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

Bonvanie, Irma J.; Kallesøe, Karen H.; Janssens, Karin A.M.; Schröder, Andreas; Rosmalen, Judith G.M.; Rask, Charlotte U.

doi:10.1016/j.jpeds.2017.03.017

Cited by 84Psychosomatic Disorders and Their TreatmentsPediatric Pain Management TechniquesFibromyalgia and Chronic Fatigue Syndrome Research

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

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Bonvanie, Irma J., Kallesøe, Karen H., Janssens, Karin A.M., Schröder, Andreas, Rosmalen, Judith G.M., Rask, Charlotte U.·2017·The Journal of Pediatrics

DOI 10.1016/j.jpeds.2017.03.017

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Abstract

Objective 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.Study design 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.Results 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.Conclusions 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.

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Research has so far focused on treatment of single syndrome FSS based on sub-specialties in the paediatric setting.
“research has so far focused on treatment of single syndrome FSS based on sub-specialties in the paediatric setting [24].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [24]
The Study Characteristics section reports that 24 of the 27 pediatric treatment studies focused on a specific symptom category or syndrome, supporting the claim that research has largely been syndrome-specific. The Treatments and Controls section says most treatments were delivered in specialized clinics, but it does not establish that the research was organized around pediatric subspecialties. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Further research on generic treatment options has been suggested to diminish the risk of fragmented care in specialized clinics.
“Further research on generic treatment options has been suggested to diminish the risk of fragmented care in specialized clinics [24, 43–45].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [24]
The Discussion (page not available in our copy) calls for further research on treatment delivery and implementation, including collaboration between specialized centers. It does not recommend generic treatment options or say they would reduce fragmented care. (LLM, conf=0.78)
Experimental — accuracy not yet measured
The majority of studies of CBT for functional somatic syndromes in children and adolescents are quite small and heterogeneous with regard to inclusion criteria, setting, dose and type of delivered treatment and therapist experience.
“However, the results should be interpreted with caution as the majority of these studies are quite small and heterogeneous with regard to e.g. inclusion criteria, setting, dose and type of delivered treatment and therapist experience (Abbott et al., 2018; Bonvanie et al., 2017).”
From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Bonvanie et al., 2017
The Discussion says studies differed considerably in inclusion criteria, treatment type, setting, dose, and therapist experience. Study Characteristics reports 24–273 randomized participants per study, but our copy does not establish that a majority were quite small; it also covers psychological interventions more broadly, not only CBT. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Across age groups, patient-activating therapies are the most promising treatments, and CBT has so far been the most prevailing in intervention studies.
“Across age groups, patient-activating therapies are the most promising treatments, and cognitive behavioural therapy (CBT) has so far been the most prevailing in intervention studies (Abbott et al., 2018; Bonvanie et al., 2017; Henningsen et al., 2018).”
From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Bonvanie et al., 2017
The Treatments and Controls section reports that 15 of 27 included studies investigated CBT-based treatments, supporting CBT as the most prevalent approach in this review. The Discussion reports benefits from psychological treatments in children and adolescents, but does not identify patient-activating therapies as the most promising treatments across age groups; the review is limited to children and adolescents. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Overall, the effect sizes for CBT in children and adolescents with functional somatic syndromes are somewhat larger than the corresponding estimates in adult studies.
“Overall, the ES are found to be somewhat larger than the corresponding estimates in adult studies (Bonvanie et al., 2017).”
From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Bonvanie et al., 2017
The Abstract reports effect sizes for psychological treatments in children with functional somatic symptoms, and the Treatments and Controls section says 15 studies examined CBT-based treatments. Our copy does not compare those effect sizes with estimates from adult studies, so it does not support the claim that they are somewhat larger. (LLM, conf=0.78)
Experimental — accuracy not yet measured

With regard to functional somatic syndromes, existing studies have almost exclusively focused on CBT-based treatments for single symptoms or syndromes, primarily functional abdominal symptoms, chronic fatigue, tension-type headache, fibromyalgia or mixed pain complaints in children as young as 6 years of age.
“With regard to FSS, existing studies have almost exclusively focused on CBT-based treatments for single symptoms or syndromes; primarily functional abdominal symptoms, chronic fatigue, tension-type headache, fibromyalgia or mixed pain complaints in children as young as 6 years of age (Abbott et al., 2018; Bonvanie et al., 2017).”
From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Bonvanie et al., 2017
The Study Characteristics section reports the listed symptom groups and participants aged 6–18. But Treatments and Controls says only 15 of 27 studies investigated CBT-based treatments, which does not support “almost exclusively.” (LLM, conf=0.91)
Experimental — accuracy not yet measured
CBT-based programs still have much better evidence for children and adolescents than third wave treatments.
“Thus, CBT-based programs still have much better evidence for this age group (Bonvanie et al., 2017).”
From Third wave treatments for functional somatic syndromes and health anxiety across the age span: A narrative review (2019) · cites this paper as Bonvanie et al., 2017
The Treatments and Controls section reports that 15 of 27 studies of children with functional somatic symptoms investigated CBT-based treatments; Table I (p. 281.e4) also lists an ACT study. This supports a larger evidence base for CBT in this condition, but the review does not establish that CBT has much better evidence than third-wave treatments across children and adolescents generally. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Psychological interventions, particularly based on CBT principles, are effective for FSS in children and adolescents in reducing symptom load, disability and school absence.
“Recent reviews show that psychological interventions, particularly based on cognitive behavioural therapy (CBT) principles, are effective for FSS in children and adolescents in reducing symptom load, disability and school absence [24, 25].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [24]
The findings are in accordance with previously reported positive impact of psychological treatment on symptom load and functioning in children and adolescents with FSS and of ACT-based interventions in adults with FSS.
“The findings are in accordance with the previously reported positive impact of psychological treatment on symptom load and functioning in children and adolescents with FSS [24–26, 28] and of ACT-based interventions in adults with FSS [29–31].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [24]

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Authors: Bonvanie, I. J., Kallesøe, K. H., Janssens, K. A. M., Schröder, A., Rosmalen, J. G. M., & Rask, C. U.
Affiliations: University Medical Center Groningen (NL)
Aarhus University Hospital (DK)
Corresponding author: Bonvanie, Irma J.
ORCID: Bonvanie, Irma J.
Kallesøe, Karen H.
Janssens, Karin A.M.
Schröder, Andreas
Rosmalen, Judith G.M.
Rask, Charlotte U.
Venue: The Journal of Pediatrics
Publisher: Elsevier BV
Published: 2017-08
Volume: 187
Pages: 272-281.e17
ISSN: 0022-3476 (ISSN-L)
DOI: 10.1016/j.jpeds.2017.03.017
OpenAlex: W2606343223
Cited by: 84
References: 81
Citations by year: 2026: 2 · 2025: 11 · 2024: 6 · 2023: 7 · 2022: 10 · 2021: 16 · 2020: 14 · 2019: 8 · 2018: 9 · 2017: 1
FWCI: 1.33
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Journal of Pediatrics (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (acceptedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords: functional somatic symptoms, psychological intervention, children, symptom burden, disability, school absenteeism, treatment effectiveness, treatment moderators
MeSH terms: Medically Unexplained Symptoms, Adolescent, Child, Female, Humans, Male, Psychotherapy, Treatment Outcome, Disease Management

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

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