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Licensed Unlicensed Requires Authentication Published by De Gruyter December 10, 2015

Family functioning as a protective factor in treating adolescents with complex medico-psychosocial presentations

  • Ronalda Hoffman EMAIL logo , Helen Bibby , David Bennett , Emily Klineberg , Alexandra Rushworth and Susan Towns



Studies of adolescents with somatic symptoms with no identified organic cause make a clear connection between the health and wellbeing of the adolescent and the functioning of the family. There has been little systematic examination of the role of family functioning in treatment. We aim to determine whether there was an association between family functioning and treatment outcome in this 12 month prospective study.


Fifty adolescents aged between 12 and 17 years (M=14.4, SD=1.32) and their parents were recruited. All adolescents presented with one or more physical symptoms as their primary complaint. Adolescent functioning and family relationships were measured at recruitment, 4 months into treatment and 12 months later. Generalised estimating equations (GEE) analyses were conducted to examine the relationships between the variables of interest.


Results suggested significant improvements in adolescent outcomes between baseline and 4 months (all p<0.01), which were sustained to 12 months (all p<0.01). Adolescents from healthier families at initial presentation had significantly improved psychosocial functioning over the course of the study (all p<0.001).


Our findings highlight the importance of taking a family approach to the treatment of adolescents with medically unexplained symptoms.

Corresponding author: Ronalda Hoffman, The Department of Adolescent Medicine, The Children’s Hospital at Westmead, Locked bag 4001, Sydney, Westmead, NSW 2145, Australia, Phone: +612 9845 2446, Fax: +612 9845 2517, E-mail:


Our thanks go to Prof Kate Steinbeck for proof-reading this paper. Our thanks go to Elizabeth Barnes for statistical advice. Our thanks also go to Fleur Harrison for assistance with preliminary analysis, funded by The Trust Foundation and The University of Sydney Medical Foundation, Nadishani Fernando for additional input, and the Department of Adolescent Medicine clinical team, who helped with recruitment and facilitation of the study. All authors have no conflicts of interest or financial relationships to disclose.


1. Hilbert A, Martin A, Zech T, Rauh E, Rief W. Patients with medically unexplained symptoms and their significant others: illness attributions and behaviors as predictors of patient functioning over time. J Psychosom Res 2010;68:253–62.10.1016/j.jpsychores.2009.09.012Search in Google Scholar

2. Garralda ME, Bailey D. Paediatrician identification of psychological factors associated with general paediatric consultations. J Psychosom Res 1990;34:303–12.10.1016/0022-3999(90)90086-JSearch in Google Scholar

3. Starfield B, Gross E, Wood M, Pantell R, Allen C, et al. Psychosocial and psychosomatic diagnoses in primary care of children. Pediatr 1980;66:159–67.Search in Google Scholar

4. Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007;27:855–71.10.1016/j.cpr.2007.07.007Search in Google Scholar PubMed

5. Rhee H, Holditch-Davis D, Miles MS. Patterns of physical symptoms and relationships with psychosocial factors in adolescents. Psychosom Med 2005;67:1006–12.10.1097/01.psy.0000188404.02876.8bSearch in Google Scholar PubMed

6. Hardwick PJ. Engaging families who hold strong medical beliefs in a psychosomatic approach. Clin Child Psychol Psychiatry 2005;10:601–16.10.1177/1359104505056323Search in Google Scholar

7. American Psychiatric Association. Quick reference to the diagnostic criteria from DSM-IV-TR. Arlington, VA, USA: American Psychiatric Association, 2000.Search in Google Scholar

8. World Health Organisation. Our planet, our health: report of the WHO Commission on Health and Environment. Geneva, Switzerland: World Health Organisation, 1992.Search in Google Scholar

9. Gauntlett-Gilbert J, Eccleston C. Disability in adolescents with chronic pain: patterns and predictors across different domains of functioning. Pain 2007;131:132–41.10.1016/j.pain.2006.12.021Search in Google Scholar PubMed

10. Logan DE, Scharff L. Relationships between family and parent characteristics and functional abilities in children with recurrent pain syndromes: an investigation of moderating effects on the pathway from pain to disability. J Pediatr Psychol 2005;30:698–707.10.1093/jpepsy/jsj060Search in Google Scholar PubMed

11. Liakopoulou-Kairis M, Alifieraki T, Protagora D, Korpa T, Kondyli K, et al. Recurrent abdominal pain and headache: psychopathology, life events and family functioning. Eur Child Adolesc Psychiatry 2002;11:115–22.10.1007/s00787-002-0276-0Search in Google Scholar PubMed

12. Garralda ME, Rangel L. Annotation: Chronic fatigue syndrome in children and adolescents. J Child Psychol Psychiatry 2002;43:169–76.10.1111/1469-7610.00010Search in Google Scholar PubMed

13. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994;121:953–9.10.1300/J092v01n02_06Search in Google Scholar

14. Guite JW, Logan DE, McCue R, Sherry DD, Rose JB. Parental beliefs and worries regarding adolescent chronic pain. Clin J Pain 2009;25:223–32.10.1097/AJP.0b013e31818a7467Search in Google Scholar

15. Drotar D. Relating parent and family functioning to the psychological adjustment of children with chronic health conditions: what have we learned? What do we need to know? J Pediatr Psychol 1997;22:149–65.10.1093/jpepsy/22.2.149Search in Google Scholar

16. Campbell TL. Family’s impact on health: A critical review. Fam Syst Med 1986;4:135–328.10.1037/h0089692Search in Google Scholar

17. Litman TJPD. Health care and the family: a three-generational analysis. Med Care 1971;9:67–81.10.1097/00005650-197101000-00008Search in Google Scholar

18. Patterson JM, McCubbin HI, Warwick WJ. The impact of family functioning on health changes in children with cystic fibrosis. Soc Sci Med 1990;31:159–64.10.1016/0277-9536(90)90057-YSearch in Google Scholar

19. Rangel L, Garralda ME, Gradstat J, Jeffs RG. Family health and characteristics in chronic fatigue syndrome, juvenile rheumatoid arthritis, and emotional disorders of childhood. J Am Acad Child Adolesc Psychiatry 2005;44:150–8.10.1097/00004583-200502000-00007Search in Google Scholar PubMed

20. Siqueland L, Kendall PC, Steinberg L. Anxiety in children: perceived family environments and observed family interaction. J Clin Child Psychol 1996;25:225–37.10.1207/s15374424jccp2502_12Search in Google Scholar

21. Walker LS, McLaughlin FJ, Greene JW. Functional illness and family functioning: a comparison of healthy and somaticizing adolescents. Fam Process 1988;27:317–25.10.1111/j.1545-5300.1988.00317.xSearch in Google Scholar PubMed

22. Frey J. A Family/systems approach to illness-maintaining behaviors in chronically iii adolescents. Fam Process 1984;23:251–60.10.1111/j.1545-5300.1984.00251.xSearch in Google Scholar PubMed

23. Campbell TL, Patterson JM. The effectiveness of family interventions in the treatment of physical illness. J Marital Fam Ther 1995;21:545–83.10.1111/j.1752-0606.1995.tb00178.xSearch in Google Scholar

24. Garralda ME. Practitioner review: assessment and management of somatisation in childhood and adolescence: a practical perspective. J Child Psychol Psychiatry 1999;40:1159–67.10.1111/1469-7610.00533Search in Google Scholar

25. Bonnie P, Ann NM. Chronic pain and the family: a review. Pain 1986;26:1–22.10.1016/0304-3959(86)90169-7Search in Google Scholar

26. Flor HT, Denis C, Rudy TE. Pain and families 2. Pain 1987;30: 29–45.10.1016/0304-3959(87)90081-9Search in Google Scholar

27. Bennett D, Wraith C, Reed M. Complex medico-psychosocial problems of adolescence: an integrated family approach. J Hong Kong Med Assoc 1993;44:151.Search in Google Scholar

28. Watson WH, McDaniel SH. Relational therapy in medical settings: working with somatizing patients and their families. J Clin Psychol 2000;56:1065–82.10.1002/1097-4679(200008)56:8<1065::AID-JCLP6>3.0.CO;2-SSearch in Google Scholar

29. Van der Putte EM, Van Doornen LJ, Engelbrecht RHH, Kuis W, Kimpen JLL, et al. Mirrored symptoms in mother and child with chronic fatigue syndrome. Pediatr 2006;117:2074–9.10.1542/peds.2005-2307Search in Google Scholar

30. Brace MJ, Scott Smith M, McCauley E, Sherry DD. Family reinforcement of illness behavior: a comparison of adolescents with chronic fatigue syndrome, juvenile arthritis, and healthy controls. J Dev Behav Pediatr 2000;21:332–9.10.1097/00004703-200010000-00003Search in Google Scholar

31. Lewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT. Systematic review of family functioning in families of children and adolescents with chronic pain. J Pain 2010;11:1027–38.10.1016/j.jpain.2010.04.005Search in Google Scholar

32. Palermo TM, Eccleston C. Parents of children and adolescents with chronic pain. Pain 2009;146:15–7.10.1016/j.pain.2009.05.009Search in Google Scholar

33. Ochs M, Seemann H, Franck G, Wredenhagen N, Verres R, et al. Primary headache in children and adolescents: therapy outcome and changes in family interaction patterns. Fam Syst Health 2005;23:30–53.10.1037/1091-7527.23.1.30Search in Google Scholar

34. Landgraf JM, Abetz L, Ware JE. Child health questionnaire (CHQ): a user’s manual, 2nd ed. Boston, MA: HealthAct, 1999.Search in Google Scholar

35. Spieth L. Generic health-related quality of life measures for children and adolescents. Quality of Life in Child and Adolescent Illness 2001;1:49–88.Search in Google Scholar

36. Waters EB, Salmon LA, Wake M, Wright M, Hesketh KD. The health and well-being of adolescents: a school-based population study of the self-report Child Health Questionnaire. J Adolesc Health 2001;29:140–9.10.1016/S1054-139X(01)00211-7Search in Google Scholar

37. Epstein NB, Baldwin LM, Bishop DS. The McMaster family assessment device. J Marital Fam Ther 1983;9:171–80.10.1037/t06314-000Search in Google Scholar

38. Novack TA, Gage RJ. Assessment of family functioning and social support. In: Cushman LA, Scherer MJ, editors. Psychological Assessment in Medical Rehabilitation. Washington, DC: American Psychological Association, 1995:275–97.10.1037/10175-006Search in Google Scholar

39. Byles J, Byrne C, Boyle MH, Offord DR. Ontario child health study: reliability and validity of the general functioning subscale of the McMaster family assessment device. Fam Process 1988;27:97–104.10.1111/j.1545-5300.1988.00097.xSearch in Google Scholar PubMed

40. Weinman J, Petrie KJ, Moss-Morris R, Horne R. The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychol Health 1996;11:431–45.10.1080/08870449608400270Search in Google Scholar

41. Szyndler J, Towns S, Hoffman R, Bennett D. Clinical assessment, management and outcomes of a group of adolescents presenting with complex medico-psychosocial conditions. Ann Acad Med Singapore 2003;32:51–7.Search in Google Scholar

42. McDaniel S, Hepworth J, Doherty W. Medical family therapy: a biopsychosocial approach to families with health problems. New York: Basic Books, 1992.Search in Google Scholar

43. Klineberg E, Rushworth A, Bibby H, Bennett D, Steinbeck K, et al. Adolescent chronic fatigue syndrome and somatoform disorders: A prospective clinical study. J Paediatr Child Health 2014;50:775–81.10.1111/jpc.12653Search in Google Scholar PubMed

Received: 2015-4-28
Accepted: 2015-9-16
Published Online: 2015-12-10
Published in Print: 2016-11-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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