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Review Article

Functional Somatic Syndromes (FSS) in Children and Adolescents

Conceptual, Measurement and Treatment Issues

Published Online:May 19, 2020https://doi.org/10.1027/2151-2604/a000401

Abstract

Abstract. Unspecific somatic health complaints and symptoms are common in children and adolescents, varying on a continuum of severity. When persistent and impairing, they are often referred to as functional somatic syndromes (FSS). The overarching objective of this paper is to provide an overview of the pediatric literature in relation to conceptual, assessment, and treatment issues for youth presenting with FSS. Clinical recommendations are outlined including addressing potential feasibility and barrier issues for families presenting to medical and mental health services. Assessment and treatment issues are further discussed in context of two recent psychotherapy trials conducted with children and older age adolescents (aged from 7 to 19 years). Finally, we address ongoing research gaps in this field with view to strengthen the evidence base in the assessment and treatment of youth presenting with FSS.

References

  • Agger, J. L., Schroder, A., Gormsen, L. K., Jensen, J. S., Jensen, T. S., & Fink, P. K. (2017). Imipramine versus placebo for multiple functional somatic syndromes (STreSS-3): A double-blind, randomised study. The Lancet: Psychiatry, 4, 378–388. https://doi.org/10.1016/S2215-0366(17)30126-8 First citation in articleCrossref, Google Scholar

  • Allen, J. L., & Rapee, R. M. (2009). Are reported differences in life events for anxious children due to comorbid disorders? Journal of Anxiety Disorders, 23, 511–518. https://doi.org/10.1016/j.janxdis.2008.10.005 First citation in articleCrossref, Google Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual for mental disorders (DSM-5) (5th ed.). Arlington, VA: Author. First citation in articleCrossref, Google Scholar

  • Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995). The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249. First citation in articleGoogle Scholar

  • Beck, J. E. (2008). A developmental perspective on functional somatic symptoms. Journal of Pediatric Psychology, 33, 547–562. https://doi.org/10.1093/jpepsy/jsm113 First citation in articleCrossref, Google Scholar

  • Blake, L., Davies, V., Conn, R., & Davie, M. (2018). Medically unexplained symptoms (MUS) in children and young people: A guide to assessing and managing patients under the age of 18 who are referred top secondary care. UK: Royal College of Psychiatrists and Paediatric Mental Health Association (PMHA). Retrieved from https://paedmhassoc.files.wordpress.com/2018/12/mus-guide-with-leaflet-nov-2018.pdf First citation in articleGoogle Scholar

  • Boakye, P. A., Olechowski, C., Rashiq, S., Verrier, M. J., Kerr, B., Witmans, M., … Dick, B. D. (2016). A critical review of neurobiological factors involved in the interactions between chronic pain, depression and sleep disruption. The Clinical Journal of Pain, 32, 327–336. https://doi.org/10.1097/AJP.0000000000000260 First citation in articleCrossref, Google Scholar

  • Bonilla, S., & Nurko, S. (2018). Focus on the use of antidepressants to treat pediatric functional abdominal pain: Current perspectives. Clinical and Experimental Gastroenterology, 11, 365–372. https://doi.org/10.2147/CEG.S146646 First citation in articleCrossref, Google Scholar

  • Bonnert, M., Olen, O., Lalouni, M., Benninga, M. A., Bottai, M., Engelbrektsson, J., … Ljotsson, B. (2017). Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome: A randomized controlled trial. The American Journal of Gastroenterology, 112, 152–162. https://doi.org/10.1038/ajg.2016.503 First citation in articleCrossref, Google Scholar

  • Bonvanie, I. J., Janssens, K. A. M., Rosmalen, J. G. M., & Oldehinkel, A. J. (2017). Life events and functional somatic symptoms: A population study in older adolescents. British Journal of Psychology, 108, 318–333. https://doi.org/10.1111/bjop.12198 First citation in articleCrossref, Google Scholar

  • Bonvanie, I. J., Kallesoe, K. H., Janssens, K. A. M., Schroder, A., Rosmalen, J. G. M., & Rask, C. U. (2017). Psychological interventions for children with functional somatic symptoms: A systematic review and meta-analysis. The Journal of Pediatrics, 187, 272–281.e17. https://doi.org/10.1016/j.jpeds.2017.03.017 First citation in articleCrossref, Google Scholar

  • Boterhoven de Haan, K. L., Hafekost, J., Lawrence, D., Sawyer, M. G., & Zubrick, S. R. (2015). Reliability and validity of a short version of the general functioning subscale of the McMaster Family Assessment Device. Family Process, 54, 116–123. https://doi.org/10.1111/famp.12113 First citation in articleCrossref, Google Scholar

  • Brostrom, S. (2019). Improving care for patients with functional disorders in Denmark. Journal of Psychosomatic Research, 116, 22–24. https://doi.org/10.1016/j.jpsychores.2018.11.003 First citation in articleCrossref, Google Scholar

  • Brent, M., Lobato, D., & LeLeiko, N. (2009). Psychological treatments for pediatric functional gastrointestinal disorders. Journal of Pediatric Gastroenterology and Nutrition, 48, 13–21. https://doi.org/10.1097/MPG.0b013e3181761516 First citation in articleCrossref, Google Scholar

  • Bruehl, S., Dengler-Crish, C. M., Smith, C. A., & Walker, L. S. (2010). Hypoalgesia related to elevated resting blood pressure is absent in adolescents and young adults with a history of functional abdominal pain. Pain, 149, 57–63. https://doi.org/10.1016/j.pain.2010.01.009 First citation in articleCrossref, Google Scholar

  • Campo, J. V. (2012). Annual research review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice. Journal of Child Psychology and Psychiatry, 53, 575–592. https://doi.org/10.1111/j.1469-7610.2012.02535.x First citation in articleCrossref, Google Scholar

  • Campo, J. V., Bridge, J., Lucas, A., Savorelli, S., Walker, L., Di Lorenzo, C., … Brent, D. A. (2007). Physical and emotional health of mothers of youth with functional abdominal pain. Archives of Pediatrics and Adolescent Medicine, 161, 131–137. https://doi.org/10.1001/archpedi.161.2.131 First citation in articleCrossref, Google Scholar

  • Cappucci, S., & Simons, L. E. (2015). Anxiety sensitivity and fear in pediatric headache patients. European Journal of Pain, 19, 246–252. https://doi.org/10.1002/ejp.542 First citation in articleCrossref, Google Scholar

  • Chalder, T., & Willis, C. (2017). “Lumping” and “splitting” medically unexplained symptoms: Is there a role for a transdiagnostic approach? Journal of Mental Health, 26, 187–191. https://doi.org/10.1080/09638237.2017.1322187 First citation in articleCrossref, Google Scholar

  • Cooper, T. E., Fisher, E., Gray, A. L., Krane, E., Sethna, N., van Tilburg, M. A., … Wiffen, P. J. (2017). Opioids for chronic non-cancer pain in children and adolescents. The Cochrane Database of Systematic Reviews, 7, CD012538. https://doi.org/10.1002/14651858.CD012538.pub2 First citation in articleGoogle Scholar

  • Cottrell, D. J. (2016). Fifteen-minute consultation: Medically unexplained symptoms. Archives of Disease in Childhood: Education and Practice Edition, 101, 114–118. https://doi.org/10.1136/archdischild-2015-309344 First citation in articleCrossref, Google Scholar

  • den Boer, C., Dries, L., Terluin, B., van der Wouden, J. C., Blankenstein, A. H., van Wilgen, C. P., … van der Horst, H. E. (2019). Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments. Journal of Psychosomatic Research, 117, 32–40. https://doi.org/10.1016/j.jpsychores.2018.12.010 First citation in articleCrossref, Google Scholar

  • Eccleston, C., Cooper, T. E., Fisher, E., Anderson, B., & Wilkinson, N. M. (2017). Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents. The Cochrane Database of Systematic Reviews, 8, CD012537. https://doi.org/10.1002/14651858.CD012537.pub2 First citation in articleGoogle Scholar

  • Elgar, F. J., Washbusch, D. A., Dadds, M. R., & Sigvaldason, N. (2007). Development and validation of a short form of the Alabama Parenting Questionnaire. Journal of Child Family Studies, 16, 243–259. https://doi.org/10.1007/s10826-006-9082-5 First citation in articleCrossref, Google Scholar

  • Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136. First citation in articleCrossref, Google Scholar

  • Fisher, E., Law, E., Dudeney, J., Palermo, T. M., Stewart, G., & Eccleston, C. (2018). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. The Cochrane Database of Systematic Reviews, 9, CD003968. https://doi.org/10.1002/14651858.CD003968.pub5 First citation in articleGoogle Scholar

  • Ford, J. D., & Rogers, K. (1997, November). Empirically-based assessment of trauma and PTSD with children and adolescents. Paper presented at the annual meeting of the International Society for Traumatic Stress Studies, Montreal, Quebec. First citation in articleGoogle Scholar

  • Frostholm, L., & Rask, C. (2019). Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review. Clinical Psychology in Europe, 1, e32217. https://doi.org/10.32872/cpe.v1i1.32217 First citation in articleCrossref, Google Scholar

  • Garnefski, N., Rieffe, C., Jellesma, F., Meerum Terwogt, M., & Kraaij, V. (2007). Cognitive emotion regulation strategies and emotional problems in early adolescents: The development of an instrument. European Child & Adolescent Psychiatry, 16, 1–9. https://doi.org/10.1007/s00787-006-0562-3 First citation in articleCrossref, Google Scholar

  • Garralda, M. E., & Rask, C. U. (2015). Somatoform and related disorders. In A. ThaparD. S. PineJ. F. LeckmanS. ScottM. J. SnowlingE. A. TaylorEds., Rutter’s child and adolescent psychiatry (6th ed., pp. 1038–1054). West Sussex, UK: Wiley. First citation in articleGoogle Scholar

  • Guite, J. W., McCue, R. L., Sherker, J. L., Sherry, D. D., & Rose, J. B. (2011). Relationships among pain, protective parental responses, and disability for adolescents with chronic musculoskeletal pain: The mediating role of pain catastrophizing. The Clinical Journal of Pain, 27, 775–781. https://doi.org/10.1097/AJP.0b013e31821d8fb4 First citation in articleCrossref, Google Scholar

  • Gullone, E., & Taffe, J. (2012). The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA): A psychometric evaluation. Psychological Assessment, 24, 409–417. https://doi.org/10.1037/a0025777 First citation in articleCrossref, Google Scholar

  • Heimann, P., Herpertz-Dahlmann, B., Buning, J., Wagner, N., Stollbrink-Peschgens, C., Dempfle, A., & von Polier, G. G. (2018). Somatic symptom and related disorders in children and adolescents: Evaluation of a naturalistic inpatient multidisciplinary treatment. Child and Adolescent Psychiatry and Mental Health, 12, 34. https://doi.org/10.1186/s13034-018-0239-y First citation in articleCrossref, Google Scholar

  • Hechler, T. (2019). Interoceptive exposure for children and adolescents with chronic pain: On the way, but not yet there. Pediatric Pain SIG Newsletter (Spring). Retrieved from https://www.smore.com/k7wtj First citation in articleGoogle Scholar

  • Horwitz, B. N., Marceau, K., Narusyte, J., Ganiban, J., Spotts, E. L., Reiss, D., Leichenstein, P., & Neiderhiser, J. M. (2015). Parental criticism is an environmental influence on adolescent somatic symptoms. Journal of Family Psychology, 29, 283–289. https://doi.org/10.1037/fam0000065 First citation in articleCrossref, Google Scholar

  • Hulgaard, D., Dehlholm-Lambertsen, G., & Rask, C. U. (2019). Family-based interventions for children and adolescents with functional somatic symptoms: A systematic review. Journal of Family Therapy, 41, 4–28. https://doi.org/10.1111/1467-6427.12199 First citation in articleCrossref, Google Scholar

  • Hulgaard, D. R., Rask, C. U., Risor, M. B., & Dehlholm, G. (2020). Illness perceptions of youths with functional disorders and their parents: An interpretative phenomenological analysis study. Clinical Child Psychology and Psychiatry, 25, 45–61. https://doi.org/10.1177/1359104519846194 First citation in articleCrossref, Google Scholar

  • Ibeziako, P., Brahmbhatt, K., Chapman, A., De Souza, C., Giles, L., Gooden, S., … Plioplys, S. (2019). Developing a clinical pathway for somatic symptom and related disorders in pediatric hospital settings. Hospital Pediatrics, 9, 147–155. https://doi.org/10.1542/hpeds.2018-0205 First citation in articleCrossref, Google Scholar

  • Kaczynski, K. J., Simons, L. E., & Claar, R. L. (2011). Anxiety, coping, and disability: A test of mediation in a pediatric chronic pain sample. Journal of Pediatric Psychology, 36, 932–941. https://doi.org/10.1093/jpepsy/jsr024 First citation in articleCrossref, Google Scholar

  • Kallesoe, K. H., Schroder, A., Wicksell, R. K., Fink, P., Ornbol, E., & Rask, C. U. (2016). Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial. BMJ Open, 6, e012743. https://doi.org/10.1136/bmjopen-2016-012743 First citation in articleCrossref, Google Scholar

  • Kangas, M., Rapee, R., Jones, M., & Lemberg, D. (2018). RCT for functional somatic symptoms with comorbid anxiety and depression in youth: Cool Kids and adolescent Health program. Australian Psychologist, 53, 42. First citation in articleGoogle Scholar

  • Logan, D. E., Simons, L. E., & Carpino, E. A. (2012). Too sick for school? Parent influences on school functioning among children with chronic pain. Pain, 153, 437–443. https://doi.org/10.1016/j.pain.2011.11.004 First citation in articleCrossref, Google Scholar

  • McGrath, P. J., Walco, G. A., Turk, D. C., Dworkin, R. H., Brown, M. T., Davidson, K., … Zeltzer, L. (2008). Consensus Statement: Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. The Journal of Pain, 9, 771–783. https://doi.org/10.1016/j.jpain.2008.04.007 First citation in articleCrossref, Google Scholar

  • Malas, N., Ortiz-Aguayo, R., Giles, L., & Ibeziako, P. (2017). Pediatric somatic symptom disorders. Current Psychiatry Reports, 19, 11. https://doi.org/10.1007/s11920-017-0760-3 First citation in articleCrossref, Google Scholar

  • Moulin, V., Akre, C., Rodondi, P. Y., Ambresin, A. E., & Suris, J. C. (2015). A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived? Journal of Adolescence, 45, 317–326. https://doi.org/10.1016/j.adolescence.2015.10.003 First citation in articleCrossref, Google Scholar

  • Neville, A., Jordan, A., Beveridge, J. K., Pincus, T., & Noel, M. (2019). Diagnostic uncertainty in youth with chronic pain and their parents. The Journal of Pain, 20, 1080–1090. https://doi.org/10.1016/j.jpain.2019.03.004 First citation in articleCrossref, Google Scholar

  • O’Connell, C., Shafran, R., & Bennett, S. (2020). A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes. Clinical Child Psychology and Psychiatry, 25, 273–290. https://doi.org/10.1177/1359104519855415 First citation in articleCrossref, Google Scholar

  • Palermo, T. M., Valrie, C. R., & Karlson, C. W. (2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69, 142–152. https://doi.org/10.1037/a0035216 First citation in articleCrossref, Google Scholar

  • Rask, C. U., Bonvanie, I. J., & Garralda, M. E. (2018). Risk and protective factors and course of functional somatic symptoms in young people. In M. HodesS. GauS. G. Petrus De VriesEds., Understanding uniqueness and diversity in child and adolescent mental health (1st ed., pp. 77–115). San Diego, CA: Academic Press. First citation in articleGoogle Scholar

  • Rask, C. U., Ornbol, E., Fink, P. K., & Skovgaard, A. M. (2013). Functional somatic symptoms and consultation patterns in 5- to 7-year olds. Pediatrics, 132, e459–e467. https://doi.org/10.1542/peds.2013-0159 First citation in articleCrossref, Google Scholar

  • Ravens-Sieberer, U., Herdman, M., Devine, J., Otto, C., Bullinger, M., Rose, M., & Klasen, F. (2014). The European KIDSCREEN approach to measure quality of life and well-being in children: Development, current application, and future advances. Quality of Life Research, 23, 791–803. https://doi.org/10.1007/s11136-013-0428-3 First citation in articleCrossref, Google Scholar

  • Rief, W., Burton, C., Frostholm, L., Henningsen, P., Kleinstauber, M., Kop, W. J., … EURONET-SOMA Group. (2017). Core outcome domains for clinical trials on somatic symptom disorder, bodily distress disorder, and functional somatic syndromes: European network on somatic symptom disorders recommendations. Psychosomatic Medicine, 79, 1008–1015. https://doi.org/10.1097/PSY.0000000000000502 First citation in articleCrossref, Google Scholar

  • Schemer, L., Vlaeyen, J. W. S., Doerr, J. M., Skoluda, N., Nater, U. M., Rief, W., & Glombiewski, J. A. (2018). Treatment processes during exposure and cognitive-behavioural therapy for chronic back pain: A single-case experimental design with multiple baselines. Behaviour Research and Therapy, 108, 58–67. https://doi.org/10.1016/j.brat.2018.07.002 First citation in articleCrossref, Google Scholar

  • Schroder, A., & Fink, P. (2011). Functional somatic syndromes and somatoform disorders in special psychosomatic units: Organizational aspects and evidence-based treatment. The Psychiatric Clinics of North America, 34, 673–687. https://doi.org/10.1016/j.psc.2011.05.008 First citation in articleCrossref, Google Scholar

  • Schulte, I. E., & Petermann, F. (2011). Somatoform disorders: 30 years of debate about criteria! What about children and adolescents? Journal of Psychosomatic Research, 70, 218–228. https://doi.org/10.1016/j.jpsychores.2010.08.005 First citation in articleCrossref, Google Scholar

  • Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566. https://doi.org/10.1016/s0005-7967(98)00034-5 First citation in articleCrossref, Google Scholar

  • Stone, A. L., Bruehl, S., Smith, C. A., Garber, J., & Walker, L. S. (2018). Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain. Pain, 159, 298–305. https://doi.org/10.1097/j.pain.000000000001085 First citation in articleCrossref, Google Scholar

  • The Danish Health Authorities. (2018). Functional disorders: Recommendations for assessment, treatment, rehabilitation and destigmatization [Funktionelle Lidelser: Anbefalinger til udredning, behandling, rehabilitering og afstigmatisering]. Copenhagen, Denmark: Danish Health Authorities. First citation in articleGoogle Scholar

  • Thorgaard, M. V., Frostholm, L., & Rask, C. U. (2018). The influence of family factors in the development of health anxiety – a systematic review. Children’s Health Care, 47, 198–238. https://doi.org/10.1080/02739615.2017.1318390 First citation in articleCrossref, Google Scholar

  • Toscano, L. (2012). In M. RosendalP. FinkA. SchröderEds., When the body says stop (information about functional disorders) [Når kroppen siger fra]. Copenhagen, Denmark: The Danish Committee for Health Education. Retrieved from http://funktionellelidelser.dk/fileadmin/www.funktionellelidelser.au.dk/patient_Pjecer/When_the_body_says_stop.pdf First citation in articleGoogle Scholar

  • Toscano, L. (2017). In C. U. RaskK. H. KallesøeG. TeilmannEds., Malte og maltes mave (Danish) [Not yet translated to English] (1st ed.). Copenhagen, Denmark: The Danish Committee for Health Education. First citation in articleGoogle Scholar

  • Van der Felt-Cornelis, C. M., Elfeddali, I., Werneke, U., Malt, U. F., Van der Bergh, O., Schaefert, R., … Lowe, B. (2018). A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate Delphi expert study. Frontiers in Psychiatry, 9, 151. https://doi.org/10.3389/fpsyct.2.018.00151 First citation in articleCrossref, Google Scholar

  • Van Slyke, D. A., & Walker, L. S. (2006). Mothers’ responses to children’s pain. Clinical Journal of Pain, 22, 387–391. https://doi.org/10.1097/01.ajp.0000205257.80044.01 First citation in articleCrossref, Google Scholar

  • Walker, L. S. (2019). Commentary: Understanding somatic symptoms: From dualism to systems, diagnosis to dimensions, clinical judgment to clinical science. Journal of Pediatric Psychology, 44, 862–867. https://doi.org/10.1093/jpepsy/jsz050 First citation in articleCrossref, Google Scholar

  • Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s Somatization Inventory: Psychometric properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430–440. https://doi.org/10.1093/jpepsy/jsn093 First citation in articleCrossref, Google Scholar

  • Walker, L. S., & Garber, J. (2018). Manual for the Children's Somatic Symptom Inventory (CSSI). Retrieved from https://www.childrenshospital.vanderbilt.org/uploads/documents/CSSI_Manual.pdf First citation in articleGoogle Scholar

  • Walker, L. S., & Greene, J. W. (1991). The functional disability inventory: Measuring a neglected dimension of child health status. Journal of Pediatric Psychology, 16, 39–58. https://doi.org/10.1093/jpepsy/16.1.39 First citation in articleCrossref, Google Scholar

  • Walker, L. S., Smith, C. A., Garber, J., & Claar, R. L. (2007). Appraisal and coping with daily stressors by pediatric patients with chronic abdominal pain. Journal of Pediatric Psychology, 32, 206–216. https://doi.org/10.1093/jpepsy/jsj124 First citation in articleCrossref, Google Scholar

  • Walker, L. S., Smith, C. A., Garber, J., & Slyke, V. (1997). Development and validation of the pain response inventory for children. Psychological Assessment, 9, 392–405. https://doi.org/10.1037/1040-3590.9.4.392 First citation in articleCrossref, Google Scholar

  • Wilson, A. C., Moss, A., Palermo, T. M., & Fales, J. L. (2014). Parent pain and catastrophizing are associated with pain, somatic symptoms, and pain-related disability among early adolescents. Journal of Pediatric Psychology, 39, 418–426. https://doi.org/10.1093/jpepsy/jst094 First citation in articleCrossref, Google Scholar

  • World Health Organization. (2018). International Classification of Diseases (11th ed.). Retrieved from https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f264310751 First citation in articleGoogle Scholar

  • Wright, K. D., & Asmundson, G. J. G. (2003). Health anxiety in children: Development and psychometric properties of the Childhood Illness Attitude Scales. Cognitive Behaviour Therapy, 32, 194–202. https://doi.org/10.1080/16506070310014691 First citation in articleCrossref, Google Scholar