Challenges to high-quality care in autism with functional somatic symptoms: A case-inspired narrative review and exploratory biopsychosocial model

Abstract

Background

Children and adolescents with autism spectrum disorder (ASD) frequently experience functional somatic symptoms (FSS), although the underlying causes often remain unclear. Various biological and psychological factors, both individual and within families, such as alexithymia or health anxiety, can intensify these symptoms, sometimes resulting in excessive and unnecessary medical interventions.

Methods

A narrative review of the literature was conducted, alongside the presentation of a case report involving a 13-year-old boy with ASD. The case illustrates how personal and familial factors can influence the presentation of FSS and the risks of inappropriate treatment.

Discussion

The findings suggest that psychological and familial factors play a significant role in the manifestation of FSS in ASD. These factors can increase the risk of unnecessary medicalization, as they often lead to misinterpretation of symptoms by caregivers and healthcare providers. The case report further underscores how the interaction of personal and familial dynamics can complicate the management of FSS. A comprehensive biopsychosocial approach that addresses both the individual and the family is crucial for managing FSS in ASD. Future research should focus on developing targeted interventions that address these psychological and familial influences to enhance the quality of care and reduce unnecessary and potentially harmful healthcare utilization in ASD.

Plain language summary

Barriers to Effective Healthcare for Autism with Physical Symptoms: A Holistic Approach: Children and adolescents with autism often experience physical symptoms like stomach aches or headaches, but doctors can struggle to find a medical reason for them. These are known as “functional somatic symptoms” (FSS), meaning the symptoms don't stem from any physical disease. This can lead to unnecessary medical tests and treatments. The study highlights how factors such as family stress and difficulty understanding emotions (a condition called alexithymia) play a role in making these symptoms worse. A case report of a 13-year-old boy with autism is discussed, where the family was suspected of fabricating or exaggerating the boy’s symptoms, resulting in numerous hospital visits and invasive tests. However, the study shows that these suspicions may stem from a misunderstanding of the boy's condition, emphasizing the need to assess both the emotional and family context when managing FSS in autism. By using a holistic biopsychosocial model, which takes into account the body, mind, and family environment, the study recommends that both the individual and family should be involved in the treatment plan. This approach can lead to better health outcomes and less strain on families.