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

Abstract

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.

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“…Bailey and her family were referred to the Department of Psychological Medicine for admission assessment into the Mind-Body Program for FND. 4,5 The family assessment took place via telehealth (due to the COVID-19 pandemic). Bailey's history of cumulative stress, with both psychological (associated with school) and physical (mycoplasma infection and fractured toe) stressors, coupled with panic attacks that had, with time, morphed into functional seizures, was consistent with FND.…”

“…The Mind-Body Program is a rehabilitation setting for children disabled by FND. 5 On a daily basis, it includes individual therapy to learn regulation skills for managing functional seizures, 4 physiotherapy to build physical resilience and stress resistance, 6,7 and school attendance. There are also weekly family sessions.…”

“…A neurology review confirmed the working diagnosis of functional seizures from clinical history, review of video material, and review of EEG data. Bailey and her family were referred to the Department of Psychological Medicine for admission assessment into the Mind-Body Program for FND 4,5 . The family assessment took place via telehealth (due to the COVID-19 pandemic).…”

Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder

“…Eighty children admitted for treatment of FND to the inpatient Mind-Body Program at the Children's Hospital at Westmead [72] during the period January 2019 to May 2023 agreed to participate in the FND research study. All children had undergone a comprehensive neurology assessment and had been given a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of FND by a paediatric neurologist [73].…”

“…The illness-promoting psychological processes were identified, documented in the clinical notes, and identified-as a problem area that required a targeted therapeutic intervention-in individual psychotherapy sessions with the child and also in family sessions with the child and family. When possible, interventions to target one or more of the processes were implemented during the mind-body inpatient admission (a component of a broader biopsychosocial intervention) [72]. The psychological processes that required ongoing intervention were subsequently documented in the child's discharge report and handed over-both verbally and via the report-to the child's psychotherapist in the community.…”