Behavioural treatment of somatic disorders in children and adolescents

Somatising in children and adolescents. 2. Management and outcomes

In this paper I outline the assessment, engagement and management of children and adolescents with somatising conditions. The major diagnostic groups, in rough order of prevalence, are adjustment, dissociative (transient and chronic), somatoform and factitious disorders and chronic fatigue. See Eminson (2001) for more detailed descriptions and subtypes.

Online Psychological Treatment for Pediatric Recurrent Pain: A Randomized Evaluation

OBJECTIVE

To evaluate the efficacy of a distance treatment delivered through Internet and telephone for pediatric recurrent pain.

METHODS

Forty-seven participants (9-16 years of age) were randomly assigned to either an Internet-based treatment or a standard medical care waitlist. Treatment employed a Web-based manual for children and parents with weekly therapist contact by telephone or e-mail. At 1- and 3-month follow-ups, participants were assessed on the outcome variables of pain and quality of life. A 50% reduction in diary pain scores was considered clinically significant.

RESULTS

Significant between-group differences were found: 71 and 72% of the treatment group achieved clinically significant improvement at the 1- and 3-month follow-ups, respectively, whereas only 19 and 14% of the control group achieved the criterion. No significant differences were found on the quality of life variable.

CONCLUSIONS

Distance methods have considerable potential for making effective treatments more accessible with lower associated costs.

Psychological interventions for children with asthma

BACKGROUND

Asthma is a chronic disease of inflammation and smooth muscle dysfunction, including bronchoconstriction. These symptoms are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. Psychological factors may influence the symptoms and management of asthma in children in many ways, for example, evidence suggests that emotional stress can either precipitate or exacerbate both acute and chronic asthma.

OBJECTIVES

To assess the efficacy of psychological interventions in improving health and behavioural outcomes for children with asthma.

SEARCH STRATEGY

The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until March 2005.

SELECTION CRITERIA

Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a control intervention in children and adolescents with asthma were included in the review. Cross-over trials were considered inappropriate for studies using psychological interventions and were therefore excluded from this systematic review.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted.

MAIN RESULTS

Twelve studies (588 children) were included in the review. Study quality was poor and sample sizes were frequently small. A meta-analysis was possible on two studies only examining the effects of relaxation therapy on PEFR which favoured the treatment group (32 L/min, 95% CI 13 to 50 L/min). No other meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. In addition, many studies reported insufficient data.

AUTHORS' CONCLUSIONS

This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. This review demonstrates the absence of an adequate evidence base and highlights the need for well-conducted and reported randomised trials in this area.

Expressive Writing Intervention for Adolescents' Somatic Symptoms and Mood

The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n=106) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postintervention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time Condition effects indicated that optimism scores increased, negative-affect scores decreased, and positive-affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents; further work with clinical populations may lead to even more robust results.

Psychiatric management of severe somatoform disorders in childhood and adolescence

BACKGROUND

Unexplained medical symptoms are common in children. They constitute the main feature of somatoform disorders of childhood (i.e. pain disorders, conversion disorder and chronic fatigue syndrome or neurasthenia).

OBJECTIVE

To describe assessment and treatment strategies for severe somatoform disorders of childhood.

METHODS

Review of recommendations for clinical practice and clinical trials.

RESULTS

A number of specific techniques have been described. Clinical accounts indicate that many children benefit and can recover. There is some empirical evidence supporting the beneficial effects of techniques such as family cognitive-behavioural therapy and relaxation technique for the less severe disorders.

CONCLUSIONS

Existing helpful clinical guidelines require empiric validation.

Somatisation in children

This review summarises recent work on somatisation in childhood. Minor physiological dysfunction may play a part in a number of cases and associated psychiatric disorders are commonly though not universally found. Contributory family factors include high rates of health problems and of parental psychological distress and there is some evidence for the role of family modelling and reinforcement of illness behaviour. There is suggestive evidence linking somatisation to emotional closeness in families, to family togetherness around health matters and to anomalies in children's social relationships. Somatisation in children can respond to treatments involving cognitive-behavioural and family techniques as well as to sensitive, psychologically sound advice from paediatricians.