Abstract
Pervasive Refusal Syndrome (PRS) is a rare child psychiatric condition. We describe a case of PRS in a 9-year-old boy with a diagnosis of Autism Spectrum Disorder (ASD) presenting with severe weight loss due to extreme restriction of food and fluids. Other prominent symptoms included total mutism, school refusal, and self-neglect. He was admitted to a specialist Child and Adolescent Mental Health Unit. We discuss the symptoms present in this case and the differential diagnosis of ASD in PRS. Although this differential has briefly been considered one in previous case, there have been no reported cases of PRS with a prior diagnosis of ASD. We explore comorbidity and interaction of the two diagnoses. We discuss the possible impact of ASD as a predisposing factor upon the progression and prognosis of PRS.
Highlights
Pervasive Refusal Syndrome (PRS) is a rare and little understood child psychiatric condition
The diagnostic criteria are (i) clear food refusal and weight loss (ii) social withdrawal and school refusal (iii) partial or complete refusal in 2 or more of the following domains: mobilisation, speech, and attention to personal care (iv) active and angry resistance to acts of help and encouragement (v) no organic condition to account for the severity of the degree of symptoms (vi) no other psychiatric disorder that could better account for the symptoms
It is known that children with Pervasive Developmental Disorders, including Autistic Spectrum Disorder (ASD), are more likely to present with school refusal
Summary
Pervasive Refusal Syndrome (PRS) is a rare and little understood child psychiatric condition. In one other published case report of a 4-year-old boy, with some atypical features of PRS, the differential diagnosis of ASD or of a generic pervasive developmental disorder is discussed. In this case no prior or concurrent diagnosis of ASD was made [5]. It is known that children with Pervasive Developmental Disorders, including ASD, are more likely to present with school refusal. This is more likely when the child has an intellectual disability or obsessional traits [12]. Urinary and faecal incontinence are more common in the ASD population [13]
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