School refusal — Who should intervine? (Diagnostic and treatment categories)

A Systematic Review of Somatic Symptoms in School Refusal

“…Several studies documented that parents give their children permission to remain home mainly because of somatic symptoms (50–57). Parents were reported to have a range of difficulties when faced with their children’s somatic symptoms (46,55,58,59).…”

“…Some doctors justified unnecessary absences (51,61). Seven studies, mainly written by pediatricians, affirmed it was the pediatricians’ and physicians’ role to identify school refusal (46,53,61,66,82,88,89) and to treat it especially in the absence of psychiatric comorbidity (46,48,53,54,57,61). However, one study stated that primary care physicians would be unlikely to ask about the child’s behavior, possibly as a consequence of time constraints (87).…”

“…Multiple studies showed that a pathophysiological organic explanation could not be found to account for the somatic symptoms in school refusers (30,48,51,53–55,58,61,71,73,77–80,87,91,97,100,104,106,107,116,127). Terms such as “hypochondriacal” (26,82,96,128), “psychosomatic” (34,46,49,53,78,82,105,112–114,119,127,129–134), “somatoform disorder” (81,86,135), “somatization” (24,136), and “hysteria” (26,128,137) were used to describe these conditions.…”

“…The main etiology reported was anxiety (17,24,34,45,48,49,53,64,67,68,70,71,75,77,93,94,98,106,124,137,143–148), alternatively referred to as stress (4,22,47,71,75,84,102,149), or emotional distress (26,28,30,34,48,54,95,100,102,150–152). Underlying causes of anxiety were depression (24,75,113) and fear of a specific object or situation (48,104,118,153).…”