Techniques for managing Functional Somatic Symptoms in children and adolescents

Kasia Kozlowska and colleagues have identified a comprehensive list of techniques to help professionals and families address somatic issues in children and adolescents. Techniques, and the causes of somatic illnesses are described in their book, Functional Somatic Symptoms in Children and Adolescents: A Stress-System Approach to Assessment and Treatment, Kasia Kozlowska, Stephen Scher, Helene Helgeland (2020), Palgrave Macmillan.

This post lists the intervention techniques identified in the book. Many can be used by legal and other professionals. CSI believes techniques such as these are generally applicable in many legal settings, particularly child protection cases. The techniques are organized around the mind-body-relationship (MBRx) approach used by the authors. Their relational approach is primarily centered on the Dynamic Maturational Model of Attachment and Adaptation (DMM). A book summary, and a summary of the MBRx approach, is available here.

Please note, information in brackets are CSI’s summary of concepts from the book. Information in parentheses are CSI’s ideas.

Treatment interventions I: Working with the body

1. Interventions that target the body itself [bottom up focus, giving attention to the body in order to stimulate the body to send calming information to the brain and other neural systems]
   1. Stabilizing sleep and the circadian clock
   2. Documenting somatic symptoms on a body map
   3. Tracking the sequencing of body sensations
   4. The body scan [assisted mindful focus on each part of the body]
   5. Slow breathing interventions
   6. Alternatives to breathing actions [humming, etc, to activate vagal parasympathetic systems in the child]
   7. Grounding interventions [mindfully connecting to the ground and sensations in the environment]
   8. Tensing muscles in the legs
   9. Progressive muscle relaxation
   10. Completion of self-protective motor responses or action tendencies
   11. Bottom-up mindfulness practice [meditation focused on body sensations, which calm neural activity]
   12. Regular exercise
   13. Physiotherapy
   14. Occupational therapy
   15. Releasing trigger points
2. Interventions that target key brain systems
   1. Pharmacotherapy to down-regulate arousal [such as SSRI’s and SNRI’s]
   2. Pharmacotherapy to treat comorbid anxiety and depression
   3. Pharmacotherapy as a neuromodulation intervention [limit use for sleep, pain, extreme arousal]
   4. Trauma-processing interventions [EMDR, Somatic Experiencing, etc.]
   5. Neuromodulation?

Treatment interventions II: Working with the mind

1. Expectations and the placebo effect
2. Psychoeducation and giving the child (and parents) space for questions
3. Changing the focus of attention [from pain to an object, music, craftwork or other activity]
4. Cognitive-behavioral interventions [to calm negative mental thoughts which send signals down to the body, a top-down approach]
   1. Use of second-wave CBT techniques
5. Top-down mindfulness interventions
6. Visualization exercises
7. Hypnosis
8. Pain coping skills

Treatment interventions III: Working with the family and implementing behavioral interventions

1. Interventions to establish a foundation for moving forward
   1. Advocating for the family in the health care system
   2. Identifying the level of capacity when working with the family
   3. Using the body as a beacon to track stressful events within the family and child’s social context
   4. Containing anxiety in the family system: the therapist [or other professional] as a container of anxiety (or as a Transitional Attachment Figure, connecting on both the feeling and doing levels)
   5. Facilitating healing from Adverse Childhood Experiences in the health care system
   6. Starting interventions with a working formulation [unencumbered by family and professional information processing bias]
2. Structural interventions involving the family
   1. Stepping back and giving the child space
   2. Changing the focus of attention [from the problem to capacity and the solution, and to enjoyable family activities done together]
      1. (For lawyers, it is often necessary for us to do the opposite at certain points of the attorney-client relationship, and focus the client’s attention on the source of their psychological pain, such as when we need to learn the details of abuse. After we get the information we need, we can then be mindful to focus on positive activities the client engages in, and SNACCMS activities clients are engaging in with their children. Sometimes it helps to let the client know what the process is and that focusing on unwanted topics will only last a little while, as described in the next technique.)
   3. Timetable activities: getting on with normal activities as much as possible [in an organized and supported manner]
      1. Figure 16.1 in the book offers a nice graphic and description of how to start with simple and easy steps, and the need to be clear there may be many steps and a step-by-step approach is the plan, in order to avoid overwhelm.
3. Intra-familial issues and interventions
   1. Learning skills to identify and talk about stress and distress
   2. Addressing [parental] health issues in the family system [so that parents and children are supported]
   3. Addressing other family issues [such as family conflict
4. Working with behavioral interventions
   1. Daily timetable
   2. Goal setting
   3. Managing avoidance behaviors
   4. The traffic light safety plan [Implementing immediate responses to danger signs such as negative thoughts]
   5. Using a bike/rugby helmet to protect the head from falls
5. Working with the school system

The list above is copyrighted by the authors, Kasia Kozlowska, Stephen Scher, Helene Helgeland (2020), and licensed under CC BY 4.0.