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Psychological Interventions for Children with Functional Somatic Symptoms: Review and Meta-Analysis

Discussion in 'Latest ME/CFS Research' started by hixxy, Apr 19, 2017.

  1. hixxy

    hixxy Senior Member

    J Pediatr. 2017 Apr 14. pii: S0022-3476(17)30366-9. doi: 10.1016/j.jpeds.2017.03.017.

    Psychological Interventions for Children with Functional Somatic Symptoms: A Systematic Review and Meta-Analysis

    Bonvanie IJ, Kallesøe KH, Janssens KAM, Schröder A, Rosmalen JGM, Rask CU.


    To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects.

    Cochrane, PubMed, PsycINFO, EMBASE, and CINAHL were searched for randomized controlled trials published in peer-reviewed journals. Randomized controlled trials studying the effect of a psychological treatment on symptom load and disability in children with functional somatic symptoms were selected. Data on symptom load, disability, and school absence directly post-treatment and at follow-up were extracted by 2 assessors. Studies were appraised with the Cochrane risk of bias tool. Standardized mean differences were pooled in a random-effects model. Heterogeneity in effect-sizes was explored by use of meta-regressions. PROSPERO Registration ID: CRD42015029667.

    Out of 4098 identified records, 27 studies were included in this review of which 21 were included in meta-analyses. Psychological treatments reduced symptom load (Hedges g = -0.61), disability (Hedges g = -0.42), and school absence (Hedges g = -0.51) post-treatment in children suffering from various functional somatic symptoms. Effects were maintained at follow-up. Type and duration of symptoms, age, and treatment dose did not explain heterogeneity in effect-sizes between studies. Effect-sizes should be interpreted with caution because of the variety in outcome measures, unexplained heterogeneity in found effects and potential publication bias.

    Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.

    Copyright © 2017 Elsevier Inc. All rights reserved.

    chronic fatigue syndrome; chronic pain; fibromyalgia; headache; irritable bowel syndrome; medically unexplained; pediatric; therapy; treatment

    PMID: 28416243
    DOI: 10.1016/j.jpeds.2017.03.017
    AndyPR likes this.
  2. shannah

    shannah Senior Member

    I'm always interested in the history of some of these papers and where they're from. Looks like this one was revised.

    Netherlands and Denmark

    Publication History
    Published online:April 14, 2017
    Accepted:March 7, 2017
    Received in revised form:January 3, 2017
    Received:September 4, 2016
    AndyPR likes this.
  3. Esther12

    Esther12 Senior Member

    Can't find full text.

    Wonder if this is 'pulling a PACE', with no significant differences between groups:

    AndyPR and trishrhymes like this.
  4. Mohawk1995

    Mohawk1995 Senior Member

    It, of course, is a study of averages of averages as all Cochrane Reviews and large studies are. That being said, it seems to support a logical conclusion that children suffering with disabling disease benefit from emotional support and the enhancement of coping strategies that psychological support can provide. Not sure you can take any specific strategies from this as it is too broad of a review. If indeed the results are maintained at follow up, it is because the child gained some abilities through the process. Also hard to measure this in a group this large. Like all research it has to be effectively applied to the individual patient (child in this case) through the filter of the practitioner's expertise. If it is not effective, it is not relevant to that child (something the PACE folks seemed to have forgotten).
    MEMum and Diwi9 like this.
  5. duncan

    duncan Senior Member

    Little-known companion study: Prayer Interventions For Children Possessed By Demons
    antherder, A.B., slysaint and 2 others like this.
  6. Valentijn

    Valentijn Senior Member

    There's a big difference between "psychological interventions" for the presumed fake symptoms discussed in the trial, and coping strategies and support.

    All of the researchers are in psychiatric, psychosomatic, and/or psychopathology departments, by the way. Full text available at

    The process was indeed aimed at changing thoughts about symptoms, not supporting ill children:
    The presumed psychosomatic disorders included:
    Primary outcomes were subjective pain and fatigue, which are the usual explicit targets of psychosomatic therapies:
    The outcome of school attendance was a lot less objective than it sounds, since it included reports from the children and parents in some studies, rather than actual review of attendance records. There were also only 7 trials with school attendance as an outcome, and most lacked either post-treatment or followup data, so this review did some dodgy combining of post-treatment and followup data to reach their conclusions.

    All 4 CFS trials showed a benefit of course: Al-hagger 2006, Chalder 2010/Lloyd 2012, Nijhof 2012 (Dutch FITNET), and Stulemeijer 2005/Knoop 2008. Which should be a good indication that the studies of these treatments in children with other diagnoses were equally worthless. They don't seem to consider the results from Bakker (2011) and van Geelen (2011) from the CFS bunch in determining treatment effectiveness, and probably others as well.
  7. Esther12

    Esther12 Senior Member

    Thanks. Am I missing something, of do they not include FITNET follow-up (Nijhof 2013) at follow-up? It's in there as reference 51, but I couldn't see it in any of their figures.

    I'm not really familiar with many of the studies on children.
    Valentijn likes this.
  8. TiredSam

    TiredSam The wise nematode hibernates

    Crap in, crap out.

    I collected ten dog turds today and put them in a big pile. Surprisingly, the pile smelt the same as the individual turds, only stronger.
    Woolie, Solstice, Molly98 and 3 others like this.
  9. Research 1st

    Research 1st Severe ME, POTS & MCAS.

    I wonder if children given these non evidence based labels by psychiatrists are given a full biological work before hand? Or simply given a full blood count, electrolytes, LFT ESR/CRP if they report pain and then told they are somatizers.

    Gee let me think....

    This all comes down to money, power and control. Of which in the UK, the NHS has no money and the patients have no choice. Same goes for European countries with socialised 'free' health care systems. Happens less in America, as you have to pay to have your kids abused by psychiatrists, rather than it being 'free' (tax payer funded).

    Common sense in medicine is very expensive (testing) so common sense goes out of the window very quickly due to 'wasting resources'.

    I'd bet my bottom dollar even if something as simple as nutrition has been tested for before they get told they're mentally ill, they'd only test for something like Vitamin D, Folate then give up. Not good enough and a false psychological label is pinned on the poor child who then is bullied into submission. Often if they parents go against the wishes of the doctor, the child can then even be taken away from the parents.

    Funny old world but not very funny if you're a kid who's freedom to find out the causes of potential undiagnosed chronic disease depends on the level of stupidity and lazyness of the doctor 'looking after' them.

    Without extensive testing, all of these 'theories' on children being somatizers are null and find.
    Everyone with POTS is deemed a somatizer unless they get given a TILT test. MS patients were too before the creation of an MRI scan.

    There's nothing worth with these theories of fatigue hoovering up people, including kids, of which the person diagnosing 'somatization' actually has no clue why the individual is sick, so it's presumed to be their mind.

    As science progresses, all of this practice will be banned as the vast majority of somatizers will be proven to have medical reasons for their symptoms anyway. Or they can be found now if you spend $50,000 per patient on tests. The state simply isn't prepared to spend that, and neither is private health care unless you pay by American Express.

    Now granted, wealthier families can do this, but what about those with less money? They get trapped and cannot escape.

    Exactly what happened to all of us with 'CFS' and being told we need CBT/GET to reduce fears of activity leading to deconditioning and thus symptoms of 'fatigue'.

    We are also guilty until proven innocent. We know how these kids feel.
    Last edited: Apr 19, 2017
    cyclamen, Molly98, Valentijn and 3 others like this.
  10. Esther12

    Esther12 Senior Member

    I was just going to close this study without looking at it further, when this sentance stood out:

    If they all have a high risk of bias for that, this should be recorded! Just because it's a near universal problem doesn't mean it's not a problem.
    Woolie, Cheshire, Solstice and 6 others like this.
  11. BruceInOz

    BruceInOz Senior Member

    That's a very good point. Did the Cochrane CFS review pull the same stunt?
  12. Esther12

    Esther12 Senior Member

    I don't remember.

    The only mention of the risk of bias assessment tool was in one of the criticial comments submitted by Robert Courtney: "Comment: Assessment of Selective Reporting Bias in White 2011"

    He also made some points on this under the heading "Bias Inherent in Open-Label Studies"

    Every time I re-read the responses to Courtney's comments I feel my blood pressure rise.

    I found this vague point in the review itself:


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