Screening for Somatoform Disorders in Children and Adolescents
Affiliation(s)
1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitatsmedizin, Berlin, Germany. 2 Institute of Medical Biometrics and Clinical Epidemiology, Charité-Universitatsmedizin, Berlin, Germany.
1 Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitatsmedizin, Berlin, Germany. 2 Institute of Medical Biometrics and Clinical Epidemiology, Charité-Universitatsmedizin, Berlin, Germany.
ABSTRACT
Until now, no German diagnostic instrument existed for somatoform disorders in children and adolescents. Therefore the Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) was developed based on the SOMS-2 (Screening for Somatoform Disorders 2) (Rief & Hiller, 2008). This study investigates to what extent the SOMS-CA can differentiate significantly between children and adolescents with clinically diagnosed somatoform disorders and a control group and whether the SOMS-CA is superior to the GSCL-C (Giessen Subjective Complaint List for Children) (Braehler, 1992). 30 patients (11 - 17 years) with somatoform disorders and a control group (n = 31) were examined with the SOMS-CA (N = 61). The results from the SOMS-CA in both groups were compared with one another by means of a contingency analysis (chi-square test). The sensitivity and specificity were calculated and an optimal cut-off value was determined (Receiver Operating Characteristic curve (ROC-curve) analysis). A comparison analysis of the ROC-curves of the SOMS-CA and the GSCL-C followed. The sum score of complaints in the patients was significantly higher than that in the control group. The ROC-curve for the SOMS-CA demonstrates its excellent ability to differentiate between the two groups with an AUC (area under the curve) = 0.983 (SE = 0.14; N = 61). The sensitivity was 97.6%, the specificity 96.8%. In comparison to the AUC of the GSCL-C the SOMS-CA shows a much higher result. The SOMS-CA successfully identifies patients with somatoform disorders from a paediatric population and differentiates from healthy test subjects. A comparison to the GSCL-C shows a considerable superiority of the SOMS-CA. Further studies on the validity of the SOMS-CA are necessary.
Until now, no German diagnostic instrument existed for somatoform disorders in children and adolescents. Therefore the Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) was developed based on the SOMS-2 (Screening for Somatoform Disorders 2) (Rief & Hiller, 2008). This study investigates to what extent the SOMS-CA can differentiate significantly between children and adolescents with clinically diagnosed somatoform disorders and a control group and whether the SOMS-CA is superior to the GSCL-C (Giessen Subjective Complaint List for Children) (Braehler, 1992). 30 patients (11 - 17 years) with somatoform disorders and a control group (n = 31) were examined with the SOMS-CA (N = 61). The results from the SOMS-CA in both groups were compared with one another by means of a contingency analysis (chi-square test). The sensitivity and specificity were calculated and an optimal cut-off value was determined (Receiver Operating Characteristic curve (ROC-curve) analysis). A comparison analysis of the ROC-curves of the SOMS-CA and the GSCL-C followed. The sum score of complaints in the patients was significantly higher than that in the control group. The ROC-curve for the SOMS-CA demonstrates its excellent ability to differentiate between the two groups with an AUC (area under the curve) = 0.983 (SE = 0.14; N = 61). The sensitivity was 97.6%, the specificity 96.8%. In comparison to the AUC of the GSCL-C the SOMS-CA shows a much higher result. The SOMS-CA successfully identifies patients with somatoform disorders from a paediatric population and differentiates from healthy test subjects. A comparison to the GSCL-C shows a considerable superiority of the SOMS-CA. Further studies on the validity of the SOMS-CA are necessary.
KEYWORDS
Somatoform Disorders in Children and Adolescents, Diagnostics, SOMS-CA, Sensitivity, Specificity
Somatoform Disorders in Children and Adolescents, Diagnostics, SOMS-CA, Sensitivity, Specificity
Cite this paper
Winter, S. , Quinn, C. , Lenz, K. , Pfeiffer, E. & Lehmkuhl, U. (2014). Screening for Somatoform Disorders in Children and Adolescents. Psychology, 5, 1629-1637. doi: 10.4236/psych.2014.514173.
Winter, S. , Quinn, C. , Lenz, K. , Pfeiffer, E. & Lehmkuhl, U. (2014). Screening for Somatoform Disorders in Children and Adolescents. Psychology, 5, 1629-1637. doi: 10.4236/psych.2014.514173.
References
[1] Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry. [2] Achenbach, T. M. (1991b). Manual for the Youth Self-Report and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry. [3] Bass, C., & Murphy, M. (1995). Somatoform and Personality Disorders: Syndromal Comorbidity and Overlapping Developmental Pathways. Journal of Psychosomatic Research, 39, 403-427.
http://dx.doi.org/10.1016/0022-3999(94)00157-Z [4] Benjamin, S., & Eminson, D. M. (1992). Abnormal Illness Behavior: Childhood Experiences and Long-Term Consequences. International Review of Psychiatry, 4, 55-69.
http://dx.doi.org/10.3109/09540269209066302 [5] Bernal, P., Estroff, D. B., Aboudarham, J. F., Murphy, M., Keller, A., & Jellinek, M. S. (2000). Psychosocial Morbidity: The Economic Burden in a Pediatric Health Maintenance Organization Sample. Archives of Pediatrics & Adolescent Medicine, 154, 261-266.
http://dx.doi.org/10.1001/archpedi.154.3.261 [6] Braehler, E. (1992). Der Gießener Beschwerdebogen fur Kinder und Jugendliche GBB-KJ—Handanweisung. Bern: Hans Huber. [7] Briggs-Gowan, M. J., Horwitz, S. M., Schwab-Stone, M. E., Leventhal, J. M., & Leaf, P. J. (2000). Mental Health in Pediatric Settings: Distribution of Disorders and Factors Related to Service Use. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 841-849.
http://dx.doi.org/10.1097/00004583-200007000-00012 [8] Brockhaus, S. (2008). Symptome von somatoformen Storungen bei Kindern und Jugendlichen im Alter von 7-18 Jahren und Vergleich mit den Symptomen dieser Storungen bei Erwachsenen anhand von ICD-10 und DSM-IV. Berlin: Klinik fur Psychiatrie, Psychosomatik und Psychotherapie des Kindesund Jugendalters, Campus Virchow-Klinikum, Charité— Universitatsmedizin Berlin. [9] Campo, J. V., Jansen-McWilliams, L., Comer, D. M., & Kelleher, K. J. (1999). Somatization in Pediatric Primary Care: Association with Psychopathology, Functional Impairment, and Use of Services. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1093-1101.
http://dx.doi.org/10.1097/00004583-199909000-00012 [10] Di Lorenzo, C., Colletti, R. B., Lehmann, H. P., Boyle, J. T., Gerson, W. T., Hyams, J. S., Walker, L. et al. (2005). Chronic Abdominal Pain in Children. Pediatrics, 115, 812-815.
http://dx.doi.org/10.1542/peds.2004-2497 [11] Dopfner, M., & Lehmkuhl, G. (2003). Diagnostik-System fur psychische Storungen im Kindesund Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ) (2nd ed.). Bern: Hans Huber. [12] Eminson, M., Benjamin, S., Shortall, A., Woods, T., & Faragher, B. (1996). Physical Symptoms and Illness Attitudes in Adolescents: An Epidemiological Study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 519-528.
http://dx.doi.org/10.1111/j.1469-7610.1996.tb01438.x [13] Essau, C. A., Conradt, J., & Petermann, F. (2000). Haufigkeit und Komorbiditat Somatoformer Storungen bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Zeitschrift fur Klinische Psychologie und Psychotherapie, 29, 97-108.
http://dx.doi.org/10.1026//0084-5345.29.2.97 [14] Fritz, G. K., Fritsch, S., & Hagino, O. (1997). Somatoform Disorders in Children and Adolescents: A Review of the Past 10 Years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1329-1338.
http://dx.doi.org/10.1097/00004583-199710000-00014 [15] Hotopf, M., Carr, S., Mayou, R., Wadsworth, M., & Wessely, S. (1998). Why Do Children Have Chronic Abdominal Pain and What Happens to Them When They Grow Up? Population Based Cohort Study. BMJ, 316, 1196-1200.
http://dx.doi.org/10.1136/bmj.316.7139.1196 [16] Huertas-Ceballos, A. A., Logan, S., Bennett, C., & Macarthur, C. (2009). Dietary Interventions for Recurrent Abdominal Pain (RAP) and Irritable Bowel Syndrome (IBS) in Childhood. Cochrane Database of Systematic Reviews, 1, CD003019.
http://dx.doi.org/10.1002/14651858.CD003019.pub3 [17] Janssen, J., & Laatz, W. (2010). Statistische Datenanalyse mit SPSS fur Windows. Eine anwendungsorientierte Einfuhrung in das Basissystem und das Modul fur Exakte Tests (6th ed.). Berlin: Springer.
http://dx.doi.org/10.1007/978-3-642-01841-1 [18] Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. (1996). Diagnostic Interview: Kiddie-Sads-Present and Lifetime Version (K-Sads-PL). Pittsburgh: University of Pittsburgh School of Medicine: Department of Psychiatry. [19] Lindley, K. J., Glaser, D., & Milla, P. J. (2005). Consumerism in Healthcare Can Be Detrimental to Child Health: Lessons from Children with Functional Abdominal Pain. Archives of Disease in Childhood, 90, 335-337.
http://dx.doi.org/10.1136/adc.2003.032524 [20] Noeker, M. (2008). Funktionelle und somatoforme Storungen im Kindesund Jugendalter (Vol. 11). Gottingen: Hogrefe. [21] Perquin, C. W., Hunfeld, J. A., Hazebroek-Kampschreur, A. A., van Suijlekom-Smit, L. W., Passchier, J., Koes, B. W., & van der Wouden, J. C. (2001). Insights in the Use of Health Care Services in Chronic Benign Pain in Childhood and Adolescence. Pain, 94, 205-213.
http://dx.doi.org/10.1016/S0304-3959(01)00355-4 [22] Pfeiffer, E., Schroder, G., & Lehmkuhl, U. (1997). Somatoforme Storungen bei Kindern und Jugendlichen. Psychotherapie, 2, 102-105. [23] Reid, S., Wessely, S., Crayford, T., & Hotopf, M. (2002). Frequent Attenders with Medically Unexplained Symptoms: Service Use and Costs in Secondary Care. The British Journal of Psychiatry: The Journal of Mental Science, 180, 248-253.
http://dx.doi.org/10.1192/bjp.180.3.248 [24] Rief, W., & Hiller, W. (1999). Toward Empirically Based Criteria for the Classification of Somatoform Disorders. Journal of Psychosomatic Research, 46, 507-518.
http://dx.doi.org/10.1016/S0022-3999(99)00023-9 [25] Rief, W., & Hiller, W. (2008). Screening fur Somatoforme Storungen (SOMS). Manual. (2., vollstandig uberarbeitete und neu normierte Auflage). Bern: Hans Huber. [26] Tomasson, K., Kent, D., & Coryell, W. (1991). Somatization and Conversion Disorders: Comorbidity and Demographics at Presentation. Acta Psychiatrica Scandinavica, 84, 288-293.
http://dx.doi.org/10.1111/j.1600-0447.1991.tb03146.x [27] Voss, K. (2012). Vergleich des SOMS-KJ mit dem YSR und des SOMS-E mit der CBCL/4-18 hinsichtlich der Klassifikation somatoformer Storungen in einer kinderund jugendpsychiatrischen Inanspruchnahmepopulation. [28] Walker, L. S., & Garber, J. (1992). Children’s Somatization Inventory: Preliminary Manual. Nashville: Vanderbilt University Medical Center. [29] Walker, L. S., Garber, J., & Greene, J. W. (1991). Somatization Symptoms in Pediatric Abdominal Pain Patients: Relation to Chronicity of Abdominal Pain and Parent Somatization. Journal of Abnormal Child Psychology, 19, 379-394.
http://dx.doi.org/10.1007/BF00919084 [30] Walker, L. S., Garber, J., Smith, C. A., Van Slyke, D. A., & Claar, R. L. (2001). The Relation of Daily Stressors to Somatic and Emotional Symptoms in Children with and without Recurrent Abdominal Pain. Journal of Consulting and Clinical Psychology, 69, 85-91.
http://dx.doi.org/10.1037/0022-006X.69.1.85 [31] Wedekind, D., Bandelow, B., Fentzahn, E., Trumper, P., & Ruther, E. (2007). The Quantification Inventory for Somatoform Syndromes (QUISS): A Novel Instrument for the Assessment of Severity. European Archives of Psychiatry and Clinical Neuroscience, 257, 153-163.
http://dx.doi.org/10.1007/s00406-006-0700-4 [32] Weiß, R. H. (2006). CFT 20-R Grundintelligenztest Skala 2-Revision. Gottingen: Hogrefe. [33] Winter, S., Koeberle, C., Lenz, K., Pfeiffer, E., & Lehmkuhl, U. (2012). Systematik Somatoformer Storungen. Monatsschrift Kinderheilkunde, 160, 20-26. [34] Winter, S., Koeberle, C., Lenz, K., Pfeiffer, E., & Lehmkuhl, U. (2013). Systematik Somatoformer Storungen des Kindesund Jugendalters. Praxis der Kinderpsychologie und Kinderpsychiatrie, 9, 639-669. [35] Wittchen, H. U., & Pfister, H. (1997). DIA-X-Interviews: Manual fur Screening-Verfahren und Interview; Interviewheft Langsschnittuntersuchung (DIA-X-Lifetime); Erganzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Erganzungsheft (DIA-X-12Monate); PC-Programm zur Durchfuhrung des Interviews (Langsund Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets & Zeitlinger.
[1] Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry. [2] Achenbach, T. M. (1991b). Manual for the Youth Self-Report and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry. [3] Bass, C., & Murphy, M. (1995). Somatoform and Personality Disorders: Syndromal Comorbidity and Overlapping Developmental Pathways. Journal of Psychosomatic Research, 39, 403-427.
http://dx.doi.org/10.1016/0022-3999(94)00157-Z [4] Benjamin, S., & Eminson, D. M. (1992). Abnormal Illness Behavior: Childhood Experiences and Long-Term Consequences. International Review of Psychiatry, 4, 55-69.
http://dx.doi.org/10.3109/09540269209066302 [5] Bernal, P., Estroff, D. B., Aboudarham, J. F., Murphy, M., Keller, A., & Jellinek, M. S. (2000). Psychosocial Morbidity: The Economic Burden in a Pediatric Health Maintenance Organization Sample. Archives of Pediatrics & Adolescent Medicine, 154, 261-266.
http://dx.doi.org/10.1001/archpedi.154.3.261 [6] Braehler, E. (1992). Der Gießener Beschwerdebogen fur Kinder und Jugendliche GBB-KJ—Handanweisung. Bern: Hans Huber. [7] Briggs-Gowan, M. J., Horwitz, S. M., Schwab-Stone, M. E., Leventhal, J. M., & Leaf, P. J. (2000). Mental Health in Pediatric Settings: Distribution of Disorders and Factors Related to Service Use. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 841-849.
http://dx.doi.org/10.1097/00004583-200007000-00012 [8] Brockhaus, S. (2008). Symptome von somatoformen Storungen bei Kindern und Jugendlichen im Alter von 7-18 Jahren und Vergleich mit den Symptomen dieser Storungen bei Erwachsenen anhand von ICD-10 und DSM-IV. Berlin: Klinik fur Psychiatrie, Psychosomatik und Psychotherapie des Kindesund Jugendalters, Campus Virchow-Klinikum, Charité— Universitatsmedizin Berlin. [9] Campo, J. V., Jansen-McWilliams, L., Comer, D. M., & Kelleher, K. J. (1999). Somatization in Pediatric Primary Care: Association with Psychopathology, Functional Impairment, and Use of Services. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1093-1101.
http://dx.doi.org/10.1097/00004583-199909000-00012 [10] Di Lorenzo, C., Colletti, R. B., Lehmann, H. P., Boyle, J. T., Gerson, W. T., Hyams, J. S., Walker, L. et al. (2005). Chronic Abdominal Pain in Children. Pediatrics, 115, 812-815.
http://dx.doi.org/10.1542/peds.2004-2497 [11] Dopfner, M., & Lehmkuhl, G. (2003). Diagnostik-System fur psychische Storungen im Kindesund Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ) (2nd ed.). Bern: Hans Huber. [12] Eminson, M., Benjamin, S., Shortall, A., Woods, T., & Faragher, B. (1996). Physical Symptoms and Illness Attitudes in Adolescents: An Epidemiological Study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 37, 519-528.
http://dx.doi.org/10.1111/j.1469-7610.1996.tb01438.x [13] Essau, C. A., Conradt, J., & Petermann, F. (2000). Haufigkeit und Komorbiditat Somatoformer Storungen bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Zeitschrift fur Klinische Psychologie und Psychotherapie, 29, 97-108.
http://dx.doi.org/10.1026//0084-5345.29.2.97 [14] Fritz, G. K., Fritsch, S., & Hagino, O. (1997). Somatoform Disorders in Children and Adolescents: A Review of the Past 10 Years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1329-1338.
http://dx.doi.org/10.1097/00004583-199710000-00014 [15] Hotopf, M., Carr, S., Mayou, R., Wadsworth, M., & Wessely, S. (1998). Why Do Children Have Chronic Abdominal Pain and What Happens to Them When They Grow Up? Population Based Cohort Study. BMJ, 316, 1196-1200.
http://dx.doi.org/10.1136/bmj.316.7139.1196 [16] Huertas-Ceballos, A. A., Logan, S., Bennett, C., & Macarthur, C. (2009). Dietary Interventions for Recurrent Abdominal Pain (RAP) and Irritable Bowel Syndrome (IBS) in Childhood. Cochrane Database of Systematic Reviews, 1, CD003019.
http://dx.doi.org/10.1002/14651858.CD003019.pub3 [17] Janssen, J., & Laatz, W. (2010). Statistische Datenanalyse mit SPSS fur Windows. Eine anwendungsorientierte Einfuhrung in das Basissystem und das Modul fur Exakte Tests (6th ed.). Berlin: Springer.
http://dx.doi.org/10.1007/978-3-642-01841-1 [18] Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. (1996). Diagnostic Interview: Kiddie-Sads-Present and Lifetime Version (K-Sads-PL). Pittsburgh: University of Pittsburgh School of Medicine: Department of Psychiatry. [19] Lindley, K. J., Glaser, D., & Milla, P. J. (2005). Consumerism in Healthcare Can Be Detrimental to Child Health: Lessons from Children with Functional Abdominal Pain. Archives of Disease in Childhood, 90, 335-337.
http://dx.doi.org/10.1136/adc.2003.032524 [20] Noeker, M. (2008). Funktionelle und somatoforme Storungen im Kindesund Jugendalter (Vol. 11). Gottingen: Hogrefe. [21] Perquin, C. W., Hunfeld, J. A., Hazebroek-Kampschreur, A. A., van Suijlekom-Smit, L. W., Passchier, J., Koes, B. W., & van der Wouden, J. C. (2001). Insights in the Use of Health Care Services in Chronic Benign Pain in Childhood and Adolescence. Pain, 94, 205-213.
http://dx.doi.org/10.1016/S0304-3959(01)00355-4 [22] Pfeiffer, E., Schroder, G., & Lehmkuhl, U. (1997). Somatoforme Storungen bei Kindern und Jugendlichen. Psychotherapie, 2, 102-105. [23] Reid, S., Wessely, S., Crayford, T., & Hotopf, M. (2002). Frequent Attenders with Medically Unexplained Symptoms: Service Use and Costs in Secondary Care. The British Journal of Psychiatry: The Journal of Mental Science, 180, 248-253.
http://dx.doi.org/10.1192/bjp.180.3.248 [24] Rief, W., & Hiller, W. (1999). Toward Empirically Based Criteria for the Classification of Somatoform Disorders. Journal of Psychosomatic Research, 46, 507-518.
http://dx.doi.org/10.1016/S0022-3999(99)00023-9 [25] Rief, W., & Hiller, W. (2008). Screening fur Somatoforme Storungen (SOMS). Manual. (2., vollstandig uberarbeitete und neu normierte Auflage). Bern: Hans Huber. [26] Tomasson, K., Kent, D., & Coryell, W. (1991). Somatization and Conversion Disorders: Comorbidity and Demographics at Presentation. Acta Psychiatrica Scandinavica, 84, 288-293.
http://dx.doi.org/10.1111/j.1600-0447.1991.tb03146.x [27] Voss, K. (2012). Vergleich des SOMS-KJ mit dem YSR und des SOMS-E mit der CBCL/4-18 hinsichtlich der Klassifikation somatoformer Storungen in einer kinderund jugendpsychiatrischen Inanspruchnahmepopulation. [28] Walker, L. S., & Garber, J. (1992). Children’s Somatization Inventory: Preliminary Manual. Nashville: Vanderbilt University Medical Center. [29] Walker, L. S., Garber, J., & Greene, J. W. (1991). Somatization Symptoms in Pediatric Abdominal Pain Patients: Relation to Chronicity of Abdominal Pain and Parent Somatization. Journal of Abnormal Child Psychology, 19, 379-394.
http://dx.doi.org/10.1007/BF00919084 [30] Walker, L. S., Garber, J., Smith, C. A., Van Slyke, D. A., & Claar, R. L. (2001). The Relation of Daily Stressors to Somatic and Emotional Symptoms in Children with and without Recurrent Abdominal Pain. Journal of Consulting and Clinical Psychology, 69, 85-91.
http://dx.doi.org/10.1037/0022-006X.69.1.85 [31] Wedekind, D., Bandelow, B., Fentzahn, E., Trumper, P., & Ruther, E. (2007). The Quantification Inventory for Somatoform Syndromes (QUISS): A Novel Instrument for the Assessment of Severity. European Archives of Psychiatry and Clinical Neuroscience, 257, 153-163.
http://dx.doi.org/10.1007/s00406-006-0700-4 [32] Weiß, R. H. (2006). CFT 20-R Grundintelligenztest Skala 2-Revision. Gottingen: Hogrefe. [33] Winter, S., Koeberle, C., Lenz, K., Pfeiffer, E., & Lehmkuhl, U. (2012). Systematik Somatoformer Storungen. Monatsschrift Kinderheilkunde, 160, 20-26. [34] Winter, S., Koeberle, C., Lenz, K., Pfeiffer, E., & Lehmkuhl, U. (2013). Systematik Somatoformer Storungen des Kindesund Jugendalters. Praxis der Kinderpsychologie und Kinderpsychiatrie, 9, 639-669. [35] Wittchen, H. U., & Pfister, H. (1997). DIA-X-Interviews: Manual fur Screening-Verfahren und Interview; Interviewheft Langsschnittuntersuchung (DIA-X-Lifetime); Erganzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Erganzungsheft (DIA-X-12Monate); PC-Programm zur Durchfuhrung des Interviews (Langsund Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets & Zeitlinger.