Treatment Approaches for Functional Neurological Disorders in Children

Abstract

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.

Keywords: Clinical ethics; Functional neurological disorder (FND); Functional seizures; Pediatric; Psychogenic non-epileptic seizures; Treatment.

Fig. 1

Stepped care approach to functional neurological disorder. Stepped-care model for the management of pediatric functional neurological disorder. For other stepped-care models—developed for functional somatic symptoms more generally—see Schröder and Fink and in Garralda and Rask [44, 70]. © Kasia Kozlowska, Areti Vassilopoulos, & Aaron D. Fobian 2021. ADLs, activities of daily living.