Position statement: Somatic symptom and related disorders: Guidance on assessment and management for paediatric health care providers

Somatic symptom and related disorders: Guidance on assessment and management for paediatric health care providers
Canadian Paediatric Society

Spoiler: Canadian Paediatric Society Mental Health And Developmental Disabilities Committee (2023-2024)

Members: Anne Kawamura MD (Chair), Johanne Harvey MD (Board Representative), Natasha Saunders MD, Megan Thomas MBCHB, Scott McLeod MD, Ripudaman Minhas MD, Alexandra Nieuwesteeg MD (Resident Member)
Liaisons: Olivia MacLeod MD (Canadian Academy of Child and Adolescent Psychiatry), Angela Orsino MD (CPS Developmental Paediatrics Section), Leigh Wincott MD (CPS Mental Health Section)
Author(s): Natasha Ruth Saunders MD MSc, Anne Kawamura MD, Olivia MacLeod MD, Alexandra Nieuwesteeg MD, Claire De Souza MD

ABSTRACT
Somatic symptom and related disorders (SSRDs) pose significant challenges in paediatric health care due to their impacts on child and adolescent well-being, functioning, and family systems. This statement offers comprehensive guidance to health care providers on the assessment and management of SSRDs as well as communication strategies for clinical encounters.

Specific SSRD diagnoses are outlined along with common clinical presentations and recommended approaches to medical investigations and patient/family communication early in the diagnostic journey. Evidence-based treatments for SSRDs once a diagnosis has been established are delineated. Psychoeducational approaches that help to shift the onus of care from unnecessary medical testing and procedures, thereby shortening the diagnostic journey, and promote more functional, rehabilitative care therapies, are reviewed. Specific strategies to support patients and their families and validate their perspectives are outlined.

ABBREVIATIONS
EDS, Ehlers-Danlos syndrome; FNSD, functional neurologic symptom disorder; IBS, irritable bowel syndrome; PNES, psychogenic non-epileptiform seizures; POTS, postural orthostatic tachycardia; SSRD, somatic symptom and related disorder

 

FYI @dave30th in case you haven't already seen and your books aren't already full enough.

 

O M G

particularly on the transparent admitting of the nonsense fairy tales about stress response

it’s like the heady days of selling Prozac ‘cos people need their brain chemistry changed’


Ahhh now I’m thinking back to that spiel and who it was successful for I’m now realising where the fervour is coming from

 

Telling a child that their emotions are causing serious chronic symptoms is child abuse, unless it was actually true.

It sets these children up for years of feeling like a failure when they fail again and again to somehow cure themselves, and it distorts their perception of reality when they are told that something is going on inside their mind that isn't actually happening.

They should focus on helping patients feel good and manage daily life as best as possible without postulating hidden unfalsifiable emotional causes of illness.

 

The enshittification of health care and medicine continues unopposed. In fact, met with applause and celebratory laughter.

When you think about it, this is natural. Our entire civilization is enshittifying, so why would medicine escape this? In fact, it's going at it faster and more committed than any other institution.

Right alongside a historic rise in the very illnesses they misrepresent. At the same time as this rise is leading to backlash from governments who enable this rise, but choose instead to harm twice the people they fail. At the tail end of completing a merger with alternative medicine, leaving basically no separation between either.

All leaving no institution worth trusting about anything. Well, maybe engineering, as long as they stick to engineering. At least that stuff works reliably. It's so awful.

They even explicit describe and embrace pseudoscience, the process of explaining made-up models using the tools and language of science:

Expertise is dead. It never stood a chance against beliefs. In the end, it's either technology or beliefs, and beliefs always matter more unless you can make more money with technology. We are actually worse than the satirical civilization that believes in astrology depicted in The Orville. So much dumber in every way, it's seriously embarrassing.

 

It also breeds intense distrust in experts, authorities, even parents. With good reasons. This is so deeply impactful and harmful, it actually creates the perfect conditions for abuse and trauma. Given how widespread chronic illness is becoming, how stretched thin health care services are, this will only amplify as it becomes first-line bullshit care. It will raise a generation who despises the society they grew in, unworthy of being trusted for anything.

The death of expertise leads to the death civilized society. Not that we've ever had much of that.

 

"We have a lot of theories, but not a lot of evidence".

They assert plainly that there is evidence while they admit there is no evidence, and it's not even true for chronic pain, where the situation is just as disastrous. Absolutely insane stuff. And it doesn't just involve lying, it's nothing but lying. To the children, to the patients, to society. A giant magical con.

Even the way they talk about is explicitly "imagine a world in which X is true". It's all superfluous fluff about the potential that this may do that. Including the garbage evidence they rely on. It's all possibilities. It's as ridiculous as a government minting a trillion dollar coin and thinking they now have a trillion dollars to spend.

"Imagine a world of diagnostic impression". Just balls out insane stuff.

And to make it clear why this is happening at all:

Medicine is responsible for enabling a historic rise in illnesses they can't treat and don't believe in. And in response they do this. Evil rarely gets this banal.

 

Since when was EDS a functional somatic symptom disorder?
This seems to be some sort of professional consensus, while being medically illiterate.
The mind/brain boggles.

 

A modern version of when they put ill women into asylums - except with kids?

 

If you look at the NHS FND list you will find it on there. Each hospital now has FND clinic. So even though you have other conditions they can still get you

Functional neurological disorder (FND) | NHS inform | NHS inform

 

I have been stating how children and young people are abused in this way for over 10 years now and it should come as no surprise they are going forward with the full support of the NHS England. There is a big push to get FND centers in all hospitals and I think they have achieved that, I stated a few years back on here about Addenbrooks FND encompassing all conditions. IMPARS was just the beginning.

Talking to CEO at SNEE ICB they did not understand that FND was a conversion disorder, they thought it was a function, meaning very physical condition. If they can be fooled then I guess everyone else can be? MP etc I gave a talk to SNEE a couple of weeks ago and did a PowerPoint presentation with it, to show the impact on children.

I gave another talk to 1st year medical students about the how we are misunderstood because of the lack of understanding and data and if this does not change soon we are going to be in a pickle.
I also posted above this post the link to NHS FND that states even if you have MS you can still have FND

We need the SNOMED codes to be used and for children and all to be evaluated properly with ME PEM hEDS EDS POTS and Mast cell, sort them into cohorts and start to sift through the case studies with longitudinal studies. Show the true picture through the lived experience and what we know.

 

I didn't see any reference to EDS there.

 

I don't think they're suggesting EDS is a functional disorder, although as above I'm sure they would be happy to say EDS can have a co-existing functional disorder.

Referencing Multidisciplinary Approach to Treating Chronic Pain in Patients with Ehlers–Danlos Syndrome: Critically Appraised Topic (2022, Journal of Pain Research)

 

No I probably misread that but they do reference that garbage review on 'EDS' and chronic pain.
And they seem to accept that EDS has 'similar common symptoms and Muti-systemic presentations'.

 

It is how they look at symptoms such as the Functional dizzyiness pain fatigue and movement you pick out how they can use this to explain classic EDS/hEDS without taking the time to look at joints, gut allergy. FND is a gatekeeping hold all hide it away causing long term harm.

The GP toolkit https://gptoolkit.ehlers-danlos.org/.

Then match up the list on the https://www.nhsinform.scot/illnesse...-spinal-cord/functional-neurological-disorder

you can see the deliberate targeting of conditions that they want to stop treating and researching

 

So this is trying to introduce SSD but under the one word different name SSRD via the back door, early on, through aiming it at children ie before they could have got into the hands of a diagnostician for certain diseases heading off with a catch all list of symptoms to label them functional first ?

I have no words , what is behind all this in the world , it feels like such a sinister and organised push at the moment