(PS5-97) Chronic Pain, School Attendance, and Internalizing Adjustment: Investigating the Impact of the COVID-19 Pandemic on Adolescents with Debilitating Chronic Pain or Autonomic Dysfunction

Chronic pain and autonomic dysfunction (CPAD) are common problems in pediatric patient populations (Huguet & Miro, 2008; Kizilbash et al., 2013). The biopsychosocial model emphasizes the influence of psychological and social forces alongside biological contributors to pain and chronic symptoms (Gatchel et al., 2007). Indeed, adolescents with CPAD frequently endorse psychological and social concerns such as lower quality of life (Gold et al., 2009), difficulty functioning in multiple domains (Liossi & Howard, 2016; McTate & Weiss, 2016), elevated anxiety/depressive symptoms (Benore et al., 2015; Kashikar-Zuck et al., 2001), and increased school difficulties/absenteeism compared to their symptom-free counterparts (Logan et al., 2017). Evidence suggests that restriction of school access and social interaction contributes to increased anxiety and reduced opportunities for cognitive and social development in adolescents (Kneale et al., 2020; Lee, 2020). Thus, the school closures due to the COVID-19 pandemic and shifts to online or hybrid school models after the pandemic may be contributing to increased internalizing disorders in adolescents. Accordingly, the current study examined the differences in internalizing adjustment and school attendance pre- and post-pandemic for adolescents with debilitating chronic pain or autonomic dysfunction.

Participants (n=272; ages 13-18 [M=15.83, SD=1.50]) included adolescents who had been struggling with debilitating chronic pain or autonomic dysfunction and enrolled in an Intensive Interdisciplinary Pain Program (IIPT). Pre-pandemic was defined as prior to March 2020, and post-pandemic was defined as after October 2022 as this was when COVID-19 restrictions were reduced and the IIPT program returned to pre-pandemic admission processes (rolling admission).  Differences in school attendance were examined via chi-square analysis. Differences in internalizing adjustment were examined via t-tests. No differences in internalizing adjustment were found pre- and post-pandemic, however there was a significant difference in type of school attended in pre- and post-pandemic groups (χ2 (6, 272) = 18.96, p < .01.). Most notably, there was an increase in patients attending online and hybrid schooling options.

The results of the current study provide support for the resilience of pediatric CPAD populations through the COVID-19 pandemic regarding internalizing adjustment, but also highlights changes in schooling type with the increase of online and hybrid options post-pandemic. Pediatric CPAD treatment often emphasizes returning to school as a treatment component to help with social/emotional development and reduction in social isolation. Accordingly, future research should investigate the implications of increased online/hybrid schooling for treating chronic pain and autonomic dysfunction in pediatric populations.