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The Youngest Case of Pervasive Refusal Syndrome?

Royal Alexandra Hospital for Children, Sydney, Australia

David R. Dossetor

Royal Alexandra Hospital for Children, Sydney, Australia

Henry Kilham

Royal Alexandra Hospital for Children, Sydney, Australia

Elizabeth Bernard

Royal North Shore Hospital, St Leonard’s, Australia

To date, the youngest previously recorded case of pervasive refusal syndrome (PRS) was eight years old. A four-year-old Australian-born Chinese boy presented to a tertiary paediatric referral centre with a four-week history of food refusal and selective mutism; he was severely dehydrated and marasmic. During admission several behavioural problems were noted including: persistent refusal to eat or drink, obsessions with images of food, failure to cooperate, lack of social interaction and toileting in inappropriate places. There were features of early maternal separation, concerns over the quality of parenting and confusion of language and culture. An exhaustive assessment (to exclude an organic explanation) by a multi- disciplinary team was completed. All investigations were normal with the exception of the single photon emission computerized tomography (SPECT) scan, which showed mild increase uptake to the right insular and mild decrease uptake to the right temporal region. He was hospitalized for 67 days over which time his medical difficulties resolved. The differential diagnosis included an organic disease, child abuse, an eating disorder, a degenerative disorder, reactive attachment disorder, pervasive developmental disorder and a psychotic disorder, which were all considered. We felt that this case fulfilled the diagnostic criteria for PRS and was the youngest reported case. The similarity of the SPECT scan result with that found in anorexia nervosa is of interest and suggests that there is a neurobiological vulnerability common to this group of disorders.

Key Words: eating disorder • neurobiological vulnerability • pervasive refusal syndrome

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