A Systematic Review of Somatic Symptoms in School Refusal

Abstract

Objective: School refusers often display somatic symptoms that are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. Methods: PubMed and PsycINFO databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1025 identified studies, 148 were included. Results: Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue, and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training, and ignoring the somatic symptoms. Conclusions: Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third-wave behavioral therapies, and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians, and psychologists/psychiatrists is needed to improve well-being in children who experience somatic symptoms as related to school avoidance.

What Contributes to the Development and Maintenance of School Refusal in Chinese Adolescents: A Qualitative Study

“…Meanwhile, it is partially consistent with the opinions of attachment theory that the emotional instability of caregivers is correlated with children's uncertainty and insecure attachment experience and related to more psychosomatic complaints among children ( 32 ). As implied by Li et al's ( 33 ) study, school refusers often display somatic symptoms including headache, abdominal pain, vomiting, nausea, dizziness, diarrhea, muscular ache, fatigue and palpitation, and anxiety was found to be the most recurrent etiology of those somatic complains. Moreover, prior studies have also suggested that children's school refusal is correlated with their interpersonal conflicts, their enmeshment with their parents and parental psychopathology ( 9 , 13 , 14 , 16 ).…”

Types and correlates of school absenteeism among students with intellectual disability

“…Absence due to illness applied to 34% of those with absence due to school withdrawal and 51% of those with absence due to school refusal. The high rate of co-occurring absence due to school refusal and illness likely reflects somatic symptoms in the presentation of school refusal (Li et al 2021).…”

School attendance and school absenteeism: A primer for the past, present, and theory of change for the future

“…Many forms of school attendance/absenteeism exist across multiple instructional formats, including virtual or distance learning formats, that demand new and broader metrics (e.g., log-ins, completed assignments, student-teacher interactions, and mastery of skills) for measuring these constructs (National Forum on Education Statistics, 2021). In addition, school absenteeism comprises a spectrum of attendance problems that can include full or partial day absences, missing classes, tardiness, student/family problems in the morning, and distress, somatic complaints, and other psychological problems that interfere with school attendance (Li et al, 2021;Kearney and Gonzálvez, 2022). This has led to broader definitions of school attendance/absenteeism that focus less on physical presence/absence and more on engagement (Patrick and Chambers, 2020;Kearney, 2021).…”