Ambushed by Memories of Trauma: Memory-Processing Interventions in an Adolescent Boy with Nocturnal Dissociative Episodes

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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Learning objectives:• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND) • Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions Abstract: Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

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Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

Self Cite

“…10Karla, one of the case studies described in this article presented with multiple functional neurological symptoms including several occasions where she was unresponsive to social interaction, sensory stimuli, and pain–for over 24 hours–following a family session where traumatic family material was discussed {Kozlowska, 2003 #783}. For other examples see case of Jasmine in Kozlowska and colleagues 2017 (Kozlowska et al 2018) (Ratnamohan et al 2018). …”

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confidence: 98%

Asylum-seeking children in shutdown: Neurobiological models

Developmental Child Welfare

Scher

Helgeland

et al. 2021

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Asylum-seeking children presenting in the shutdown state have been the subject of much discussion and controversy—on both government and medical system levels—in Australia and in Sweden. In this article, we conceptualize the shutdown state as an evolutionary response to extreme threat. We adopt a neuroscience approach to present five plausible models for explaining this shutdown state, their strengths and shortcomings, and the overlaps between them. Model 1—the sustained autonomic arousal model—draws on polyvagal theory. Model 2—the innate-defence model—draws on research pertaining to animal and human innate defence responses. Model 3—the catatonia model—draws on clinical and research data with patients presenting with catatonia. Model 4—the hypometabolic model—draws on an emerging body of work pertaining to hypometabolic states in animals and humans. Model 5—the defence cascade model of dissociation—draws on clinical research pertaining to human trauma states that present as dissociation. At present, each of the models provides a plausible pathophysiological explanation—or a component of a potential pathophysiological explanation—and none of them, for the moment, has enough evidence to be either accepted or disregarded. We hope that our discussion of the models advances scientific discussion and opens up possibilities for effective treatment.

The Brain Stress Systems I: The Implicit Level of Brain Operations

Functional Somatic Symptoms in Children and Adolescents

Scher

Helgeland

2020

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In this chapter we continue our exploration of the neurobiology of functional somatic symptoms by considering the role of the brain. The brain plays a key role in regulation, in coordinating the stress response, and in helping the child adapt to the circumstances of living over time. Every component of the body stress system-the HPA axis, autonomic nervous system, and immune-inflammatory system-is regulated by the brain or connected to it, or communicating with it, in some way. When a child is exposed to stress that is chronic, uncontrollable, unpredictable, cumulative, recurrent, or overwhelming, it leads to activation of brain systems that are involved in managing stress and in stress-related adaptations. Because these regions interact with and modulate motor-, sensory-, pain-, and fatigue-processing regions, the sustained activation of the brain stress systems changes patterns of neural activation and connectivity across and between these systems, and sets up the necessary conditions for generating functional 11 The Brain Stress Systems I: The Implicit Level of Brain Operations