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Ditte Hulgaard, 1. Reservelæge, PhD stud. (1); dhulgaard@health.sdu.dk Gitte Dehlholm, overlæge, PhD (1); mailto:Gitte.Dehlholm@rsyd.dk Charlotte Ulrikka Rask Overlæge, PhD (2); mailto:charrask@rm.dk (1) Børne- og ungdomspsykiatrisk afdeling Odense; SDU (2) Forskningsklinikken for funktionelle lidelser, Århus; Århus universitet Aim & Background: Functional somatic symptoms (FSS) can be defined as physical symptoms that cannot be fully explained by organic pathology. FSS are prevalent in children worldwide and in all medical settings, and when severe, pose a major burden on those with FSS and on society. In clinical practice and current research in child mental health, focus on family factors is increasing. The aim of this systematic review was to explore and describe the current family based approaches used for youngsters with FSS, and to evaluate the quality of the existing research in this area. Method: The review was conducted with reference to the PRISMA guidelines. A protocol was published in advance on PROSPERO. The individual study quality was assessed by the standardised Psychotherapy outcome study methodology rating form – revised (POMF – R) followed by an overall descriptive synthesis of the findings. Results: This review included sixteen papers based on fifteen studies that delivered family therapy to youngsters with FSS. The majority of the participants were diagnosed with functional somatic syndromes (pain and CFS) and the family based treatments were primarily based on CBT and the remaining on systemic therapy. Heterogeneity across the studies was found with regards to a number of issues such as amount of therapy, focus of therapy, settings and profession of therapist. The studies varied with regard to overall quality with the newer studies on family based CBT obtaining the best quality scores on the POMRF. Many different outcome measures were employed, and the outcome measures chosen did not necessarily reflect what was targeted in the therapy. Focus on illness beliefs and shifting focus away from an organic explanation was agreed upon in all studies, with the alternative explanations being influenced by the psychological foundation of the applied treatment. Conclusions: Research on family interventions for youngsters with FSS is limited. The existing studies are heterogeneous and have methodological limitations. There is consensus on the importance of targeting the family’s illness beliefs. The role of family factors in the management of FSS in children is still unclear. Implications will be discussed.

FSS are common in children and adolescents, resulting in significant morbidity and health expenses. In daily clinical practice there is limited consensus regarding the treatment. To understand FSS, a biopsychosocial framework is generally accepted. This includes, biological, psychological and social elements with special emphasis on the significance of family factors. Thus there is an increasing focus on interventions targeting family processes, and the empirical support for family- based treatment for children with mental health problems is growing. However, research is challenged by the fact that “family therapy” is based on a broad definition, which encompasses a wide range of interventions with theoretical and technical eclictism dominating the field. Research in adults shows that psychological treatment is effective for FSS. According to children and adolescents there is a growing evidence on the effect of psychological treatment. At the department of Child and Adolescent Psychiatry, University Hospital of Southern Denmark, a team of experienced therapists has developed an approach for the treatment of adolescents with FSS. This approach includes a formalized and well-established collaboration with the Pediatric department, University Hospital of Southern Denmark. The treatment is based on a biopsychosocial understanding combined with family therapy with elements of systemic and narrative theories. Objective: • Presentation of the family therapy approach used in the department of Child and Adolescent Psychiatry, University Hospital of Southern Denmark. • Discussion of different approaches to family therapy for adolescents with functional somatic symptoms • Discussion of challenges and advantages of a systemic narrative approach to families of adolescents with functional somatic symptoms.

Background: Young patients with Functional Somatic Symptoms (FSS) are common and may present in all clinical settings. Clinical presentation varies from self–limiting to severe and disabling symptoms with impairment in several domains of daily life.Psychological treatment targeting dysfunctional illness beliefs and poor sense of empowerment has been shown effective for FSS in adults. In comparison current knowledge about psychological treatment and the significance of illness beliefs and empowerment in children and adolescents with severe FSS is scarce.Aims: To conduct a qualitative study which aims to examine how specific illness beliefs and a sense of empowerment evolve and change during specialized family-based treatment delivered in a child and adolescent mental health services (CAMHS) setting. Further, how these affect symptom experiences and coping strategies. Methods: Data collection by semi-structured interviews with approx. 10 children with FSS and their Parents at strategic points in treatment, followed by analysis using Interpretative phenomenological analysis (IPA). IPA is a well-described qualitative method combining hermeneutic and phenomenological thoughts. Results: Preliminary data from interviews conducted prior to family therapy, indicate that illness beliefs and sense of empowerment may be diverging for children and their parents, and are influenced by many factors, such as health professionals, family history, media and personal experiences.Conclusions: Increased knowledge about how family therapy is perceived, and how the treatment affects illness beliefs and sense of empowerment may be used in the further development of effective family-based treatment programmes for this patient group.