Functional Symptoms Information for Families Functional Symptoms Are Physical Symptoms Without an Obvious Cause
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Functional symptoms Information for families Functional symptoms are physical symptoms without an obvious cause. They can also be called Medically Unexplained Symptoms, Somatic Symptom Disorder, Somatoform Disorder or Functional Neurological Disorder. This information sheet from Great Ormond Street Hospital (GOSH) explains about functional symptoms in children and young people and how they can be managed. An Easy Read information sheet is also included within this leaflet. What causes functional symptoms? 3 Can functional symptoms 7 get worse? What sort of issues and stresses 3 can lead to functional symptoms? What can parents do to help? 7 How are functional symptoms 4 Reducing the focus on symptoms 8 diagnosed? Boom and bust 8 What happens next? 4 Will my child always have 9 Why does my child have 5 functional symptoms? functional symptoms? Final words 9 Predisposing factors 5 Further information 9 Precipitating factors 5 and support Perpetuating factors 6 All about symptoms 10 Protective factors 6 with no physical cause Functional symptoms 2 Information for families 20F02324 What sort of issues and Everyone can have physical symptoms such as painful or uncomfortable stresses can lead to feelings inside the body. Usually they functional symptoms? get better on their own, and if they Functional symptoms often occur at times do not, we might ask the doctor of stress. During stressful situations our about them. bodies might react in different ways. Often a reason for them can be found, Some common stressful events may but sometimes it cannot, even after include the doctor has done a range of tests. Starting a new school If the symptoms continue and get in Being bullied the way of everyday life we call these Being stressed at school (for example Functional Symptoms (FS) or Medically exams, friendship difficulties) Unexplained Symptoms (MUS). Changes in your family (for example Functional symptoms are common – loss of a loved one or someone moving one in four children have them – and away) almost everyone has experienced unexplained physical symptoms such as Some children with functional symptoms dizziness, headaches, or tummy aches. have additional mental health problems. It can be frustrating not to know It is important to detect and diagnose the cause. However, these ‘medically these alongside functional symptoms unexplained symptoms’ can be as they may have their own effective understood better over time. interventions or treatments. They might include anxiety or depression What causes or other difficulties such as Autism functional symptoms? Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Sometimes we Most of us have been taught to think of never work out which came first – the our minds and bodies as separate things. physical symptoms or, for example, For example, if we have a tummy ache, the anxiety. In reality it doesn’t matter we may automatically assume that we too much. Both the physical symptoms have caught a tummy bug. It may be and the mental health symptoms need surprising to hear that it is equally likely treatment and sometimes it is the same that the tummy ache is due to worry or treatment for both as the mind and body anxiety rather than a bug. work closely together. When people are upset or nervous, our bodies respond in different ways. Many people get headaches or ulcers, while other people might feel dizzy. Each of our bodies has a unique way of showing us how we feel and when we are in need of extra support. Functional symptoms Information for families 3 20F02324 How are functional What happens next? symptoms diagnosed? Once professionals have an idea of Many children and families begin their what might be causing the functional journey by feeling very frustrated symptoms, they can start planning with because the tests that doctors carry out you how to deal with them. do not always show why their symptoms We would recommend that your child are there. is assessed by a team who knows Even though doctors might not be able about functional symptoms such as a to find a physical cause for functional mental health (CAMHS) team or similar symptoms, there are ways to work out who will be able to generate tailored why someone is having them. Often recommendations for your child. a number of issues and stresses come However, there may be steps that you together at the same time, which can then can try at home and at school to help show up as a physical symptom, such as your child get started on the road to a pain or dizziness. full recovery. You and your child’s GP It might take a lot of thinking to work can begin by identifying some lifestyle out what is going on – everyone will changes and goals. need to work together like detectives Your child’s school also needs to to work out what is causing the issue or understand how best to help your stress. This might include paediatricians, child when they experience functional neurologists, psychologists, psychiatrists symptoms. Health professionals might and school staff. One or more of these contact them to provide advice. It’s vital professionals need to work together that the teachers also understand what in order to recognise and diagnose functional symptoms are. functional symptoms. Functional symptoms 4 Information for families 20F02324 Why does my child have functional symptoms? Generally a mix of different factors will play a part in the symptoms starting, continuing and getting better. These are likely to include biological (physical body), psychological (thoughts and feelings) and social aspects (friends, family and life circumstances) factors. It can be useful to divide these factors into four groups: predisposing, precipitating, perpetuating and protective, as follows: Predisposing factors Autism can make social communication These are what makes a child more likely and understanding friendships difficult, to get functional symptoms at some point. especially in teenage years when this Examples of predisposing factors include: becomes more complicated. It is also difficult for people with autism to Someone else in the family having understand and identify their emotions, functional symptoms – there is evidence and instead they may express emotions in that both genetics and family beliefs a physical way. play a part in developing functional symptoms. ADHD can also mean that a young person may miss social cues or respond Being an anxious or perfectionist kind impulsively, and this can lead to of person. difficulties with friends, as well as criticism Long-standing stress, where our bodies from teachers. are on constant high alert waiting for Learning difficulties that are not something to happen. For example, recognised can lead to confusion and a living with a family member with a sense of underachievement. long term health condition or living in dangerous circumstances. Precipitating factors Other neurological or developmental These are what set off or trigger the difficulties, such as Autism Spectrum child’s functional symptoms. Disorder, Attention Deficit Hyperactivity Examples of precipitating factors include: Disorder (ADHD), learning difficulties, Physical injury, infection or illness, can increase the likelihood of where for example, pain may continue developing functional symptoms. long after the injury has healed. Distressing life events, such as parents splitting up or moving to a new area or experiencing loss of someone special. Confusing results and opinions from health professionals trying to find the cause of functional symptoms. Functional symptoms Information for families 5 20F02324 Perpetuating factors Protective factors These are what keeps someone’s These work against the predisposing, functional symptoms going. precipitating and perpetuating factors Examples of perpetuating factors include: to help protect against developing more severe symptoms and may help make Reinforcing responses to symptoms them better. such as talking a lot about them or using them as a source of comfort or Examples of protective factors include: reassurance. Good understanding of symptoms and Stopping playing a full part in school the stressors that might be causing life or normal everyday family activities. them. Having lots of medical examinations Good social resources like supportive and tests that might not be needed friends, school and family. (because this can make someone feel Parenting that is kind and supportive, even more uncertain and worried). with family members working together Having treatment for the physical ‘on the same page’, providing clear symptoms rather than both physical boundaries and consistent responses. and psychological – this separates the Avoiding responses and actions that mind and body even further. may reinforce the symptoms, for instance, allowing a child to avoid household chores in case it hurts. Support from school to address emotional, social and academic development. Getting quick and effective help for any mental health difficulties that go with the symptoms. Functional symptoms 6 Information for families 20F02324 Can functional symptoms Of course, if something completely get worse? different arises then discuss this with your GP. It is often possible to have Most children's functional symptoms can a variety of different functional actually get better very quickly and may symptoms, so keep this in mind during not need any specialist support at all. For this discussion. others this journey might take a little longer. It is common for children with Tell your family members, your child’s functional symptoms to become more school and friends about the symptoms, restricted by their symptoms over time. but remember to let them know not to First of all, they might have to take time make too much of a fuss over them! off school or do less around the house. Gradually encourage your child to They might stop seeing friends, avoid resume more activities, such as walking going to shops at busy times or stop to the shop alone, going out with their using public transport for fear of having friends, starting swimming again, even unpleasant symptoms.