When a child or teen has distressing and impairing symptoms, they benefit from treatment that integrates support from medical, mental health and rehabilitation professionals. In this way, treatment for somatization, like diagnosis, is based on a biopsychosocial approach to a child’s or teen’s symptoms.
Once your child or teen identifies and agrees upon their goals with you and their health-care team, treatment aims to address those goals to restore your child’s quality of life.
Principles of treatment
The principles of treatment for somatization include:
- treating any medical and mental health conditions
- engaging in physical reconditioning (for example by doing prescribed exercises)
- returning your child or teen to a normal routine, including a gradual return to school
- encouraging balance and activity pacing
- focusing on your child's or teen's functioning, coping and ability
- supporting developmental expectations
- developing a plan to manage somatic symptoms (see below)
- promoting awareness of and expressing emotions
- getting regular follow-up to monitor symptoms, functioning and progress towards goals.
Developing a somatic symptom action plan
Children and teens can work with their health-care team to develop a somatic symptom action plan to help them feel more in control of their symptoms and less distressed.
An action plan usually includes a list of:
- typical symptom triggers (such as stressors)
- early warning signs that symptoms are getting worse
- strategies, or techniques, to manage symptoms, for example deep breathing or places to rest and recover
- supports that are available at school and elsewhere.
It is important to offer your child or teen support to put this plan into action in their everyday life.
Medical support
Children and teens should see their primary care doctor regularly to monitor symptoms, functioning and progress towards goals. New symptoms can arise and require review.
Rehabilitation support
Rehabilitation, including physiotherapy, occupational therapy or speech therapy, can be helpful to establish routine, improve functioning and return to regular activities gradually.
Treatment may include education, goal setting, activity pacing and planning (for example by allowing for rest breaks) and adjustments to activities as needed, for example by using assistive devices or other equipment.
Physiotherapy
Physiotherapists can help children improve their ability to walk and reduce the need for aids such as a wheelchair, walker or cane. They can also help children return to sports and increase their level of physical activities. In some cases, physiotherapists can also help prevent muscles from becoming weak or tight if a child has not been physically active for a while.
Physiotherapy is recommended early on, as children can improve their physical abilities even when they have distressing symptoms.
Occupational therapy
Occupational therapists work with children and families to identify and help your child take part in meaningful activities in the areas of self-care (such as feeding or sleep), productivity (such as school) and leisure (such as drawing or reading).
Speech therapy
Speech-language pathologists (SLPs) assess, treat and prevent speech and language difficulties to develop, maintain or increase communicative functions. You can access SLP services in the community or through your local children’s treatment network.
Psychotherapy (talk therapy)
Talk therapy is an effective form of treatment for somatization and can benefit both the child and the family as a whole. There are a number of options for individual and family therapy.
Cognitive behavioural therapy (CBT)
This involves connecting physical symptoms with underlying thoughts, feelings and actions in a given situation by:
- identifying physical symptoms or body cues
- noticing the situation that gives rise to the physical symptoms
- labelling any feelings or emotions
- identifying the underlying thoughts before, during and after the physical symptoms
- noticing the actions and behaviour before, during and after the physical symptoms
- developing coping strategies and ways to shift unhelpful thoughts and beliefs as well as calm the body down
Narrative therapy
This involves working with the child and family to create narratives, or stories, about themselves that are helpful to them by:
- collaborating with the child and family to identify areas of strength and times when physical symptoms are not present or are less impairing
- focusing on the child’s values, skills and abilities
- separating the problems and symptoms from the child or teen (for example by asking questions like “If the symptom were sitting beside you, what would it look like and how much space would it take up?”)
- reflecting on what life was like before the symptoms, how life has changed as a result and what the future may hold
Supportive-expressive therapy
This type of therapy involves creating an environment that supports the child or family and their goals and using different techniques to help the child or family express themselves. Techniques include:
- reviewing various stressors for a child or teen
- reflecting the feelings and issues that may be contributing to physical symptoms
- helping the child or teen talk about their feelings and thoughts
- connecting thoughts and feelings with physical symptoms
- developing coping strategies
Mindfulness and acceptance based therapies
These therapies involve learning how to focus your attention to stay in the present moment while being open to your thoughts, feelings and physical experiences without judgement.
Mindfulness techniques teach people how to respond to unwanted internal or external experiences instead of reacting to their circumstances. These techniques can help people make choices that are aligned with their goals and what is important to them instead of reacting to their physical symptoms. Mindfulness and acceptance techniques can involve both formal meditation and informal exercises that help you become more aware and present during everyday activities such as eating and walking.
Group therapy
Education in a group setting allows children, teens and parents to learn how physical symptoms can develop after a physical injury or illness or because of stressors. Hearing from other children and teens about similar experiences provides support and education in a meaningful way.
Therapeutic groups allow children, teens and parents to express their emotions, connect with one another and gain support through sharing. Experiences of somatization can be very isolating, so it is important and beneficial for children, teens and parents to know that this is a common experience, there is support, they are not alone and there is hope for recovery.
Behavioural approaches to treat somatization
A behavioural approach can help teach skills and provide resources for structure in your child's or teen's home and school environment.
First, a behaviour analyst does a functional behaviour assessment. This involves:
- noting your child's symptoms over time in terms of intensity, duration and frequency
- looking at the factors that might trigger the symptoms and/or make symptoms better or worse
- noting the early warning signs of more distressing symptoms
The behaviour analyst then provides behaviour therapy based on how your child's or teen's symptoms relate to their environment. Behaviour therapy plans usually involve small systematic steps towards a successful end goal, especially if your child's behaviour has regressed.
Parent training
Parent training can provide coaching on how to respond to your child or teen and how to make practical and long-lasting changes in the home, community and school.
