Pervasive Refusal Syndrome among Asylum-seeking Children

Abstract

A number of asylum-seeking children in Sweden have developed a pervasive loss of function associated with profound social withdrawal. The syndrome is called Depressive Devitalization. The aim of this study was to identify possible aetiological factors, outline the similarities between Depressive Devitalization and Pervasive Refusal Syndrome and to explore possible differential diagnoses. The research was based on a literature study. Databases searched included PsychINFO, Medline, Pub med, COCHRANE and PILOTS. Possible aetiological factors identified included: Children having a perfectionist, ambitious and conscientious premorbid personality, psychiatric problems of children and parents, and traumatic events. Symptoms between the two syndromes differed only in pattern of refusal and neurological symptoms. None of the differential diagnoses explored could account for all features. The individual impact of aetiological factors requires further investigation. Children might previously have been diagnosed with a number of differential diagnoses, though none of these accounts for all symptoms seen in the syndromes. Depressive Devitalization and Pervasive Refusal Syndrome are suggested to be subgroups of the same refusal syndrome.

Keywords

asylum-seeking children depression Depressive Devitalization mental health Pervasive Refusal Syndrome

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References

Adjukovic, M. , & Adjukovic, D. (1993). Psychological well-being of refugee children . Child Abuse and Neglect, 17, 843–854 .

Adjukovic, M. , & Adjukovic, D. (1998). Impact of displacement on the psychological well-being of refugee children . International Review of Psychiatry, 10, 186–195 .

Ahmadi, N. (2005). Asylsökande barn med uppgivenhetssymtom: Kunskapsöversigt och kartläggning[Asylum-seeking children with symptoms of giving up: An overview]. Sweden: Statens Offentliga Utredningar .

Bishop, D.V.M. (1994). Developmental disorders of speech and language. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 546–568). Bath: The Bath Press .

Bodegård, G. (2004a). Asylsökande flyktingbarn utvecklar livshotande funktionsbortfall [Asylum-seeking children develop a life-threatening lack of function] . Läkartidningen, 101, 1696–1699 .

Bodegård, G. (2004b, July). Depressiv devitalisering: Ett tillstånd av livshotande funktionsbortfall hos asylsökande flyktingbarn [Depressive Devitalization: A state of life-threatening loss of function, among asylum-seeking children]. Sammanställning till socialstyrelsen.

Bodegård, G. (2005). Life threatening loss of function in refugee children: Another expression of pervasive refusal syndrome? Clinical Child Psychology and Psychiatry, 10, 337–350 .

Fazel, M. , & Stein,A. (2002). Mental health of refugee children. Archives of Disease in Childhood , 87, 366–370 .

Garmezy, N. (1983). Stressors of childhood. In N. Garmezy & M. Rutter (Eds.), Stress, coping and development in children (pp. 43–83). New York: McGraw-Hill .

10.

Graham, P.J. , & Foreman, D.M. (1995). An ethical dilemma in child and adolescent psychiatry . Psychiatric Bulletin, 19, 84–86 .

11.

Hersov, L. (1994). Faecal soiling. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 520–528). Bath: The Bath Press .

12.

Hjern,A. , Angel, B. , & Jeppson, O. (1998). Political violence, family stress and mental health of refugee children in exile . Scandinavian Journal of Social Medicine, 26, 18–25 .

13.

Jule,W. (1994). Posttraumatic Stress Disorders. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 392–406). Bath: The Bath Press .

14.

Lask, B. (1996). Pervasive Refusal Syndrome: ACPP occasional paper . Psychosomatic Problems in Children, 12, 33–35 .

15.

Lask, B. (2004). Pervasive Refusal Syndrome . Advances in Psychiatric Treatment, 10, 153–159 .

16.

Lask, B. , Britten, C. , Kroll, L. , Magagna, J. , & Tranter, M. (1991). Children with pervasive refusal . Archives of Disease in Childhood, 66, 866–869 .

17.

Lask, B. , Taylor, S. , & Nunn, K. (2003). Practical child psychiatry: The clinician's guide. London: BMJ Publishing Group .

18.

Lustig, S.L. , Kia-Eating, M. , Grant-Knight,W. , Geltman, P. , Ellis, H. , Kinzie, D. , Keane,T. , & Saxe, G.N. (2004). Review of child and adolescent refugee mental health . Journal of the American Academy of Child and Adolescence Psychiatry, 43, 24–36 .

19.

McGowan, R. , & Green, J. (1998). Pervasive Refusal Syndrome: A less severe variant with defined aetiology . Clinical Child Psychology and Psychiatry, 3, 583–590 .

20.

Magagna, J. (2004). ‘I didn't want to die, but I had to’: The Pervasive Refusal Syndrome. In G. Williams , P. Williams , J. Desmarais , & K. Ravenscroft (Eds.) Exploring eating disorders in adolescents: The generosity of acceptance (pp. 107–138). London: Karnac .

21.

Migrationsverket . (2005). Asylsökande 2004 efter medborgarskap, världsdel, kön, barn 0–17 år och barn utan vårdnadshavare [Asylum seekers 2004 classified after citizenship, continent, sex, children 0–17 years and children without guardian]. Accessed August, 2005 from http://www.migrationsverket.se/pdffiler/statistik/statistik_1_2004.pdf

22.

Montgomery, E. (1998). Refugee children from the Middle East . Scandinavian Journal of Social Medicine, 54, 1–152 .

23.

Montgomery, E. , & Foldspang,A. (2001). Traumatic experience and sleep disturbance in refugee children from the Middle East . European Journal of Public Health, 11, 18–22 .

24.

Montgomery, E. , Krogh,Y. , Jacobsen,A. , & Lukman, B. (1992). Children of torture, victims' reactions and coping . Child Abuse and Neglect, 16, 797–805 .

25.

Mrazek, D.A. (1994). Psychiatric aspects of somatic disease and disorders. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 697–710). Bath: The Bath Press .

26.

Seligman, M.E.P. (1975). Theory of learned helplessness: On depression, development and death. San Francisco: W.H. Freeman and Company .

27.

Shaffer, D. (1994). Enuresis. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 505–519). Bath: The Bath Press .

28.

Steinhausen, H.C. (1994). Anorexia and bulimia nervosa. In M. Rutter , E. Taylor , & L. Hersov (Eds.), Child and adolescent psychiatry (pp. 425–440). Bath: The Bath Press .

29.

Taylor, S. , Dossetor, D. , Kilham, H. , & Bernard, E. (2000). The youngest case of pervasive refusal syndrome? Clinical Child Psychology and Psychiatry, 5, 23–29 .

30.

Thompson, S. , & Nunn, K. (1996). The Pervasive Refusal Syndrome: Learned helplessness and hopelessness . Clinical Child Psychology and Psychiatry, 1, 121–132 .

31.

Thompson, S. , & Nunn, K. (1997). The Pervasive Refusal Syndrome: The RAHC experience . Clinical Child Psychology and Psychiatry, 2, 145–165 .

32.

Thompson, S. , Nunn, K. , Moore, S. , English, M. , Burke, E. , & Byrne, N. (1998). Managing pervasive refusal syndrome: Strategies of hope . Clinical Child Psychology and Psychiatry, 3, 229–249 .

33.

Tunström,A. (2004). Barn som gett upp [Children that have given up]. Stockholm: Stockholms Läns Sjukvårdsområde, Flyktingenheten, BUP .

34.

UNHCR . (2002). Meeting the rights and protection needs of refugee children: An independent evaluation of the impact of UNHCR's activities. Oxford: Valid International .

35.

World Health Organization . (1993). International Classification of Diseases (ICD-10): Classification of mental and behavioural disorders. Geneva: Author .

36.

World Health Organization . (2001). International classification of functioning, disability and health. Geneva: Author .