Factors influencing adherence to therapeutic recommendations made after diagnostic reassessment of medically unexplained symptoms in children and adolescents.

Background: Medically unexplained symptoms (MUS) are common among children and adolescents and may be highly impairing. Even after long diagnostic and/or therapeutic trajectories, many of these children and their parents feel dissatisfied with the advice and therapies they were given. Objectives: After a 2-week hospitalisation for somatic and psychiatric reassessment, children and their families were given recommendations for further treatment. This study evaluates which of these recommendations were carried out (primary outcome measure) and which factors influenced the (non-)adherence to therapeutic advice. Methods: Parents of 27 children aged 7–17 with impairing MUS took part in a structured telephone survey to assess adherence to and perceived effectiveness of therapeutic recommendations (cross-sectional study). Influencing factors were analysed retrospectively. Results: Psychotherapy was recommended to all 27 patients and their families; 19 of them (70.4%) carried out this advice. When physiotherapy was recommended, adherence proved lower (6/22 children; 27.3%). No influencing factors were found to have a statistically significant correlation with adherence. Effect sizes may be indicative of clinically relevant influential factors, but should be considered cautiously. Conclusion: Results suggest that more efforts need to be made to ensure adherence to therapeutic recommendations. Known risk factors for non-adherence to treatments for chronic somatic disorders may not apply for children with somatoform disorders.