions (gastric sensitivity, abuse history, 'state' and 'trait' psychological factors, somatic symptom reporting and QoL) in FD.

Multidisciplinary pain education program (MPEP) for chronic pain patients: preliminary evidence for effectiveness and mechanisms of change.

OBJECTIVE: There is a need for effective brief interventions in chronic pain patients, and the identification of mechanisms of change. METHOD: In the present study, we tested the effectiveness of MPEP (Multidisciplinary Pain Education Program), a very brief, four-session cognitive-behaviorally based psycho-educational intervention for chronic pain using a pre-and post-test design. In addition, pre- to post-treatment change scores were calculated to investigate factors associated with change in pain. Participants of the study were 53 patients with chronic non-cancer pain. Primary outcome measures were (1) pain severity, (2) health perception, and (3) severity of depression. Secondary outcome measures included factors that have been implicated in the maintenance of chronic pain and that might be associated with worse treatment outcome: (1) catastrophizing, (2) kinesiophobia, and (3) action-proneness. RESULTS: Findings provided preliminary evidence for the effectiveness of MPEP in that patients showed significant and clinically meaningful improvements in pain symptoms (F = 24.503, p < 0.001, d = 0.59) and action-proneness (F = 178.504, p < 0.001, d = 1.95), and small improvements in health perception (F = 7.116, p < 0.05, d = 0.30). Furthermore, results showed that changes in catastrophizing (ß = -0.455, p = 0.001) and severity of depression (ß = -0.300, p < 0.05) were independently and significantly associated with changes in pain. However, changes in health perception, kinesiophobia, and action-proneness were not significantly associated with changes in pain (ß = 0.203, ns; ß = 0.003, ns; and ß = 0.154, ns, respectively). Importantly, duration of chronic pain was not related to treatment outcome (ß = 0.070, ns). CONCLUSIONS: Overall, this study provides preliminary evidence for the effectiveness of MPEP and possible mechanisms through which MPEP is effective. Yet, further research is needed to investigate the efficacy of MPEP.