Behavioral management of conversion disorder in children

Abstract

Objective: To describe the behavioral management of conversion disorder in children and to preliminarily assess its effectiveness.

Design: Retrospective case series.

Setting: Inpatient pediatric rehabilitation unit.

Patients: The first eight patients with conversion disorder treated on our pediatric rehabilitation unit, between 9 and 18 years of age. Six were girls. Three cases are described in detail.

Interventions: All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a reward system was established for good attainment. Some patients had a "level" system instituted, with increasing privileges for goal achievement. All patients and their families had psychological assessment and instruction in pain and stress management strategies.

Main outcome measures: Restoration of normal gait and function, independence in activities of daily living (ADL), and symptom recurrence after discharge.

Results: All patients attained normal gait and ADL function before discharge.

Conclusions: (1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at times a behavioral reward or "level" system may be necessary for adequate reinforcement. (2) Instruction of the patient and family in appropriate stress and pain management appears key to maintaining treatment effect over time.