E0 ConsensusModerate confidencePEM not requiredSystematic-ReviewPeer-reviewedReviewed
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Psychological Interventions for Children with Functional Somatic Symptoms: A Systematic Review and Meta-Analysis.
Bonvanie, Irma J, Kallesøe, Karen H, Janssens, Karin A M et al. · The Journal of pediatrics · 2017 · DOI
Quick Summary
This review looked at 27 studies testing whether talking therapies and psychological treatments help children with long-lasting physical symptoms like pain, fatigue, and nausea. The researchers found that psychological treatments did help reduce symptoms, disability, and school absences, and these improvements lasted even after treatment ended.
Why It Matters
While this review focuses on functional somatic symptoms generally rather than ME/CFS specifically, it demonstrates that psychological approaches can meaningfully reduce symptom burden and functional disability in children with persistent physical symptoms—findings relevant to understanding non-pharmacological treatment options for pediatric ME/CFS. The identification of sustained improvements post-treatment suggests potential long-term benefits worth investigating in ME/CFS populations.
Observed Findings
Psychological treatments reduced symptom load with an effect size of Hedges g = -0.61 post-treatment
Psychological treatments reduced disability with an effect size of Hedges g = -0.42 post-treatment
Psychological treatments reduced school absence with an effect size of Hedges g = -0.51 post-treatment
Treatment effects were maintained at follow-up assessments
Symptom duration, age, and treatment dose did not explain variation in treatment outcomes across studies
Inferred Conclusions
Psychological interventions produce measurable reductions in symptom load, functional disability, and school absence in children with functional somatic symptoms
Treatment benefits persist beyond the intervention period, suggesting sustained improvement
Current evidence does not identify clear moderators of treatment response based on patient or treatment characteristics, indicating need for more refined analysis
Significant heterogeneity in methods and outcomes limits confidence in a single treatment approach across all children
Remaining Questions
Which specific psychological treatment modalities or components are most effective for different symptom presentations in children?
What This Study Does Not Prove
This review does not establish that psychological treatments are a primary cure for functional somatic symptoms or that symptoms are primarily psychological in origin. The study cannot determine which specific psychological techniques are most effective, nor can it prove causation—it only demonstrates association between treatment and symptom reduction. Additionally, the heterogeneity and variety of outcome measures mean results should be interpreted cautiously and may not generalize equally to all children or symptom presentations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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