Childhood sexuality -what's normal and what's notSara Williams, Ph.D and Nicole Zahka, Ph.D are the authors of Treating Somatic Symptoms in Children and Adolescents, a recently published manual for clinicians seeking to better understand physical symptoms that are not necessarily linked to a known medical problem. They collaborated on all answers to all questions in this interview.

 We’ll start with the basics: What are somatic symptoms?

 Somatic symptoms are physical complaints that are not associated with an acute disease or injury. They are more noticeable in situations where someone feels physically or emotionally stressed, like on a really hot day, or when speaking in public.

 Common somatic symptoms include pain, such as headaches and stomach aches, dizziness or fainting and even changes in neurological function like conversion disorder and psychogenic non-epileptic seizures (PNES).

 Somatic symptoms can come and go and not cause a lot of problems or they can be frequent, and can impair a person’s ability to do even the most basic every day tasks.

 The most important thing we want everyone to know about somatic symptoms is that they are not made up or “all in your head.”

Working with children and families with somatic symptoms are not like typical referrals. What are some of the most common barriers to treatment that occur in these cases?

Children with somatic symptoms who present for psychological treatment are a bit different from a typical referral because they are usually not presenting for concerns related to anxiety or depression. It’s important for mental health providers to recognize that even in the absence of these more common diagnoses, they can and should play a role in treatment of somatic symptoms.

 Similar to anxiety and depression, somatic symptoms get better by first increasing function while building a set of coping tools to manage stressful situations that are associated with symptoms. Providers who are familiar with cognitive behavioral therapy (CBT) can learn to apply those skills to patients with somatic symptoms quite effectively.

There are many barriers to children with somatic symptoms receiving treatment. Somatic symptoms present as a medical problem, so understandably, families seek a medical solution, which unfortunately can have limited effectiveness. Children may undergo multiple unnecessary medical tests and there is typically not much that a medical provider has to offer in the way of treatment, aside from medication to manage (but not cure) symptoms.

Even when children get the right diagnosis and are referred for mental health treatment, they may not have access to mental health providers who are familiar with treating somatic symptoms.  

You mention in your new book that children who are receiving mental health treatment are also often experiencing somatic symptoms whether the clinician is aware of it or not. Is this something that clinicians should actively seek out during assessments, in case the child does not bring it up on his or her own?

 Somatic symptoms are part of the diagnostic criteria for anxiety and depression, so yes, we do feel it’s important for clinicians to assess these symptoms in their patients with these conditions. Of course not every child with anxiety or depression will experience somatic symptoms, but to the degree that they also can be limiting to children’s every day function, assessing for and addressing them will only contribute to treatment success. For example, if children are missing school due to worry about performance in the classroom and for stomach aches, it’s equally important to address both of those issues in treatment.

What made you believe there was a need for the book? And who is the audience of the book?

The inspiration for this book came from our own clinical work with children and adolescents with somatic symptoms. We recognized a need in the field after meeting multiple children with very straightforward symptom presentations who easily responded to treatment, but who were not able to find a provider with the expertise to work with them in their local setting.

 Our goal in writing this book was to get information out to providers who are already familiar with CBT so they can apply this familiar treatment to a new patient population. This is important because children with somatic symptoms often go without the right treatment and experience significant disability, but there is an empirically-supported treatment that can help them.

 We want to do everything we can to ensure delivery of those services and to the best of our knowledge this is one of the first books available on treating a broad range of symptoms in children and adolescents including functional neurological, cardiac, pain and gastrointestinal disorders.

 The book is for psychologists, counselors, social workers, psychiatrists, graduate students and other mental health clinicians.

What would you say the main role of the mental health provider is when it comes to treating children and adolescents with somatic symptoms?

The mental health provider is all at once an educator, coach, symptom validator, problem solver, advocate and therapist for the child with somatic symptoms. One of the important things a mental health provider can do for their patient on the very first visit is validate the symptoms and offer hope for an effective treatment by simply saying, “I know what you have, I believe you and I know how to help.”

End of Part 1.