Discordance between Adolescents and Parents in Functional Somatic Symptom Reports:... 2023 Hogendoorn, Rosmalen et al

Full title: Discordance between Adolescents and Parents in Functional Somatic Symptom Reports: Sex Differences and Future Symptom Prevalence

Functional somatic symptoms, i.e., physical complaints that cannot be sufficiently explained by an objectifiable biomedical abnormality, become increasingly more prevalent in girls than in boys during adolescence. Both parents and adolescents report more functional somatic symptoms in girls, but their reports correspond only limitedly. It remains unknown whether parent-adolescent discordance contributes to the higher symptom prevalence in girls.

This study investigated parent-adolescent discordance in reported functional somatic symptoms throughout adolescence, examined the longitudinal association of parent-adolescent discordance with symptom prevalence in early adulthood and focused on sex differences in these processes. Participants included 2229 adolescents (50.7% female) from four assessments (age 11 to 22 years) of the TRAILS population cohort. Parents and adolescents reported significantly more symptoms in girls than in boys during adolescence. Variance analyses showed that throughout adolescence, parents reported fewer symptoms than girls self-reported and more than boys self-reported. Regression analyses using standardized difference scores showed that lower parent-report than self-report was positively associated with symptom prevalence in early adulthood. Polynomial regression analyses revealed no significant interaction between parent-reported and adolescent self-reported symptoms. Associations did not differ between boys and girls.

The findings show that lower parent-reported than self-reported symptoms predict future symptom prevalence in both sexes, but this discordance was more observed in girls. The higher functional somatic symptom prevalence in girls might be partly explained by parental underestimation of symptoms.

Open access, https://link.springer.com/article/10.1007/s10964-023-01810-w

 

How much of this can be attributed to the fact that for the same symptoms, boys will get extensive medical evaluation but girls will be told to see psychiatry/be prescribed antidepressants/told to lose weight/told it's their periods?

 

Also, in our society, boys are discouraged from voicing any pain or distress, perhaps making them less willing to admit they have symptoms in general. There's a joke among doctors that if a man comes to the ER, and when asked why, says, "Because my wife told me to," it's probably very serious.

 

Wow, talk about a misleading quote. They report symptoms that are labeled as functional by someone who cannot even make that determination as there is no possible way to validate, it's just a lazy default explanation. The patients and the parents obviously aren't reporting functional symptoms, they're merely describing what is happening. The way this sentence is construed strongly suggests patients and parents agree the symptoms are functional and report them as such.

I don't even understand what the point of this could possibly be. Are they expecting that parents have full knowledge of symptoms, which by definition are subjective, that their adolescent kids are experiencing? And what would that discrepancy even matter for? At 11-12 language isn't very advanced, people don't have the knowledge and vocabulary so explanations are inherently difficult. The very premise makes no sense at all, it's just bizarre and trying to grasp at any straw.

 

I find this very worrying, not just the paper itself (the same old elements of medical misogyny-girls are more prone to neurosis-it's because of the behaviour of the mother -type of thing in a modern wrapper, disguised as "science") but its context.

As I explain here, I'm getting really uneasy about Rosmalen's activities within Lifelines. Participants enroll because they think they are helping researchers getting more insight in health and disease, in "how to get old healthily" as per the LL website.

It looks like Rosmalen is using those volunteering participants to fuel psychosomatic research. And I really wonder if those participants would agree to that if they knew their data was used as such.

For example, if I had MS and was participating in Lifelines, I would not be happy to know they were using my data in a study that said: "certain personality traits are assumed to increase a person’s risk of becoming severely fatigued in response to a chronic disease. Indeed, there is evidence from research in patients with MS that there is a link between neuroticism and fatigue.".

Or if I was a LL participant with

Spoiler: one of these diseases

migraine, epilepsy, MS, PD, stroke, hepatitis, liver cirrhosis, blood clotting disorder, hypothyroidism, hyperthyroidism, diabetes mellitus type 1 and/or 2, thrombosis, myocardial infarction, heart valve problems, pulmonary embolism, CHF, balloon angioplasty and/or bypass surgery, chronic inflammation of the throat and/or nasal cavity, COPD, ulcerative colitis, Crohn’s disease, osteoarthritis, RA) or kidney disease

, like hepatitis, COPD or diabetes, I would not be happy if I knew that my data was used to set loose Bleijenberg's CIS on (which was meant to assess "chronic fatigue syndrome" in a psychosomatic framework) and then framed within the bps-movement's views of disease by someone whose mission it is "to promote an integrated psychosomatic (biopsychosocial) approach to health and disease".

I discuss that instance here.

In this study, we see something similar (but even more questionable I find): in the same area as where Lifelines pulls their participants from, schools were approached, and then parents, to let their child participate in a mental health database, TRAILS, again with similar claims on how helpful it would be to get insight into mental health and social development if kids were followed throughout adolescence (link to recruitment info). Parents got brochures and were telephoned to ask them to participate, active recruitment.

And now this database and its participants are used to create a functional somatic symptoms framework.
I doubt parents would have participated and encouraged their children to participate, especially mothers and their daughters, if they knew it would be used to make psychosomatic suggestions about their child's illness and their parents relation to it.

 

And by assumed they mean "we interpret things that way because it creates jobs for us". One could also make very different interpretations.

 

I grew up with a father who despised sick people and just thought they were lazy attention seekers and hypochondriacs. He could just about bring himself to believe children with diseases that caused rashes or spots, swollen glands, fevers e.g. measles and mumps i.e. the visible childhood diseases. But he just couldn't believe in health problems that were invisible. So what good would his input have been on this kind of "research"? His beliefs would have been similar for many invisible diseases, so his answers wouldn't have told researchers anything special about attitudes to children with ME, if such a thing had ever happened. It would have just told you about his prejudices against the sick.

 

So many parents have so little time to actually listen to their children . when both parents are out working all hours they know precious little of their child's life . Basing any thing on discrepancies in the answers to undoubtedly heavily loaded questionnaires is not going to lead research anywhere useful .

 

Hmmmm, so this is somewhat just demonstrating sexism/misogyny...? and yes who knows if these are 'functional' at all.

But the biggie, given it is girls, the elephant in the room given how the ideology/attitude almost leaps of the page in this paper re: 'girls' is that surely there is one big thing mediating this: the very people doing this type of research influencing medicine, and attitudes/issues with misogyny in medicine itself.

It doesn't matter whether the 'girls' reported these things to their parents, or the attitude meant they didn't really does it; whether the doctors dismissed or didn't back this up with parents and pulled faces or said things like 'functional' despite not having investigated but just followed instructions from BPS model that best not because that would just encourage it.


This really is shapeshifting of data that should be open-access so that people from gender studies can take this data and document how bad the issue is in the medical community, how it directly affects how people are then treated in their own home by their own parents ie how these individuals destroy relationships and allow people to have their entire identity rewritten and their achievements removed with such 'rumour mongering and presumption it isn't depsite having untreated illness that should have been investigated properly' and therefore removed their access to life opportunities by rewriting their narrative e.g. if in exams they performed as if they had x but these people's influence meant they didn't have such extenuating circumstances on their record nor proper investigation or treatment.

When I think about how much, cumulatively over so many 'girls and women', people like this with their 'research' have changed the direction of whether important positions and qualifications have not gone to deserving females by effectively them not receiving appropriate care or even description and investigation at such key points in their life (teenage years is when they will be doing qualifications that will havve 'snowball effect on their careers') it is sickening. We all know competitive industries and positions will look at such results, will look at gaps in history, will look at extra-curriculars, that getting one grade less will mean a less great range of options at higher education and so on re: workplace competitiveness on graduate courses.

To exempt themselves from having caused ie been a major causal factor in creating this relationship issue they then describe and inaccurately attribute to other nonsense is gobsmacking indiation of how certain areas cannot/are not prepared to take responsibility for obious consequences of their actions - and to me that means they should not be allowed to keep their job titles and work in such areas where said responsibilities should be absolutely seen as understood and heeded.

They can call themselves psychosomatic ideology manifesto writers, or something similar, but really this isn't balanced or responsible if you can't acknowledge your own part and other more barn-door factors, to be allowed to keep access to terms that infer professional accounability without discussion of the impact your own work will having directly onto medical professionals and parents and indirectly via that path to both and schools and friends and everything surrounding it. After all what happened to power vs responsiblity and not getting one if you demonstrate an unwillingness/inability etc regarding the other?

 

So many obvious explanations it seems irresponsible these aren't discussed. If someone gets an illness and is dismissed and expected to carry on doing sports and so on vs e.g. the boys having a week off school then the illness worsens and accumulates. Same if walking into a medical centre as a girl = presumption of 'functional' vs the real medical of 'not being a girl' meaning no treatment takes place. Only in recent times with people who have deluded themselves that black is white taking over medicine has that not been 'basic'.

These people will never, ever care to check in 5, 10yrs time what these individuals actually ended up having if they ever did get investigated and their conditions became so obvious they were unavoidable for them to treat and document. So basically this is how the profession has made it 'unfalsifiable'.

Plus of course there is then the explanation of girls tending to be more ill in general, autoimmune and hormonal issues being ones often statistically quoted, combined with well... the whole 'ignore them if they are girls the attention will just make it worse' misogyny being spread by certain individuals through e.g. the medical profession (who parents might go to for reassurance) and laypersons, schools and so on. So again if you've driven this attitude towards females into these why are you pretending it is unusual and not actually being required to 'control for it' because you've caused it at least in explanation and describe it as 'psychosomatic attitude towards girls' instead of 'gender' or the unevidenced as they will never follow-up or check their 'functional' to confirm.

Basically 'girls who had our psychosomatic attitude and treatment levied at them' instead of 'girls' explains both 'findings' doesn't it?

 

Assumed despite their being no good evidence of any personality research, it is a non-area, basically parapsychology for the traits she is mentioning. She might as well be talking about spoon-bending abilities. Shocking

 

But also that quote, which I've heard cited a lot and is very insightful, says just as much about the doctors' attitudes. You won't find anything you don't look for. The fact that investigations will be launched if you are male will change the point you attend vs if you are automatically told to disappear for a fortnight and come back again if it hasn't disappeared multiple times (heard this lots in people who had barn-door ovarian cancer symptoms years ago for example) would change your attitude on how long you can leave something that might be serious too.

 

And then girls will have more "unexplained" symptoms, because no one bothered to investigate, and they will experience more distress over them, because they don't know if their symptoms are merely annoying or a sign of something life-threatening like cancer.

 

Problems with the FSS concept aside, I think that authors are dealing with a real phenomenon. It is undoubtedly the case that young people report a high number of potentially significant medical symptoms which are not currently related to known pathophysiology, Table 1 of the current study confirms a high rate of reporting of FSS which then reduces substantially with age in males but far less significantly in females.

Historically, at least in the UK, complaints by young people of somewhat non specific symptoms were attributed to a mythical condition of "growing pains" (the NHS still has a page on this: Growing Pains), this attribution was used as a ready dismissal of child complaints of debility, by parents who were impatient that the growing offspring stop being so burdensome. However if there is debility in adolescence which disappears with maturity in 63% of males but only in 24% in females, that is something that needs to be understood and neither parental dismissal nor medical recourse to a convenient FSS categorisation is going to help that.

The rate of parent disregard is largely the same for male and female children at T1 and T2 - parent rating is roughly half that of the child in all four domains, but while the rate stays the same for male children at T3, it increases somewhat for female children - suggesting parents of females gain worry on long duration.

So the question is, is the pathophysiology underlying symptoms which are experienced by males in early adolescence but which which disappear with maturity in 63% of affected males, the same in adolescent females where it is experienced at higher rates and reduces only marginally or are there fundamentally different processes broadly separated by gender. The discordance between parent and child assessment of debility might as the authors suggest be a useful way of highlighting those (young women) who would benefit from early intervention but given that FSS interventions are of low impact, perhaps it would be more rewarding to better understand the pathophysiology of adolescence and establish what lays behind some young people having sustained debility into adulthood. No would argue that menopause and andropause are not potentially accompanied by long lasting debility - perhaps the same sensitivity should be applied to adolescence.

 

A common childhood and adolescent problem is abdominal pain. Roughly speaking a cause is identified in 10%. Typically it will be constipation, sometimes there is mesenteric lymph node enlargement which is attributed to an acute viral infection, sometimes appendicitis, occasionally cancer. In the majority no cause is found and in most of those the problem resolves in time (though not always). Generally paediatric specialists (medical or surgical) are comfortable with not having a definitive diagnosis, if the excludable things have been excluded.

Often an imaging request form will say something like "Persistent abdominal pain, but normal examination. Exclude organic cause."

In the past I'd simply conclude a report with eg "Normal study. No cause for symptoms identified."

Now I find myself wanting to push back against that term "organic", which implies that the 90% must be non-organic or "functional" / psychogenic. So I'm trying out variations of "No macroscopic structural abnormality identified."

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Incidentally I looked at the Wikipedia page on functional constipation. Apparently there can be —

The mind is a truly powerful thing. However, I also noted this section in functional symptoms —

That passage seemed to be incorporated in Nov 2010 with the comment "Expanded comments to be less deferential. Doctors are human. Subject to the same human temptations and insecurities as their patients and everyone else. Why not admit it?"

(Also, the "citation needed" tag could be fulfilled by "far too much medical literature".)

 

You've missed out torsion of either a) the ovary or b) twisting of a large ovarian cyst destroying the ovary in the process. Imagine this happening in the 1970s with the technology available at that time.

 

It wasn't intended as an exhaustive list!