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Asylum-seeking children with resignation syndrome: catatonia or traumatic withdrawal syndrome?
Anne-Liis von Knorring1, Elisabeth Hultcrantz2
1Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, 75185, Uppsala, Sweden. anne-liis.von_knorring@neuro.uu.se.
Insights
A severe stuporous condition affected asylum-seeking children in Sweden. Most experienced persecution and violence, leading to a complete loss of responsiveness and motor skills, prompting research into its cause and treatment.
Area of Science:
- Child and Adolescent Psychiatry
- Neurology
- Trauma Studies
Background:
- Increasing cases of a severe stuporous condition in asylum-seeking children in Sweden emerged in the early 2000s.
- This condition rendered children unresponsive, unable to move, and often incontinent.
Purpose of the Study:
- To describe the clinical characteristics of 46 children with the most severe form of this illness.
- To explore potential contributing factors, including trauma, persecution, and family history.
- To discuss the nosological classification and potential treatment of this condition.
Main Methods:
- Case series reporting on 46 consecutive children with severe stuporous illness.
- Analysis of demographic data, including origin, persecution status, and exposure to violence.
- Examination of age of onset for initial symptoms and stupor, differentiating between genders.
- Review of parental mental and physical health status.
Main Results:
- The majority of children were ethnic/religious minorities and had experienced or witnessed violence.
- Onset of initial symptoms occurred around ages 11-12, with stupor onset around age 13 for both genders.
- Girls showed a tendency towards depression preceding stupor, while boys tended towards post-traumatic stress disorder (PTSD).
- A significant proportion of children had parents with mental or severe physical disorders.
Conclusions:
- The study highlights a severe, trauma-related condition in vulnerable children.
- Further research is needed to determine if this is a distinct entity or a variant of catatonia.
- Consideration of benzodiazepines as a potential treatment is suggested.
Abstract:
In the beginning of the 2000s, an increasing number of asylum-seeking children in Sweden fell into a stuporous condition. In the present study, we report 46 consecutive children with the most severe form of this illness where the children were unable to give any response at all, did not react to pain, cold or touching, could not be supported to sit or stand on their feet, could not do anything when requested, and in most cases had enuresis/encopresis. A minority of the children came from war zones (n = 8, 17.4%). A majority belonged to an ethnic or religious minority (n = 32, 69.6%) in their homeland and almost all were persecuted (n = 43, 93.5%). All had either experienced violence themselves or had witnessed or heard about violence against close family members. The age of onset of the first symptom of illness for boys was 11.2 years [CI 9.6-12.8], for girls 11.8 yrs.[CI 10.4-13.2], and the age for falling into stupor for boys was 12.9 years [CI 11.6-14.1] years and was the same for girls, 12.9 years [CI 11.6-14.2] years. Girls tended to have depression before entering the stuporous condition, while the boys tended to have PTSD first (Chi-square = 3.73, p = 0.054). A majority of the children had one (n = 13, 28.3%) or both parents (n = 14, 30.4%) suffering from mental or severe physical disorder. It is discussed whether the presented condition is a separate entity or if the syndrome should be regarded as a variant of catatonia, and whether benzodiazepines should be tried.
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