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Aviv I, Shorer M, Fennig S, Aviezer H, Singer-Harel D, Apter A, Pilowsky Peleg T. [Formula: see text]Persistent post-concussion symptoms in children: pre-injury social difficulties and acute stress reaction as risk factors. Child Neuropsychol 2023; 29:115-135. [PMID: 35545855 DOI: 10.1080/09297049.2022.2072823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Following mild traumatic brain injury (mTBI) children usually experience one or more somatic, cognitive, and/or emotional-behavioral post-concussion symptoms (PCS). PCS may be transient, however for some children, persistent post-concussion symptoms (PPCS) might linger for months or years. Identifying risk factors for PPCS may allow earlier interventions for patients at greater risk. We examined pre-injury social difficulties and acute stress reaction as risk factors to PPCS in children. Participants were 83 children (aged 8-16) with mTBI. In a prospective follow-up, pre-injury social difficulties, 24-hours post-concussion symptoms, and acute stress reactions were tested as predictors of one-week and four-months PCS reports. Parents' reports, self-reports, and neurocognitive tests were employed. One-week PCS level was associated with acute stress, and not with 24-hours post-concussion symptoms or pre-injury social difficulties. Four-months PCS level was predicted by pre-injury social difficulties and 24-hours post-concussion symptoms, with no contribution of acute stress. Interestingly, less symptoms at 24-hour from injury were associated with a higher level of PCS at four months. Cognitive functioning at four months was predicted by acute stress, with no contribution of 24-hours post-concussion symptoms or pre-injury social difficulties. Cognitive functioning did not differ between children with and without PPCS. In conclusion, non-injury, socio-emotional factors (pre-injury social difficulties, acute stress) should be considered, alongside injury-related factors, in predicting recovery from mTBI. Pre-injury social difficulties and stress reaction to the traumatic event might pose an emotional burden and limit one's social support during recovery, thus require clinical attention in children following mTBI.
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Affiliation(s)
- Irit Aviv
- Department of Psychology, The Hebrew University, Jerusalem, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Maayan Shorer
- Department of Psychology, Ruppin Academic Center, Emek-Hefer, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Hillel Aviezer
- Department of Psychology, The Hebrew University, Jerusalem, Israel
| | - Dana Singer-Harel
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University, Jerusalem, Israel.,The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
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Smith LE, Weinman J, Yiend J, Rubin J. Psychosocial Factors Affecting Parental Report of Symptoms in Children: A Systematic Review. Psychosom Med 2021; 82:187-196. [PMID: 31738317 PMCID: PMC7012335 DOI: 10.1097/psy.0000000000000767] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parents make important treatment decisions for their children based on symptoms they perceive their child to be experiencing. Multiple psychological factors are associated with subjective symptom perception, but factors affecting perception of symptoms in others have been explored less. We systematically reviewed the literature to identify parent and child psychological factors associated with parental report of physical symptoms in their child. METHODS We searched Embase, Ovid, PsycINFO, and Scopus for studies that investigated associations between psychological factors and parental report of symptoms in their child. RESULTS Thirty-six citations reporting on 34 studies that assessed the association between parent or child psychological factors and parental report of physical symptoms in the child were included in the review. Three main factors were identified as being associated with parental symptom report. First, there was evidence for an association between parental symptom report and affect, in particular parent and child anxiety. Second, child behavioral and conduct problems, and temperament-related challenges (problems with feeding and sleeping) were associated with parental symptom report. Third, parental expectations and beliefs that symptoms would occur were associated with parental symptom report, although few studies investigated these associations. CONCLUSIONS Parent and child affect, and parental expectations and beliefs may influence parents' cognition, causing them to pay more attention to their child, interpret their child's behavior as symptomatic, and recall symptoms in the child. Given the importance of parental perception of symptoms in driving decisions around care, additional research in this field is needed.
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Affiliation(s)
- Louise E Smith
- From the Institute of Psychiatry, Psychology and Neuroscience (Smith, Yiend, Rubin); and School of Cancer and Pharmaceutical Sciences (Weinman), King's College London, London, United Kingdom
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Herskovic V, Matamala M. Somatización, ansiedad y depresión en niños y adolescentes. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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O'Connell C, Shafran R, Bennett S. A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes. Clin Child Psychol Psychiatry 2020; 25:273-290. [PMID: 31232094 DOI: 10.1177/1359104519855415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
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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Affiliation(s)
- Christine O'Connell
- Department of Applied Psychology, Canterbury Christ Church University, Kent, UK.,Kaleidoscope, London, UK
| | - Roz Shafran
- UCL Institute of Child Health, University College London, London, UK
| | - Sophie Bennett
- UCL Institute of Child Health, University College London, London, UK
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Heyman I. Mind the gap: integrating physical and mental healthcare for children with functional symptoms. Arch Dis Child 2019; 104:1127-1128. [PMID: 31506259 DOI: 10.1136/archdischild-2019-317854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Isobel Heyman
- Psychological Medicine, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Tingstedt O, Lindblad F, Koposov R, Blatný M, Hrdlicka M, Stickley A, Ruchkin V. Somatic symptoms and internalizing problems in urban youth: a cross-cultural comparison of Czech and Russian adolescents. Eur J Public Health 2019; 28:480-484. [PMID: 29373646 DOI: 10.1093/eurpub/cky001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Although the association between somatic complaints and internalizing problems (anxiety, somatic anxiety and depression) is well established, it remains unclear whether the pattern of this relationship differs by gender and in different cultures. The aim of this study was to examine cross-cultural and gender-specific differences in the association between somatic complaints and internalizing problems in youth from the Czech Republic and Russia. Methods The Social and Health Assessment, a self-report survey, was completed by representative community samples of adolescents, age 12-17 years, from the Czech Republic (N = 4770) and Russia (N = 2728). Results A strong association was observed between somatic complaints and internalizing psychopathology. Although the levels of internalizing problems differed by country and gender, they increased together with and largely in a similar way to somatic complaints for boys and girls in both countries. Conclusion The association between somatic symptoms and internalizing problems seems to be similar for boys and girls across cultures.
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Affiliation(s)
- Olga Tingstedt
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Frank Lindblad
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marek Blatný
- Institute of Psychology, Academy of Sciences of the Czech Republic, Brno, Czech Republic
| | - Michal Hrdlicka
- Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Andrew Stickley
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Child Study Centre, Yale University Medical School, New Haven, CT, USA.,Säter Forensic Psychiatric Clinic, Säter, Sweden
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Heyman I, Reilly C. Seize the opportunity - Recognition and management of functional seizures in children. Eur J Paediatr Neurol 2018; 22:734-735. [PMID: 30213504 DOI: 10.1016/j.ejpn.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Isobel Heyman
- Psychological Medicine, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford St, London, WC1N 1EH, UK.
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health, University College London, 30 Guildford St, London, WC1N 1EH, UK
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Heimann P, Herpertz-Dahlmann B, Buning J, Wagner N, Stollbrink-Peschgens C, Dempfle A, von Polier GG. Somatic symptom and related disorders in children and adolescents: evaluation of a naturalistic inpatient multidisciplinary treatment. Child Adolesc Psychiatry Ment Health 2018; 12:34. [PMID: 29988308 PMCID: PMC6022439 DOI: 10.1186/s13034-018-0239-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/23/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This naturalistic study assesses the effectiveness of inpatient multidisciplinary treatment of children and adolescents with somatic symptom disorders (SSD) and investigates the role of pain coping strategies and psychiatric comorbidity (anxiety, depression). METHODS Sixty children and adolescents (mean age 14.4 years) with SSD who underwent inpatient multidisciplinary treatment were assessed regarding their school attendance, levels of discomfort, coping strategies and psychiatric comorbidity (depression, anxiety) at pretreatment, discharge and 6 months following treatment. RESULTS At discharge, the children and adolescents reported improvements in their level of discomfort, psychiatric comorbidities (anxiety, depression) and pain coping strategies, with medium to large effect sizes. Six months following treatment, the improvements remained stable, including significantly higher school attendance rates (d = 1.6; p < 0.01). Improvement in pain coping was associated with increased school attendance. CONCLUSION Inpatient multidisciplinary treatment is effective in reducing levels of discomfort, psychiatric comorbidity (anxiety, depression), and school absence and in improving coping strategies.
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Affiliation(s)
- Pola Heimann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Jonas Buning
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Norbert Wagner
- Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | | | - Astrid Dempfle
- Department of Medical Informatics and Statistic, University Schleswig-Holstein, Kiel, Germany
| | - Georg G. von Polier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Daniel MC, Coughtrey A, Heyman I, Dahlmann-Noor AH. Medically unexplained visual loss in children and young people: an observational single site study of incidence and outcomes. Eye (Lond) 2017; 31:1068-1073. [PMID: 28282066 PMCID: PMC5519277 DOI: 10.1038/eye.2017.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/13/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo determine the incidence of medically unexplained visual loss (MUVL) in children in an open access children's eye casualty.Patients and methodsWe collated demographic and clinical data of consecutive patients younger than 16 years who presented to the children's eye casualty at Moorfields Eye Hospital over a 12-month period and were diagnosed with MUVL or suspected MUVL. We reviewed the clinical records at least 3 months after initial presentation. We calculated the incidence using the number of 'new patient' attendances over the same period as denominator (n=2397). We used descriptive analysis. MAIN OUTCOME MEASURES number of patients diagnosed with MUVL, proportion of patients with a history of or present psychological problems, recovery rate, and improvement in visual acuity.ResultsWe identified 85 cases of MUVL (54 females; median age: 9 years (IQR 7-12)). The median duration of follow-up was 1.2 months (IQR 0-4.3). The estimated annual incidence was 3.5% (95% confidence interval 2.9-4.4%). Thirty-three per cent of children had a history of psychiatric disorders, reported a stressful life event, or showed signs of psychiatric disorder at the time of first presentation. The recovery rate was 25%. Median improvement in best-corrected visual acuity from presentation to last appointment was 0.22 (IQR 0.06-0.43) logMAR.ConclusionThe incidence of MUVL is higher and the rate of resolution lower than previously reported. MUVL may be associated with mental health problems. We recommend screening for psychological problems to facilitate access to psychological treatment.
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Affiliation(s)
- M C Daniel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
| | - A Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
| | - I Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London, Institute of Child Health, London, UK
| | - A H Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Anger regulation and school-related somatic complaints in children with special educational needs: A longitudinal study. LEARNING AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.lindif.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tøt-Strate S, Dehlholm-Lambertsen G, Lassen K, Rask CU. Clinical features of functional somatic symptoms in children and referral patterns to child and adolescent mental health services. Acta Paediatr 2016; 105:514-21. [PMID: 26666703 DOI: 10.1111/apa.13310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 10/12/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Abstract
AIM Functional somatic symptoms (FSS) are common in paediatric patients who are referred to Child and Adolescent Mental Health Service (CAMHS), but little is known about current referral practices. The aim of this study was to systematically investigate clinical features of paediatric inpatients with FSS referred to CAMHS and to describe why paediatricians referred them. METHODS The study population comprised 60 children with FSS admitted to a large Danish paediatric department during 2012. We compared medical record data on the clinical characteristics and paediatric management of 16 children who had been referred and 44 children who had not. RESULTS Most paediatric records lacked information on psychosocial factors and symptoms. Referred children were significantly more multisymptomatic of FSS (p < 0.01) than the controls, had longer symptom duration, underwent more clinical investigations, had longer paediatric admissions of at least two weeks and received more treatment elements before referral. The most frequently stated referral reason was inadequate treatment response. CONCLUSION Paediatric inpatients with more severe FSS were more likely to be referred to CAMHS, but referral reasons were generally vague and psychosocial information was frequently missing. Clinical guidelines are needed to improve and systematise mental health referrals for children with FSS.
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Affiliation(s)
- Simone Tøt-Strate
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Gitte Dehlholm-Lambertsen
- Department of Child and Adolescent Psychiatry Odense; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Karin Lassen
- Department of Paediatrics; Odense University Hospital; Odense Region of Southern Denmark Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics; Aarhus University Hospital; Aarhus Denmark
- Regional Centre for Child and Adolescent Psychiatry; Risskov; Aarhus University Hospital; Aarhus Denmark
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Deary V, Metcalfe L, Wilson JA. Persistent (unexplained) physical symptoms: evidence-based highlights. Br J Hosp Med (Lond) 2014; 75:564-7. [DOI: 10.12968/hmed.2014.75.10.564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Vincent Deary
- Senior Lecturer in Health Psychology, Northumbria University
| | - Louise Metcalfe
- Assistant Psychologist, Northumberland Tyne and Wear NHS Foundation Trust
| | - Janet A Wilson
- Professor of Otolaryngology Head and Neck Surgery, Newcastle University and Department of Otolaryngology Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN
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Shraim M, Blagojevic-Bucknall M, Mallen CD, Dunn KM. The association between GP consultations for non-specific physical symptoms in children and parents: a case-control study. PLoS One 2014; 9:e108039. [PMID: 25251344 PMCID: PMC4176724 DOI: 10.1371/journal.pone.0108039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/25/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-specific physical symptoms (NSPS) such as abdominal pain, headache and musculoskeletal pain are widespread in the community, and are common reasons for visiting a general practitioner (GP). Causes of NSPS are multifactorial, but may include parental influences. OBJECTIVE To investigate associations between GP consultations for NSPS in parents and their children. METHODS Matched case-control study using GP consultation data from 12 GP practices in the United Kingdom. Participants were 1328 children who consulted a GP for NSPS in 2009 (cases), 3980 controls who consulted a GP in 2009 but not for NSPS, plus parents of cases and controls (n = 8354). PRIMARY OUTCOME MEASURE child consultation status for NSPS. RESULTS Maternal consultation for NSPS was associated with significantly increased odds of their child consulting for NSPS (odds ratio (OR) 1.51, 95% confidence intervals (CI) 1.33, 1.73); there was no significant association with paternal consultations (OR 0.87, 95% CI 0.71, 1.08). Each additional maternal consultation for NSPS was associated with an increase in the rate ratio for number of consultations for NSPS in the child by 1.03 (95% CI 1.01, 1.05). This overall association was clearest in maternal-child consultations for painful NSPS and for specific bodily systems including gastrointestinal, musculoskeletal and neurologic symptoms. CONCLUSIONS Maternal GP consultation for NSPS is associated with increased odds of GP consultations for NSPS in children. This study included a large sample of children and parents and used medical records data which is not subject to recall bias. However, analysis was based on medical records, thus the presence of NSPS not leading to consultations is unknown. Medical practitioners managing children with NSPS need to be aware of this association.
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Affiliation(s)
- Mujahed Shraim
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
- Work Environment Department, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
- Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America
| | | | - Christian D. Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
| | - Kate M. Dunn
- Arthritis Research UK Primary Care Centre, Keele University, Keele, United Kingdom
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Giacobo RS, Jané MC, Bonillo A, Arrufat FJ, Araujo E. ADHD and functional somatic symptoms: structural equations of a conceptual model. Child Adolesc Ment Health 2014; 19:83-89. [PMID: 32878391 DOI: 10.1111/camh.12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/28/2022]
Abstract
AIMS To examine the effect of anxiety and parental overprotection on functional somatic symptoms (FSS) in children with attention deficit hyperactivity disorder (ADHD). METHOD Seventy-six children and adolescents (aged 6-17) with ADHD and their parents completed a clinical interview about psychiatric and somatic symptoms. Parents also reported about parenting styles. Structural equation modeling (SEM) was used. RESULTS The generalized anxiety, overprotection, and specific phobia variables each had a direct effect on FSS. CONCLUSIONS Anxiety symptoms and parental overprotection may play a role in the development of FSS in children with ADHD. Further research is necessary to corroborate our findings.
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Affiliation(s)
- Rodrigo Serra Giacobo
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Campus de Bellaterra, Edifici B, 08193, Bellaterra, Spain
| | - Maria Claustre Jané
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Campus de Bellaterra, Edifici B, 08193, Bellaterra, Spain
| | - Albert Bonillo
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | | | - Eva Araujo
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Campus de Bellaterra, Edifici B, 08193, Bellaterra, Spain
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Abstract
INTRODUCTION Although there are many studies on functional somatic symptoms (FSS), there are few conducted with Spanish samples. The aim of this study was to assess the prevalence of frequent functional somatic symptoms in a Spanish sample, and to look for relationships with psychopathology and parenting styles. PATIENTS AND METHODS The sample consisted of 672 participants from 6 to 8 years-old attending primary school in the region of Osona (Catalonia, Spain). The parents reported on the presence of FSS in children, school absence, paediatric visits; psychiatric symptoms, and parenting styles. Children who complained of frequent somatic symptoms (four or more in the previous fortnight) were compared with children who did not complain. RESULTS A total of 429 of the 672 (63.8%) children had at least one physical complaint during the two weeks prior to the study. Almost one quarter (162, 24.1%) of the participants had frequent FSS. Significant relationships were found with, separation anxiety, social phobia, and visits to the paediatrician. A small effect of overprotection/control parenting style on FSS was observed. CONCLUSIONS Functional somatic symptoms are common in a Spanish sample of children between 6 to 8 years-old. These children may be considered a risk group for future emotional distress. It is also important for future research to clarify the nature of the relationship between overprotection and FSS.
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Weersing VR, Rozenman MS, Maher-Bridge M, Campo JV. Anxiety, Depression, and Somatic Distress: Developing a Transdiagnostic Internalizing Toolbox for Pediatric Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2012; 19:68-82. [PMID: 24653642 PMCID: PMC3956652 DOI: 10.1016/j.cbpra.2011.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Anxiety, depression, and somatic complaints are a common set of comorbid problems in children and adolescents. This "internalizing cluster" is highly prevalent, impairing during youth and into adulthood, and has substantial impacts on health-care systems. Fortunately, these problem areas may share several etiological factors and, thus, respond to similar interventions. In this paper, we present (a) the rationale for focusing on this cluster, (b) clinical theory on transdiagnostic processes uniting these problems, (c) description of core treatment techniques for this group, with a description of clinical outcomes for two sample cases, and (d) implications of this approach for new transdiagnostic treatment development and everyday clinical practice.
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Affiliation(s)
| | | | | | - John V Campo
- Nationwide Children's Hospital and The Ohio State University
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Serra Giacobo R, Jané MC, Bonillo A, Ballespí S, Díaz-Regañon N. Somatic symptoms, severe mood dysregulation, and aggressiveness in preschool children. Eur J Pediatr 2012; 171:111-9. [PMID: 21611729 DOI: 10.1007/s00431-011-1495-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/09/2011] [Indexed: 12/11/2022]
Abstract
Many researchers have studied somatic symptoms in children. However, its association with severe mood dysregulation (SMD) is poorly known. The aim of this study is to detect the presence of SMD in preschool children and to know the prevalence of somatic symptoms and associations with psychopathology, SMD, and aggressiveness. The study population consists of children between 3 to 6 years of age enrolled in Barcelona's kindergarten schools (n = 319). Their parents completed questionnaires about the presence of somatic symptoms in children, absences from school and pediatric visits, child psychiatric symptoms, presence of symptoms of SMD, and aggressiveness. Teachers were also informed about SMD and aggressiveness. Children who complained frequent somatic symptoms (three or more in the last 2 weeks) were compared with those who did not. Two hundred five children (64.3%) reported at least one physical complaint in the 2 weeks preceding the study. One hundred participants (31.3%) reported frequent somatic complaints. Positive associations were found with anxiety symptomatology, separation anxiety, social phobia, pediatric visits, and school absences, but not with aggressiveness or SMD symptoms. Somatic symptoms are common in a sample of preschool children but do not show a positive association with the symptoms of SMD.
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Affiliation(s)
- Rodrigo Serra Giacobo
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Campus de Bellaterra, Bellaterra, Spain.
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Chronic somatic complaints in adolescents: prevalence, predictive validity of the parent reports, and associations with social class, health status, and psychosocial distress. Soc Psychiatry Psychiatr Epidemiol 2011; 46:1003-11. [PMID: 20644908 DOI: 10.1007/s00127-010-0273-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Chronic somatic complaint (CSC) can cause significant impairment of psychosocial functioning and therefore is of considerable interest in medicine, psychology, and related health sciences. To date, the type, distribution, and associated factors of CSC have been examined in only a limited number of studies. Main research questions of this investigation focused on the prevalence of CSC, the predictive validity of parent reports, and the associations with social class, health status, and psychosocial distress. METHODS Data were obtained from a population-based, German-wide representative Health Survey (N = 1,027 self-reports, and parent reports from 11- to 18-year-olds). In addition to study-specific items, the standardized Giessen Physical Complaints Inventory for Children and Adolescents was used (GPCI). RESULTS The most frequent CSCs in self-report forms were skin impurities/pimples, cold hands, and fatigue; older adolescents, especially females, were at a higher risk for CSC. The sensitivity of parent reports in all complaints observed was very low (Med = 0.21) and specificity varied between 0.94 and 1.00. Parents significantly underestimated CSC that were not externally observable, as well as CSC in males. Across different predictors and CSC dimensions, psychosocial distress showed the highest predictive value. CONCLUSIONS The results provide data regarding the subjective physical health of adolescents, as well as an empirical reference to evaluate the distribution of chronic symptoms in specific clinical populations (which is needed for prevention and treatment).
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Rask CU, Borg C, Søndergaard C, Schulz-Pedersen S, Thomsen PH, Fink P. A medical record review for functional somatic symptoms in children. J Psychosom Res 2010; 68:345-52. [PMID: 20307701 DOI: 10.1016/j.jpsychores.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 09/15/2009] [Accepted: 06/10/2009] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objectives of this study were to develop and test a systematic medical record review for functional somatic symptoms (FSSs) in paediatric patients and to estimate the inter-rater reliability of paediatricians' recognition of FSSs and their associated impairments while using this method. METHODS We developed the Medical Record Review for Functional Somatic Symptoms in Children (MRFC) for retrospective medical record review. Described symptoms were categorised as probably, definitely, or not FSSs. FSS-associated impairment was also determined. Three paediatricians performed the MRFC on the medical records of 54 children with a diagnosed, well-defined physical disease and 59 with 'symptom' diagnoses. The inter-rater reliabilities of the recognition and associated impairment of FSSs were tested on 20 of these records. RESULTS The MRFC allowed identification of subgroups of children with multisymptomatic FSSs, long-term FSSs, and/or impairing FSSs. The FSS inter-rater reliability was good (combined kappa=0.69) but only fair as far as associated impairment was concerned (combined kappa=0.29). CONCLUSIONS In the hands of skilled paediatricians, the MRFC is a reliable method for identifying paediatric patients with diverse types of FSSs for clinical research. However, additional information is needed for reliable judgement of impairment. The method may also prove useful in clinical practice.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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Shannon RA, Bergren MD, Matthews A. Frequent visitors: somatization in school-age children and implications for school nurses. J Sch Nurs 2010; 26:169-82. [PMID: 20065098 DOI: 10.1177/1059840509356777] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a gap in the nursing literature regarding children who frequently visit school nurses' offices with recurrent unexplained physical symptoms. A review of the scientific health literature was undertaken to examine the clinical presentation, associated variables, and implications for school nurses regarding children who are frequent school health office visitors with somatic symptoms. This subset of students with medically unexplained symptoms accounts for disproportionate use of primary care and school health resources. Common somatic complaints in school-age children, such as headache and stomachache, are associated with the psychosocial variables of anxiety and depression, childhood adversity, and school stress. Effective and practical treatment approaches to this complicated child health issue require accurate identification, appropriate referral, screening for associated conditions, and individualized treatment plans. Research to identify effective interventions for frequent health office visitors is needed.
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Arceneaux LL, Meyer WJ. Treatments for common psychiatric conditions among children and adolescents during acute rehabilitation and reintegration phases of burn injury. Int Rev Psychiatry 2009; 21:549-58. [PMID: 19919208 PMCID: PMC5201169 DOI: 10.3109/09540260903343984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Advances in critical care and surgical management during the last 20 years have decreased mortality rates among children with severe burn injuries. This improved survival rate has prompted researchers to study the psychological aspects of recovering from a burn injury. Initially research focused primarily on epidemiology, prevention and descriptions of the psychological phenomenon experienced by the children and adolescents. Whereas previously interventions were often utilized during the acute phases of burn injury without knowledge of the long-term effects, more recently, priorities have shifted to include long-term treatment outcome studies. The purpose of this paper is to review and discuss the current evidence-based techniques and their efficacy in the treatment of common psychological and psychiatric conditions among children and adolescents during the three major phases of burn injury.
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Affiliation(s)
- Lisa L Arceneaux
- Department of Surgery, Division of Burns, University of Texas Medical Branch, Shriners Hospital for Children, Galveston, Texas 77550, USA.
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Furness P, Glazebrook C, Tay J, Abbas K, Slaveska-Hollis K. Medically unexplained physical symptoms in children: exploring hospital staff perceptions. Clin Child Psychol Psychiatry 2009; 14:575-87. [PMID: 19759075 DOI: 10.1177/1359104509338437] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many children present at GP surgeries with debilitating symptoms with no obvious physical cause and are then referred to acute settings for investigation. Research with GPs suggests caring for this group of patients presents a significant challenge, however, the impact upon the range of hospital staff with whom they have contact has been little studied. This study aimed to explore perceptions and experiences of caring for children with medically unexplained physical symptoms (MUPS) and their families among the paediatric staff at one large UK hospital Trust. Data demonstrated staff awareness that children affected by MUPS have complex needs and the perception that those needs resulted in extra demands and anxieties, especially regarding time management, care protocols and communication. There was a clear desire by general paediatric staff for more information and training from psychiatric services to help them care for this group. Results also revealed staff perceptions of the quality of current MUPS care and suggestions as to how this could be improved.
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Affiliation(s)
- Penny Furness
- Sheffield Hallam University, 30 Collegiate Crescent, Sheffield S10 2BP, UK.
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Rask CU, Olsen EM, Elberling H, Christensen MF, Ornbøl E, Fink P, Thomsen PH, Skovgaard AM. Functional somatic symptoms and associated impairment in 5-7-year-old children: the Copenhagen Child Cohort 2000. Eur J Epidemiol 2009; 24:625-34. [PMID: 19633995 DOI: 10.1007/s10654-009-9366-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 06/25/2009] [Indexed: 01/26/2023]
Abstract
Research on somatisation or functional disorders, characterised by the subjective report of physical symptoms in the absence of clear physical pathology, in young children is limited. This study investigates the distribution, types and co-occurrence of parent-reported functional somatic symptoms (FSS) and their impairment in a population-based sample of Danish 5-7-year-old children. Data were obtained from a 5-7-year follow-up of the Copenhagen Child Cohort 2000. The entire study population included 3,000 randomly sampled children from the cohort. Among these FSS measures were obtained for 1,327 children. The newly introduced parent interview, the soma assessment interview, was used to assess the child's FSS. Impairing symptoms were defined as FSS that caused substantial discomfort, impairment of everyday life, absence from day-care or school and/or help-seeking in the health care system. The 1-year prevalence of any FSS was 23.2% (N = 308) and higher in girls than boys (27.6 vs. 18.8%, P < 0.0001). Impairing FSS were found in 4.4% (N = 58). Pain complaints, i.e. limb pain, headache and abdominal pain, were the most frequently reported FSS. Among the 308 children with FSS, 66 (21.4%) presented with two or more of these functional pain complaints, while 15 (4.9%) had all three types. The findings indicate that FSS are common health complaints in 5-7-year-old children. A subgroup with impairing FSS with a likely need of clinical intervention was identified. This suggests that a somatisation pattern may start early in life and call for future studies to include associated impairment in the investigation of childhood FSS.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Regional Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark.
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CBT for Anxiety and Associated Somatic Complaints in Pediatric Medical Settings: An Open Pilot Study. J Clin Psychol Med Settings 2009; 16:169-77. [DOI: 10.1007/s10880-008-9143-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 12/30/2008] [Indexed: 01/30/2023]
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Reigada LC, Fisher PH, Cutler C, Masia Warner C. An Innovative Treatment Approach for Children With Anxiety Disorders and Medically Unexplained Somatic Complaints. COGNITIVE AND BEHAVIORAL PRACTICE 2008; 15:140-147. [PMID: 19484139 PMCID: PMC2688440 DOI: 10.1016/j.cbpra.2007.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.
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Affiliation(s)
- Laura C Reigada
- New York University Child Study Center, Department of Child and Adolescent Psychiatry, School of Medicine
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