Pervasive refusal syndrome among inpatient asylum-seeking children and adolescents: a follow-up study
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Pervasive refusal syndrome (PRS) is a rare but severe condition, characterised by social withdrawal and a pervasive active refusal in terms of eating, mobilisation, speech and personal hygiene. PRS has been proposed as a new diagnostic entity in child and adolescent psychiatry, although the diagnostic criteria are debated. In the past 10 years there has been an increase in PRS symptoms among asylum-seeking children and adolescents in Sweden. Here, we describe five cases of PRS among asylum-seeking children and adolescents.
Three females and 2 males, 7–17 years of age with the clinical picture of PRS, treated as inpatients at the Department of Child and Adolescent Psychiatry, Malmö, Sweden, 2002–2010, were analysed on the basis of their medical records. Subjects were diagnosed using previously suggested criteria for PRS. At follow-up, a semi-structured interview focusing on the inpatient stay and current status was performed. The subjects were assessed with Global Assessment of Functioning (GAF) and self-rating questionnaires regarding depression and post-traumatic stress disorder (PTSD).
The pattern of refusal varied among the five subjects. All subjects originated from former Soviet republics, indicating a possible cultural factor. Mean period of inpatient treatment was 5 months. All subjects received intense nursing and were treated with nasogastric tube feeding. Parents were involved and were given support and instructions. All subjects gradually improved after receiving permanent residency permits. Depression and PTSD were co-morbid states. At follow-up, 1–8 years after discharge, all subjects were recovered.
Although a severe condition, our five cases suggest a good prognosis for PRS among asylum-seeking children and adolescents.
KeywordsPervasive refusal syndrome Asylum-seeking Adolescents Follow-up Prognosis
We wish to express our gratitude towards the subjects and their families for their participation in the study. We also wish to thank Leslie Walke for linguistic help. Grants from Kronoberg County Council, FoU Kronoberg, Växjö, Sweden, reference number 24/2011, were received.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Jaspers T, Hanssen GM, van der Valk JA, Hanekom JH, van Well GT, Schieveld JN (2009) Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report. Eur Child Adolesc Psychiatry 18(11):645–651PubMedCrossRefGoogle Scholar
- 4.American Psychiatric Association. DSM-5 Development. Psych. Org http://www.dsm5.org. Accessed 15 May 2012
- 8.Wright B, Beverley D (2011). Pervasive refusal syndrome. Clin Child Psychol Psychiatry. doi: 10.1177/1359104511403680 (6 July, Epub ahead of print) 6 July
- 10.Christensen AM, Thelle T (2011). Afvisningssyndrom hos en 12-årig dreng (Refusal syndrome in a 12-year-old boy). Ugeskr Laeger 18;173(16–17):1214–1215Google Scholar
- 16.American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders—DSM-IV-TR. American Psychiatric Association, Washington, DCGoogle Scholar
- 19.Personal contact with Hans Nidsjö, statistical administrator. Swedish Migration Board, Planning and Control, Norrköping, Sweden. (firstname.lastname@example.org)Google Scholar
- 21.Joelsson L, Dahlin K (2005). Asylprocess grogrund för apati hos vissa barn (Asylum-seeking process a breeding ground for apathy among certain children. A negative decision concerning the residence permit is often a triggering factor). Läkartidningen 102(48):3646–3650Google Scholar
- 22.Ahmadi N (2006). Asylsökande barn med uppgivenhetssymtom—trauma, kultur, asylprocess (Asylum-seeking children with symptoms of resignation—trauma, culture, asylum process). Statens offentliga utredningar SOU 2006:49. Edita, StockholmGoogle Scholar
- 24.Swedish Migration Board (2009). Migrationsverket statistik 2009-02-18, Tabell 1 2008 (Swedish Migration Board, Statistics 2009-02-18, Table 1)Google Scholar
- 25.Ascher H, Gustavsson T (2008). Clearing conference about children with refusal symptoms. Läkartidningen 9–15;105(1–2):31–33Google Scholar