Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations

Author(s):  
Stefanie M. Jungmann ◽  
Michael Witthöft
2019 ◽  
Vol 25 (1) ◽  
pp. 62-77
Author(s):  
Sam LB Bonduelle ◽  
Johan Vanderfaeillie ◽  
Katrien Denijs ◽  
Annik Lampo ◽  
Lindita Imeraj

Background: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. Objectives: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. Methods: Parents of 27 children aged 7–17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. Results: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. Conclusion: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.


2019 ◽  
Vol 25 (1) ◽  
pp. 273-290 ◽  
Author(s):  
Christine O’Connell ◽  
Roz Shafran ◽  
Sophie Bennett

Background: Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30–60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. Objectives: To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. Methods: Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. Results: In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. Conclusions: Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non–cognitive behavioural therapy interventions is recommended.


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