Pilot study of a parent-based intervention for functional somatic symptoms in children 2024 Etkin et al

[SNT Gatchaman]

That's a useless abstract. It says nothing about what the intervention actually is, nor about what changed.

Inclusion criteria were that children: (a) were between 10 and 17 years old, (b) had one or more FSS including headache, gastrointestinal symptoms, musculoskeletal pain, chronic fatigue, fibromyalgia, irritable bowel syndrome, symptoms related to chronic Lyme disease, perceived cognitive impairment, or other nonspecific symptoms not attributable to a known biomedical disorder despite adequate evaluation, (c) had symptoms for at least 3 months with some degree of impairment (e.g., missing school), (d) were proficient in English, and (e) lived with their participating parent >50% of the time.

Treatment groups meet once per week for seven consecutive weeks. Each session lasted 1.5 h, scheduled in the evenings (after work hours) to promote accessibility. Only parents, not children, attended the treatment sessions, which were conducted over Zoom. Families received the intervention at no cost.

SPACE-Somatic was adapted from the original SPACE protocol for child anxiety disorders/OCD and informed by FSS theory and research. The protocol is manualized but designed to be implemented flexibly. It includes six parts implemented sequentially over the seven group sessions. Each session involves active discussion and practice of skills in addition to didactic components. Parents are also given tasks to complete between sessions and review the following week. The key components of each part of the treatment are presented in Table 1.

Headache, fatigue and muscle pain dominated, with GI disturbance, abdominal pain, POTS, dizziness/vertigo also highly represented.

Note the drop-out rate: 17 families contacted researchers; 16 did treatment; 13 at 1 week post-intervention follow-up; 11 at 12 weeks follow-up, with 2 lost to follow-up. At early follow-up, 1 discontinued treatment because "child's symptoms improved", 2 "scheduling conflicts".

We also found preliminary evidence that SPACE-Somatic may be beneficial for improving symptoms and functioning in children with FSS. There was a statistically significant change in parent reports of children’s level of functional disability and health-related quality of life, and in parent and child reports of children’s symptom-related impairment, following treatment. Parent reports also provided evidence of maintenance 3 months later. Findings must be interpreted with caution, as the sample size limited our ability to detect moderate or smaller effects. Yet, it is promising that descriptively, all child- and parent-report measures assessing children’s FSS showed improvements across time points. Future studies containing larger, randomly assigned samples, will provide additional rigorous tests of this initial indication that SPACE-Somatic improves children’s functioning and symptoms.

While it is a strength that we collected both parent- and child-report measures at three time points, there were more missing child-report than parent-report data at 3-month FU. The parent-report data also showed more significant improvements following treatment than did the child-report data, likely impacted by the lower degree of missing data.

It is unclear, for example, whether the higher proportion of missing data and fewer significant child-report findings in our study reflect lower levels of child engagement, a possibility that underscores the importance of parent-based work in this population.

Although preliminary, these findings suggest that SPACE-Somatic holds promise as a novel intervention for pediatric FSS by offering parents specific tools for helping their child.

 

[bobbler]

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Headache, fatigue and muscle pain dominated, with GI disturbance, abdominal pain, POTS, dizziness/vertigo also highly represented.

Note the drop-out rate: 17 families contacted researchers; 16 did treatment; 13 at 1 week post-intervention follow-up; 11 at 12 weeks follow-up, with 2 lost to follow-up. At early follow-up, 1 discontinued treatment because "child's symptoms improved", 2 "scheduling conflicts".

So scary all of this

 

[rvallee]

Looking at the interventions, this seems to make some sense in terms of managing behavioral problems. Possibly, although this is all so generic that any LLM could do at least as good. But to think this can treat symptoms of illness is seriously delusional.

And as usual the data are awful and do not support the value, but the intention is always to produce more research with similar methodologies, with same flaws and weaknesses and to go ahead and use it in practice anyway, while assessing the outcomes with the same weak, flawed and mostly useless uninterpretable methodologies. What a completely rotten and useless ideology.

It's like they took the idea of the journey being more important than the destination, and just don't bother with the fact that no one applying this nonsense has ever reached any destination. It's all journey, always a novel trek, yet somehow always on the same trail, and all it does is loop back to the start.

 

[Sean]

or other nonspecific symptoms not attributable to a known biomedical disorder despite adequate evaluation,

How do they know it is 'adequate'?

All they can reasonably say is that current understanding and standard assessment techniques failed to find any significant relevant factors.

Which is a very different (and much more honest) statement.

 

[Peter T]

How do they know it is 'adequate'?

Use of the word ‘adequate’ reads to me that they believed full or detailed investigation was not necessary because they ‘knew’. Using the word adequate to me suggests that for research purposes this was not sufficient.