Since many children and adolescents around the world with functional neurological disorder (FND) do not receive proper treatment, the Mind-Body Program at The Children’s Hospital, Westmead, in Sydney, Australia, released its long-running FND program guidelines in the Harvard Review of Psychiatry.
“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,” the Mind-Body team noted.
A key goal of the interventions is to increase the child and their family’s sense of control, of positive coping, and resilience, authors say. Long term, these interventions give the child the tools to manage future stress and daily challenges.
The treatment plan has 7 steps:
Diagnosis. The authors recommend that to properly diagnose FND, clinicians need to recognize that FND is a positive diagnosis rather than a diagnosis of exclusion. Any motor symptoms should be used to rule-in the clinical diagnosis.
Triage. It is recommended that the holistic or biopsychosocial assessment is carried out both medically and therapeutically, where the process is done without any time pressures. This therapeutic process involves finishing any examinations and communicating and explaining the positive FND diagnosis to the family. If the family is resistant, a second neurology opinion should be set up to continue helping the family accept the diagnosis
Assess. A clinician’s goals in this step should be to form a therapeutic relationship with the patient and family, get a developmental history to contextualize symptoms, make a formulation—an explanation of what triggered the illness process—and use the formulation to make a treatment plan.
Formulation. Clinicians will create a composite of the factors contributing to the child’s presentation—or, a formulation. Using a biopsychosocial approach becomes most apparent in this step, according to the Mind-Body Program, due to the way it takes adverse childhood experiences (ACEs) and predispositions into account.
Plan. The formulation created in the previous step is now used to make an individualized treatment plan. Treatment interventions can include managing attention, developing safety plans, medication, physical therapy, addressing comorbid conditions, or psychotherapy.
Implementation. Previously decided upon treatments or interventions are begun based on priority.
Resilience. “We expect the child and family to ‘take the mind-body program home,’” program staff noted. This can include adopting program elements into family structure and life, setting times to facilitate communication about challenges or stress, and continuing psychological work as well as school interventions.
“Most health care professionals working in pediatrics can easily add an FND-informed skill set to their current clinical practice,” authors concluded. “Pediatricians and pediatric neurologists already have the required skill set to diagnose FND; they just need to reconceptualize some of the signs that are elicited as positive rule-in signs for FND and to practice the skill of communicating the diagnosis to children and families in a clear and straightforward way devoid of stigma.”
Reference
Kozlowska K, Chudleigh CD, Savage B, et al. Evidence-based mind-body interventions for children and adolescents with functional neurological disorder. Harv Rev Psychiatry. 2023;31(2):60-82. DOI: 10.1097/HRP.0000000000000358
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