PALGRAVE TEXTS IN COUNSELLING AND PSYCHOTHERAPY Series Editors: Arlene Vetere · Rudi Dallos Functional Somatic Symptoms in Children and Adolescents A Stress-System Approach to Assessment and Treatment Kasia Kozlowska · Stephen Scher · Helene Helgeland Foreword by George P. Chrousos Palgrave Texts in Counselling and Psychotherapy Series Editors Arlene Vetere Family Therapy and Systemic Practice VID Specialized University Oslo, Norway Rudi Dallos Clinical Psychology Plymouth University Plymouth, UK Tis series introduces readers to the theory and practice of counselling and psychotherapy across a wide range of topical issues. Ideal for both trainees and practitioners, the books will appeal to anyone wishing to use counselling and psychotherapeutic skills and will be particularly relevant to workers in health, education, social work and related settings. Te books in this series emphasise an integrative orientation weaving together a variety of models including, psychodynamic, attachment, trauma, narrative and systemic ideas. Te books are written in an accessible and readable style with a focus on practice. Each text ofers theoretical back- ground and guidance for practice, with creative use of clinical examples. Arlene Vetere, Professor of Family Terapy and Systemic Practice at VID Specialized University, Oslo, Norway. Rudi Dallos, Emeritus Professor, Department of Clinical Psychology, University of Plymouth, UK. More information about this series at http://www.palgrave.com/gp/series/16540 Kasia Kozlowska · Stephen Scher · Helene Helgeland Functional Somatic Symptoms in Children and Adolescents A Stress-System Approach to Assessment and Treatment Foreword by George P. Chrousos Kasia Kozlowska Stephen Scher Te Children’s Hospital at Westmead McLean Hospital Disciplines of Child & Adolescent Health, Department of Psychiatry and of Psychiatry Harvard Medical School University of Sydney Medical School Belmont, MA, USA Sydney, NSW, Australia Helene Helgeland Department of Child and Adolescent Mental Health in Hospitals Oslo University Hospital Oslo, Norway ISSN 2662-9127 ISSN 2662-9135 (electronic) Palgrave Texts in Counselling and Psychotherapy ISBN 978-3-030-46183-6 ISBN 978-3-030-46184-3 (eBook) https://doi.org/10.1007/978-3-030-46184-3 © Te Editor(s) (if applicable) and Te Author(s) 2020. Tis book is an open access publication. 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Cover illustration: Alfo Scisetti/Alamy Stock Photo Tis Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG Te registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Endorsements ‘Functional Somatic Symptoms in Children and Adolescents, at the inter- section of mind-body medicine, is a must-read for clinicians across pediatrics, psychiatry, neurology, psychology, social work, and allied rehabilitation disciplines involved in diagnosing and treating children and adolescents with functional symptoms. Te authors have done a masterful job of linking together emerging cutting-edge biology with case-based discussions and practical treatment suggestions to aid the development of a mind-body program. Functional disorders are com- mon in pediatrics, and this book is a major advance in bringing this set of conditions out of the shadows and into mainstream educational and clinical initiatives.’ —David L. Perez, MD, MMSc, Massachusetts General Hospital, Harvard Medical School ‘A uniquely creative, well-informed, and authoritative account that uses the latest scientifc and clinical research to inform clinical assessment and treatment of functional symptoms and syndromes in children and young people. Te authors’ stress-system model for understanding these experiences is complemented by the extensive use of clinical vignettes v vi Praise for Functional Somatic Symptoms in Children and Adolescents that are integrated into an overarching clinical framework that will prove useful for trainees and the broad range of clinicians addressing these problems in their own practices.’ —Elena Garralda, MD, MPhil, FRCPsych, FRCPCH, Emeritus Professor of Child and Adolescent Psychiatry, Imperial College London ‘Tis is the book that clinicians, researchers and educators concerned with children and adolescents with functional somatic symptoms have been waiting for. For clinicians treating these children—both paedi- atricians and mental health professionals—this is a “must-have” book. Until very recently, research in this feld has been sparse, and in the absence of a clear understanding of these symptoms, it has been difcult for clinicians to provide good, persuasive explanations to children and their distressed parents. Te frequent result has been extensive medical assessments, trips to doctor after doctor, and an increasing likelihood that the symptoms would become chronic. Advances in research meth- odologies now set a neuroscience basis for functional somatic symptoms as refecting disturbances of neurophysiological regulation. In this con- text, the book sets forth the important and clinically useful stress-system model for functional somatic symptoms. It also provides the knowledge and skills for clinicians to understand both the complexities in the neu- rophysiological dysregulation and how to communicate this under- standing to patients and families. Functional Somatic Symptoms is an impressive and important book that should become a basic work of ref- erence for multidisciplinary health professionals concerned with the role of disturbances of neurophysiological regulation in children and adoles- cents with functional somatic symptoms.’ —Trond H. Diseth, MD, Professor of Child and Adolescent Psychiatry, University of Oslo, Norway Praise for Functional Somatic Symptoms in Children and Adolescents vii ‘In this superb book Kozlowska and colleagues have provided a much- needed roadmap for accelerating our understanding of functional somatic symptoms. It describes important scientifc developments while also maintaining a strong clinical focus relevant to medicine, nursing, social work, psychology, psychiatry, and other felds of health care.’ —Leanne Williams, PhD, Professor of Psychiatry and Behavioral Sciences, Director of Center for Precision Mental Health and Wellness, Stanford University ‘Help is on the way for stressed and traumatized children (and their families) sufering from functional somatic symptoms, thanks to this great book for pediatricians, medical specialists, and mental health providers still confused by those children’s “medically unexplained” symptoms and unable to help them heal. In this brilliant, compassion- ate, and eminently practical resource, Kozlowska and her colleagues have distilled decades of clinical experience and integrated many areas of research—from attachment relationships and adverse childhood experiences to the neurobiology of the stress-system encompassing the circadian clock, autonomic nervous system, infammatory/immune system, and hypothalamic-pituitary-adrenal axis. Tey explain the “unexplained” and provide the map and toolbox for professionals to efectively apply their stress-system approach as individuals and teams. Everyone who works with children presenting with functional somatic symptoms, from pain and fatigue to non-epileptic seizures, will greatly beneft from