Anne Li1, Sélim Benjamin Guessoum, Nour Ibrahim, Hervé Lefèvre, Marie Rose Moro, Laelia Benoit. 1. AP-HP, Cochin Hospital, Maison des Adolescents - Maison de Solenn, Integrated Youth Health Care Service, F-75014 Paris, France Faculty of Medicine, Paris-Saclay University, Orsay, France University of Paris, PCPP, F-92100 Boulogne-Billancourt, France Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France Yale University, Yale School of Medicine, New Haven, CT, USA French Clinical Research Group in Adolescent Medicine and Health, France.
Abstract
OBJECTIVE: School refusers often display somatic symptoms which are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. METHODS: Pubmed and Psycinfo databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1,025 identified studies, 148 were included. RESULTS: Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training and ignoring the somatic symptoms. CONCLUSIONS: Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third wave behavioral therapies and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians and psychologists/psychiatrists is needed to improve wellbeing in children who experience somatic symptoms as related to school avoidance.
OBJECTIVE: School refusers often display somatic symptoms which are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. METHODS: Pubmed and Psycinfo databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1,025 identified studies, 148 were included. RESULTS: Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training and ignoring the somatic symptoms. CONCLUSIONS: Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third wave behavioral therapies and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians and psychologists/psychiatrists is needed to improve wellbeing in children who experience somatic symptoms as related to school avoidance.