Restricted accessReview articleFirst published online 2020-1
A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes
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.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
2.
BanduraA. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
3.
BerntssonL. T.KohlerL.GustafssonJ. E. (2001). Psychosomatic complaints in schoolchildren: A Nordic comparison. Scandinavian Journal of Public Heath, 29, 44–45. doi:10.1177/14034948010290011001
4.
BonvanieI. J.KallesøeK. H.JanssensK. A.SchröderA.RosmalenJ. G.RaskC. U. (2017). Psychological interventions for children with functional somatic symptoms: A systematic review and meta-analysis. The Journal of Pediatrics, 187, 272–281. doi:10.1016/j.jpeds.2017.03.017
5.
BrownR. J. (2007). Introduction to the special issue on medically unexplained symptoms: Background and future directions. Clinical Psychology Review, 27, 769–780. doi:10.1016/j.cpr.2007.07.003
6.
BussoneG.GrazziL.D’AmicoD.LeoneM.AndrasikF. (1998). Biofeedback-assisted relaxation training for young adolescents with tension-type headache: A controlled study. Cephalalgia, 18, 463–467. doi:10.1111/j.1468-2982.1998.1807463.x
7.
ChalderT.DearyV.HusainK.WalwynR. (2010). Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11-to 18-year-olds: A randomized controlled treatment trial. Psychological Medicine, 40, 1269–1279. doi:10.1017/S003329170999153X
8.
CrawleyE. M.GauntD. M.GarfieldK.HollingworthW.SterneJ. A.BeasantL.. . .MontgomeryA. A. (2017). Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: Randomised controlled trial. Archives of Disease in Childhood. Advance online publication. doi:10.1136/archdischild-2017-313375
9.
Domènech-LlaberiaE.JanèC.CanalsJ.BallespíS.EsparóG.GarraldaE. (2004). Parental reports of somatic symptoms in preschool children: Prevalence and associations in a Spanish sample. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 598–604. doi:10.1097/00004583-200405000-00013
10.
EggerH. L.CostelloE. J.ErkanliA.AngoldA. C. (1999). Somatic complaints and psychopathology in children and adolescent: Stomachaches, muscular-skeletal pains and headaches. Journal of American Academy of Child and Adolescent Psychiatry, 38, 852–860. doi:10.1097/00004583-199907000-00015
11.
EminsonM.BenjaminS.ShortallA.WoodsT.FaragherB. (1996). Physical symptoms and illness attitudes in adolescents: An epidemiological study. Journal of Child Psychology and Psychiatry, 37, 519–528. doi:10.1111/j.1469-7610.1996.tb01438.x
12.
FisherE.HeathcoteL.PalermoT. M.de C WilliamsA. C.LauJ.EcclestonC. (2014). Systematic review and meta-analysis of psychological therapies for children with chronic pain. Journal of Pediatric Psychology, 39, 763–782. doi:10.1093/jpepsy/jsu008
13.
GriffinA.ChristieD. (2008). Taking the psycho out of psychosomatic: Using systemic approaches in a paediatric setting for the treatment of adolescents with unexplained physical symptoms. Clinical Child Psychology and Psychiatry, 13, 531–542. doi:10.1177/1359104508096769
14.
GriffithsJ. D.MartinP. R. (1996). Clinical-versus home-based treatment formats for children with chronic headache. British Journal of Health Psychology, 1, 151–166. doi:10.1111/j.2044-8287.1996.tb00499.x
15.
HickmanC.JacobsonD.MelnykB. M. (2015). Randomized controlled trial of the acceptability, feasibility, and preliminary effects of a cognitive behavioral skills building intervention in adolescents with chronic daily headaches: A pilot study. Journal of Pediatric Health Care, 29, 5–16. doi:10.1016/j.pedhc.2014.05.001
HintonD.KirkS. (2016). Families’ and healthcare professionals’ perceptions of healthcare services for children and young people with medically unexplained symptoms: A narrative review of the literature. Health & Social Care in the Community, 24, 12–26. doi:10.1111/hsc.12184
18.
HusainK.BrowneT.ChalderT. (2007). A review of psychological models and interventions for medically unexplained somatic symptoms in children. Child and Adolescent Mental Health, 12, 2–7. doi:10.1111/j.1475-3588.2006.00419.x
19.
Kashikar-ZuckS.SwainN. F.JonesB. A.GrahamT. B. (2005). Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. The Journal of Rheumatology, 32, 1594–1602. Retrieved from http://www.jrheum.org/content/32/8/1594.short
20.
Kashikar-ZuckS.TingT. V.ArnoldL. M.BeanJ.PowersS. W.GrahamT. B.. . .LovellD. J. (2012). Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: A multisite, single-blind, randomized, controlled clinical trial. Arthritis & Rheumatism, 64, 297–305. doi:10.1002/art.30644
21.
KeefeF. J.RumbleM. E.ScipioC. D.GiordanoL. A.PerriL. M. (2004). Psychological aspects of persistent pain: Current state of the science. The Journal of Pain, 5, 195–211. doi:10.1016/j.jpain.2004.02.576
22.
LawE. F.Beals-EricksonS. E.NoelM.ClaarR.PalermoT. M. (2015). Pilot randomized controlled trial of internet delivered cognitive behavioral treatment for pediatric headache. Headache: The Journal of Head and Face Pain, 55, 1410–1425. doi:10.1111/head.12635
23.
LevyR. L.LangerS. L.WalkerL. S.RomanoJ. M.ChristieD. L.YoussefN.. . .WhiteheadW. E. (2010). Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. The American Journal of Gastroenterology, 105, 946–956. doi:10.1038/ajg.2010.106
24.
LevyR. L.LangerS. L.WalkerL. S.RomanoJ. M.ChristieD. L.YoussefN.. . .WhiteheadW. E. (2013). Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. JAMA Pediatrics, 167, 178–184. doi:10.1001/2013.jamapediatrics.282
25.
LevyR. L.WhiteheadW. E.WalkerL. S.Von KorffM.FeldA. D.GarnerM.ChristieD. (2004). Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms. The American Journal of Gastroenterology, 99, 2442–2451. doi:10.1111/j.1572-0241.2004.40478.x
26.
LiberatiA.AltmanD. G.TetzlaffJ.MulrowC.GøtzscheP. C.IoannidisJ. P.. . .MoherD. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151, 65–94. doi:10.7326/0003-4819-151-4-200908180-00136
27.
LiebR.PfisterH.MastalerM.WittchenH. U. (2000). Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: Prevalence, comorbidity and impairments. Acta Psychiatrica Scandinavica, 101, 194–208. doi:10.1034/j.1600-0447.2000.101003194.x
28.
LloydS.ChalderT.RimesK. A. (2012). Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: Long-term follow-up of an RCT. Behaviour Research and Therapy, 50, 719–725.
29.
McGrathP. J.HumphreysP.KeeneD.GoodmanJ. T.LascellesM. A.CunninghamS. J.FirestoneP. (1992). The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain, 49, 321–324. doi:10.1016/0304-3959(92)90238-7
30.
National Institute for Health and Clinical Excellence. (2012). Methods for the development of NICE public health guidance (3rd ed.). London, England: Author. Retrieved from http://www.nice.org.uk/article/pmg4/
31.
NijhofS. L.MaijerK.BleijenbergG.UiterwaalC. S.KimpenJ. L.van de PutteE. M. (2011). Adolescent chronic fatigue syndrome: Prevalence, incidence, and morbidity. Pediatrics. Advance online publication. doi:10.1542/peds.2010-1147
32.
PalermoT. M.LawE. F.FalesJ.BrombergM. H.Jessen-FiddickT.TaiG. (2016). Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: A randomized controlled multicenter trial. Pain, 157, 174–185. doi:10.1097/j.pain.0000000000000348
33.
PalermoT. M.WilsonA. C.PetersM.LewandowskiA.SomhegyiH. (2009). Randomized controlled trial of an internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146, 205–213. doi:10.1016/j.pain.2009.07.034
34.
ScharffL.MarcusD. A.MasekB. J. (2002). A controlled study of minimal-contact thermal biofeedback treatment in children with migraine. Journal of Pediatric Psychology, 27, 109–119. doi:10.1093/jpepsy/27.2.109
35.
SchurmanJ. V.WuY. P.GraysonP.FriesenC. A. (2010). A pilot study to assess the efficacy of biofeedback-assisted relaxation training as an adjunct treatment for pediatric functional dyspepsia associated with duodenal eosinophilia. Journal of Pediatric Psychology, 35, 837–847. doi:10.1093/jpepsy/jsq010
36.
SheanG. (2014). Limitations of randomized control designs in psychotherapy research. Advances in Psychiatry. Advance online publication. doi:10.1155/2014/561452
37.
SöllnerW.SchüsslerG. (2001). Psychodynamic therapy in chronic pain patients: A systematic review. Zeitschrift fur Psychosomatische Medizin und Psychotherapie, 47, 115–139.
38.
TrautmannE.Kröner-HerwigB. (2010). A randomized controlled trial of internet-based self-help training for recurrent headache in childhood and adolescence. Behaviour Research and Therapy, 48, 28–37. doi:10.1016/j.brat.2009.09.004
39.
Van der VeekS. M.DerkxB. H.BenningaM. A.BoerF.de HaanE. (2013). Cognitive behavior therapy for pediatric functional abdominal pain: A randomized controlled trial. Pediatrics, 132, 1163–1172. doi:10.1542/peds.2013-0242
40.
WalkerL. S.GarberJ.GreeneJ. W. (1991). Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization. Journal of Abnormal Child Psychology, 19, 379–394. doi:10.1007/BF00919084
41.
WarnerC. M.ColognoriD.KimR. E.ReigadaL. C.KleinR. G.Browner-ElhananK. J.. . .BenkovK. (2011). Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: An initial controlled trial. Depression and Anxiety, 28, 551–559. doi:10.1002/da.20821
42.
WesselyS.NimnuanC.SharpeM. (1999). Functional somatic syndromes: One or many?The Lancet, 354, 936–939. doi:10.1016/S0140-6736(98)08320-2
43.
WicksellR. K.MelinL.LekanderM.OlssonG. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain–A randomized controlled trial. Pain, 141, 248–257. doi:10.1016/j.pain.2008.11.006
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