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Pervasive refusal syndrome(PRS) is the name allotted to a disorder in which children
have abandoned their involvement in all phases of their life. It's characterised by refusal
to eat, drink, talk, walk or self-care, and a firm resistance to treatment
Epidemiology
Pervasive refusal syndrome is for the most part frequently seen in girls and less so in boys. The average age of onset is between the ages of 7 and 15.[2] Affected children are usually high achievers with high self-expectaions, fears of failure, and difficulty dealing with failure to achieve personal standards[3] . The onset of PRS is usually acute[3] .
Symptoms
PRS symptoms have common characteristics with many other psychiatric disorders. However, none of the present
- recurring pain
- nausea
- loss of appetite
- headache
- seizure
- motor dysfunction
- sensory dysfunction
- fatigue
- altered consciousness
- joint pains
- muscle weakness
Etiology
Trauma, in general, appears to be a vital etiological aspect, due to the fact that PRS is also repeatedly seen in
Risk Factors for PRS
Pervasive refusal syndrome is more prone in some people, these risk factors include[5] :
- Fragile X syndrome
- Maternal hypothyroidism
- Phenylketonuria
- prenataldrug and alcohol exposure
- prenatal viral infection (cytomegalovirus, herpes, measles, syphyilis, toxoplasmosis, etc)
- sibling who has a pervasive developmental disorder
- Tuberous sclerosis
Diagnosis
Thompson and Nunn were the first to introduce diagnostic criteria for PRS in 1997. The current diagnostic criteria consists of:[2]
- A) Partial or complete refusal in three or more of the following
areas: (1) eating, (2) mobilization, (3) speech, (4) interest to personal care
- B) Active and angry resistance to acts of help and support
- C) Social withdrawaland school refusal
- D) No organic condition accounts for the severity of the degree of
- E) No other psychiatric disordercould better account for the
symptoms
- F) The endangered state of the patient requires hospitalization[2]
Learned Helplessness Model
Seligman's (1990) model of learned helplessness embodies that the learned expectation of having no control over matters in the environment is met with a generalized passivity response[6] . It is speculated that the interactions between the child and events in their surroundings can end in the child encountering feelings of helplessness and therefor, a loss of personal hopefulness[6] . The patient is scared to take part in the world and feels inadequate in facing internal and external experiences, which he or she experiences through the world and thinking about his or her emotional encounters[6] . This model is effective in explaining the degradation in children with PRS when trying to rehabilitate them. If the child or adolescent is experiencing the treatment intervention as forceful, then their feeling of helplessness increases[6] .
Comorbidity
Autism and PRS
Asperger's syndrome and PRS
Treatment
Unfortunately, no evidence-based treatment is known for PRS. However it is widely accepted that the treatment must incorporate a complete
Inpatient Treatment
Due to the fact that PRS is such a severe disorder, it is almost always required to
Role of the Family
The role of the family in the treatment process is vital yet complicated, given that withdrawal of the child from therapy is a key problem. It is important to include the family of the patient in the treatment process as it eases family anxiety and distress[2] . Nonetheless, it is important to create some space because too much involvement of the family may be counterproductive. Medication seems to play a very restricted part in the management of pervasive refusal syndrome (PRS), having importance in the treatment of comorbid disorders only, for example antidepressants for comorbid depression[2] .
- ^ a b c "Pervasive Refusal Syndrome: A Parent's Perspective". Sage Journals. 6 (455). 2001.
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- ^ ISBN 978-0-19-923499-8.)
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