Screening for Somatoform Disorders in Children and Adolescents

Abstract

Until now, no German diagnostic instrument existed for somatoform disorders in children and adolescents. Therefore the Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) was developed based on the SOMS-2 (Screening for Somatoform Disorders 2) (Rief & Hiller, 2008). This study investigates to what extent the SOMS-CA can differentiate significantly between children and adolescents with clinically diagnosed somatoform disorders and a control group and whether the SOMS-CA is superior to the GSCL-C (Giessen Subjective Complaint List for Children) (Braehler, 1992). 30 patients (11 -17 years) with somatoform disorders and a control group (n = 31) were examined with the SOMS-CA (N = 61). The results from the SOMS-CA in both groups were compared with one another by means of a contingency analysis (chi-square test). The sensitivity and specificity were calculated and an optimal cut-off value was determined (Receiver Operating Characteristic curve (ROC-curve) analysis). A comparison analysis of the ROC-curves of the SOMS-CA and the GSCL-C followed. The sum score of complaints in the patients was significantly higher than that in the control group. The ROC-curve for the SOMS-CA demonstrates its excellent ability to differentiate between the two groups with an AUC (area under the curve) = 0.983 (SE = 0.14; N = 61). The sensitivity was 97.6%, the specificity 96.8%. In comparison to the AUC of the GSCL-C the SOMS-CA shows a much higher result. The SOMS-CA successfully identifies patients with somatoform disorders from a paediatric population and differentiates from healthy test subjects. A comparison to the GSCL-C shows a considerable superiority of the SOMS-CA. Further studies on the validity of the SOMS-CA are necessary.

Prevalence of Somatic Symptoms and Somatoform Disorders among a German Adolescent Psychiatric Inpatient Sample

“…The Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) questionnaire [ 36 ] was employed to screen for somatoform disorders. This is a validated self-assessment questionnaire for an age range from 11 to 17 years, which comprises of a list of 31 symptoms (dichotomous yes/no answering format), 17 questions on quality of life and illness-related behavior, and 3 questions covering differential diagnoses (also dichotomous yes/no answering format).…”

“…The SOMS-CA was developed on the basis of the SOMS adult version [ 37 ]. It shows a sensitivity of 97.6%, a specificity of 96.8% for its ability to differentiate healthy children from those suffering from a somatoform condition, and a good internal consistency (α = 0.8) [ 36 ].…”

“…A total of seven possible points can be scored in the SOMS-CA: one point is awarded for at least one reported somatic symptom, one if no medical explanation for the symptom can be found, one if the wellbeing is impaired by the symptom, one for limitation of the daily routines, one for repeated consultations of physicians, one if the physical soundness cannot be accepted by the patient and one if symptom duration is six months or longer. In order to classify children and adolescents at risk for the diagnosis of a somatoform disorder, the SOMS-screening is positive if participants report at least one somatic symptom and additionally score four of the aforementioned seven possible diagnostic points [ 36 ]. To check for current somatoform symptoms, patients were additionally asked whether any of the complaints occurred within the last seven days, since this time span corresponds well to the point prevalence of (somatoform) disorders [ 38 ].…”

Estado actual de los trastornos somatomorfos y conversivos en niños y adolescentes

“…La prevalencia de TS y TC sería mayor a lo precisado, pues su expresión convoca diversas subespecialidades pediátricas en donde suelen infradiagnosticarse, pero su reporte ha aumentado en las dos últimas décadas 3 , representando un desafío diagnóstico y terapéutico para el médico por su dificultad clínica y general desconocimiento; así, en un estudio de Ndukuba et al, sólo 3% de los pediatras conocía adecuadamente los TC 4 , los que suelen sentirse molestos o manipulados por este tipo de pacientes 5 . Por otra parte, un estudio francés verificó que los principales motivos de consulta en un servicio de emergencias psiquiátricas fueron los trastornos neuróticos y somatomorfos 6 , hecho corroborado para la población general británica, donde los desórdenes mentales más prevalentes en 2010 fueron los del espectro somatomorfo, ansioso y afectivo 7 , por lo que el gasto público y privado en salud es prominente 5 , al asociarse a consultas reiteradas a múltiples especialistas, encontrándo-se mayoritariamente hallazgos negativos 8 . Adicionalmente, los criterios diagnósticos son aún controversiales en su aplicación infantojuvenil 9 , considerando además una falta de instrumentos evaluativos confiables y válidos y el poco consenso en relación a su manejo 10 .…”

Somatoform Symptoms In Adolescents Who Visit The Emergency Department: Alexithymia And Defensive Strategies

“…According to DSM-5 (American Psychiatric Association, 2003), somatoform symptoms generally occur in adolescence (Klineberg et al, 2014) and tend to persist through adulthood without treatment (Winter et al, 2014;Jeon, 2015).…”