Original Report| Volume 16, ISSUE 3, P235-246, March 2015

The Role of Parent Psychological Flexibility in Relation to Adolescent Chronic Pain: Further Instrument Development

Published:December 11, 2014DOI:


      • Factor analysis supports a 17-item PPFQ with four subscales.
      • Subscale structure and performance was comparable across mothers and fathers.
      • PPFQ total and subscales correlate with adolescent physical and emotional functioning.


      Parental responses to their child's pain are associated with the young person's functioning. Psychological flexibility—defined as the capacity to persist with or change behavior, depending on one's values and the current situation, while recognizing cognitive and noncognitive influences on behavior—may provide a basis for further investigating the role of these responses. The Parent Psychological Flexibility Questionnaire (PPFQ) is a promising but preliminary measure of this construct. Parents of 332 young people with pain (301 mothers, 99 fathers, 68 dyads) completed the PPFQ during appointments in a pediatric pain clinic. Initial item screening eliminated 6 of the 31 items. Mothers' and fathers' data were then subjected to separate principal components analyses with oblique rotation, resulting in a 4-factor solution including 17 items, with subscales suggesting Values-Based Action, Pain Acceptance, Emotional Acceptance, and Pain Willingness. The PPFQ correlated significantly with adolescent-rated pain acceptance, functional disability, and depression. Differences were observed between mothers' and fathers' PPFQ scores, in particular, those related to school absence and fears of physical injury. The 17-item PPFQ appears reasonable for research and clinical use and may potentially identify areas for intervention with parents of young people with chronic pain.


      Parent psychological flexibility, as measured by the PPFQ, appears relevant to functioning, depression, and pain acceptance in adolescents with chronic pain. This model may help tie parental responses to adolescent distress and disability and may help clarify the development and maintenance of disability within the context of chronic pain.

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