The Utility (or Not) of Self‐Report Instruments in Family Assessment for Child and Adolescent Conversion Disorders?

Abstract

Children and adolescents with conversion disorders and their families are challenging to understand and challenging to treat. This study examined whether self‐report instruments are a useful adjunct to family and individual assessment. A total of 57 children and adolescents diagnosed with conversion disorders and 57 sex‐ aged‐matched controls, along with their parents, completed the Strength and Difficulties Questionnaire, Child Behaviour Checklist, Depression Anxiety and Stress Scales, Somatic and Psychological Health Report (SPHERE), Brief Risk‐Resilience Index for Screening, and the NEO–Five‐Factor Inventory. The conversion disorder and control groups were compared on each questionnaire, and classified participants as ‘cases’ or not according to established clinical thresholds for each questionnaire. A discriminant analysis was used to examine which components of the SDQ, CBCL, DASS, SPHERE, BRISC, and NEO‐FFI emerged as most useful in identifying the clinical characteristics of children with conversion disorders. The role of attachment strategy with regards to the utility of self‐report measures was also examined. The SPHERE was the only self‐report that our patient cohort were able to utilise to communicate their somatic and emotional discomfort and distress. Our results suggest that children and adolescents presenting with functional somatic symptoms represent a distinctive clinical population for which the ‘psychological’ focus of most currently available questionnaires is not useful for identifying the presence of somatic illness or of comorbid anxiety and depression, and that these measures – with the exception of the SPHERE – are not a useful adjunct to a family‐based assessment. Therapeutic conversations that utilise language that asks about the state of the body – the body's response to stress, illness, pain, and injury – facilitate engagement and serve as the cornerstone of treatment.

Long-term outcomes of functional neurological disorder in children

“…By definition, it also implies family willingness to entertain psychological approaches to their child’s symptoms. Rates of reported psychological comorbidity at presentation are low (table 1) but this may reflect previously-described under-reporting of psychological symptoms in FND 31 32. Although functional neurological symptoms almost invariably initially present to paediatricians, successful treatment involves collaboration between physical and mental health teams where possible 33.…”

Alexithymia in children with medically unexplained symptoms: a systematic review

“…Another factor not considered in the studies concerns the validity of measures of self-reported mental health symptoms in this population. These measures may not be useful in detecting mental health problems in children with MUS [55] and thus professional clinical diagnoses are likely to be the gold standard in the MUS population.…”

Psychogenic non-epileptic seizures in children and adolescents: Part II – explanations to families, treatment, and group outcomes

“…To a child or adolescent, it may seem that the doctor is suggesting that ‘it’s all in my head’ or that ‘I’m psycho’, ‘going off my head’, or ‘putting it on’ – that is, suffering from a severe form of craziness or severe mental illness. To complicate matters, children/adolescents with PNES typically do not perceive themselves to be anxious, depressed or emotionally distressed ( Kozlowska, Cruz, et al, 2016 ), so the implication of PNES as ‘psychological’ appears disconnected from the children/adolescents’ personal stories and also from their somatic experiences of the ‘seizures’ (and the associated non-specific somatic symptoms) as a disturbance of the body. Not surprisingly, patients and their families are frequently offended and find the diagnosis difficult to accept.…”