Functional Neurological Disorder in Children and Adolescents

Kozlowska, Kasia; Mohammad, Shekeeb S

doi:10.1007/978-3-031-10494-7_37

Cited by 7 publications

(14 citation statements)

References 72 publications

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“…When presenting a positive diagnosis to the child and family, the doctor also needs to explain the diagnosis (see Text Box 2), provide information about treatment, and, when working with children, include positive suggestions about the likelihood of a good outcome 25,37 . A number of recent publications describe the use of positive rule-in signs for diagnosis and for explaining the diagnosis in detail to both child and adult patients 38,41–45 …”

Section: Step 1: the Medical/neurological Assessment And Provision Of...mentioning

confidence: 99%

“…This scarcity of resources is the result of long-standing stigma coupled with a lack of knowledge and understanding about the neurobiology of FND and its treatment. Research efforts using newly developed technologies are rapidly building a knowledge base of FND as a mind-body (neuropsychiatric) disorder that sits at the interface of neurology and psychiatry 38,102,103 . The issue of stigma is also being addressed but will likely take decades to reverse 26,104–106 .…”

Section: Building Up An Fnd-informed Workforcementioning

confidence: 99%

“…25,37 A number of recent publications describe the use of positive rule-in signs for diagnosis and for explaining the diagnosis in detail to both child and adult patients. 38,[41][42][43][44][45] In many Western settings, the medical assessment for FND includes a blood panel and may also include imaging. Because the diagnosis is typically based on clinical examination, however, the doctor needs to prepare the child and family that the outcome of these investigations is expected to be normal.…”

Section: Step 1: the Medical/neurological Assessment And Provision Of...mentioning

confidence: 99%

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

Kozlowska

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.

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Section: Step 1: the Medical/neurological Assessment And Provision Of...mentioning

confidence: 99%

Section: Building Up An Fnd-informed Workforcementioning

confidence: 99%

Section: Step 1: the Medical/neurological Assessment And Provision Of...mentioning

confidence: 99%

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

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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“…Participants were 61 young people who had been referred for treatment for FND in the Mind-Body Program at The Children's Hospital at Westmead (October 2018 to September 2022) and who had agreed to participate in the FND research program. All young people with FND had undergone a comprehensive neurology assessment and had been given a positive diagnosis of FND (DSM-5 criteria) by a paediatric neurologist (see Supplementary Text Box S3 for positive rule-in signs for FND) [37,38]. Four participants who had participated in other components of the research program could not be contacted, and one parent decided not to participate in the current component.…”

Section: Participantsmentioning

confidence: 99%

“…The functional abdominal pain diagnosis was confirmed by a gastroenterologist. The FND diagnoses-persistent motor weakness of the lower limbs (unrelated to sleep) and functional/dissociative seizureswere confirmed by a neurologist via rule-in positive neurological signs and video EEG (gold-standard assessments) [38,54,55] (see Supplementary Text Box S3).…”

Section: Case 6 New-onset Fnd Following Covid-19 Vaccinationmentioning

confidence: 99%

COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study

et al. 2022

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Background: The emergence of acute-onset functional neurological symptoms, the focus of this study, is one of three stress responses related to immunisation. This case–control study documents the experience of 61 young people with past or current functional neurological disorder (FND) in relation to the COVID-19 vaccination program in Australia. Methods: Information about the young person’s/parent’s choice and response pertaining to COVID-19 vaccination was collected as part of routine clinical care or FND research program follow-up. Results: 61 young people treated for FND (47 females, mean age = 16.22 years) and 46 healthy controls (34 females, mean age = 16.37 years) were included in the study. Vaccination rates were high: 58/61 (95.1%) in the FND group and 45/46 (97.8%) in the control group. In the FND group, 2 young people (2/61, 3.3%) presented with new-onset FND following COVID-19 vaccination; two young people with resolved FND reported an FND relapse (2/36, 5.56%); and two young people with unresolved FND (2/20, 10.0%) reported an FND exacerbation. In the control group no FND symptoms were reported. Conclusions: Acute-onset FND symptoms following COVID-19 vaccination are uncommon in the general population. In young people prone to FND, COVID-19 vaccination can sometimes trigger new-onset FND, FND relapse, or FND exacerbation.

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Treatment Approaches for Functional Neurological Disorders in Children

Vassilopoulos

Mohammad

Dure

et al. 2022

Curr Treat Options Neurol

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Purpose of Review Functional neurological disorder (FND) is a multi-network brain disorder that encompasses a broad range of neurological symptoms. FND is common in pediatric practice. It places substantial strains on children, families, and health care systems. Treatment begins at assessment, which requires the following: the medical task of making the diagnosis, the interpersonal task of engaging the child and family so that they feel heard and respected, the communication task of communicating and explaining the diagnosis, and the logistical task of organizing treatment. Recent Findings Over the past decade, three treatment approaches—Retraining and Control Therapy (ReACT), other cognitive-behavioral therapies, and multidisciplinary rehabilitation—have been evaluated in the USA, Canada, and Australia. Of children treated in such programs, 63 − 95% showed full resolution of FND symptoms. The common thread across the programs is their biopsychosocial approach—consideration of biological, psychological, relational, and school-related factors that contribute to the child’s clinical presentation. Summary Current research strongly supports a biopsychosocial approach to pediatric FND and provides a foundation for a stepped approach to treatment. Stepped care is initially tailored to the needs of the individual child (and family) based on the pattern and severity of FND presentation. The level of care and type of intervention may then be adjusted to consider the child’s response, over time, to treatment or treatment combinations. Future research is needed to confirm effective treatment targets, to inform the development of stepped care, and to improve methodologies that can assess the efficacy of stepped-care interventions.

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Functional Neurological Disorder in Children and Adolescents

Cited by 7 publications

References 72 publications

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

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

COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study

Treatment Approaches for Functional Neurological Disorders in Children

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