Intended for healthcare professionals


Report sparks controversy over cause of children’s psychiatric symptoms

BMJ 2008; 337 doi: (Published 01 December 2008) Cite this as: BMJ 2008;337:a2818
  1. Karen McColl
  1. 1Savoie, France

    A new report from Save the Children and the Karolinska Institute in Stockholm has reignited debate in Sweden over whether several hundred children of asylum seekers had a psychiatric syndrome or whether their parents were fabricating or exaggerating their symptoms to win the right to stay in the country.

    Children with what is known as pervasive refusal syndrome—dubbed “apathetic children” by the Swedish media—withdraw from all contact and have severe loss of function, becoming unable to walk, talk, eat, or drink. In the most severe cases children become incontinent and require feeding by tube.

    Between 2003 and 2005 424 cases were recorded. Most of the children come from central Asian republics or from Balkan countries. Many belong to the Uighur ethnic group, which is said to be coming under increasing harassment and discrimination in the countries of the former Soviet Union.

    In the Swedish medical community opinions are polarised. One of the authors of the new report, Göran Bodegård, who has treated some of the children, believes that they have a variation of pervasive refusal syndrome . He sees the condition as an understandable stress response to past trauma and to a current situation of hopelessness and helplessness (Clinical Child Psychology and Psychiatry 2005;10:337, doi:10.1177/1359104505053753).

    Others in the medical profession, however, consider the condition to be either a hoax or severe child abuse. Some families have been accused of faking their child’s illness to be able to obtain the right to stay in the country. At the height of the controversy, affected children were refused hospital treatment or deported while still in a severely withdrawn state.

    In 2007 the United Nations’ then special rapporteur on the right to health, Paul Hunt, criticised the politicisation of this issue and called for more focus on the children’s fundamental human rights.

    The new report, published on 18 November, examined whether affected children had been exposed to potentially traumatising events before arriving in Sweden. It analysed case records of 33 of the most severely ill children. Of these children, 31 were subjected to threats to themselves or their families, and violence occurred in 25 cases. Fifteen of the children had seen relatives killed, and 17 were exposed to sexual violence, including four who had been raped. The more extreme the traumatic experience, the sooner the child became ill in Sweden, and the longer the child required tube feeding.

    The report’s findings remain controversial. But the authors argue that the study highlights risk factors that might contribute to this kind of response in children. Professionals working with vulnerable asylum seekers are advised to find out about traumatic events in family histories and use this information to provide support and focus on prevention.


    Cite this as: BMJ 2008;337:a2818

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