Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder
Kasia Kozlowska1, Catherine Chudleigh, Blanche Savage
1From University of Sydney Medical School (Drs. Kozlowska and Scher); Department of Psychological Medicine, The Children's Hospital at Westmead (Drs. Kozlowska, Chudleigh, Hawkes, and Nunn, and Ms. Savage); Harvard Medical School (Dr. Scher); and McLean Hospital, Belmont, MA (Dr. Scher).
Insights
Functional neurological disorder (FND) in children requires prompt diagnosis and a biopsychosocial approach. This study outlines a model for effective, community-based FND treatment programs to improve care and reduce stigma.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Psychiatry
Background:
- Functional neurological disorder (FND) affects up to 20% of pediatric neurology patients, involving biological changes due to lived experiences.
- Stigma and a lack of understanding contribute to scarce FND services globally.
- Prompt diagnosis and a biopsychosocial, stepped-care approach yield good outcomes for pediatric FND.
Purpose of the Study:
- To describe the elements of a successful biopsychosocial mind-body program for pediatric FND.
- To guide clinicians and institutions in establishing effective community and hospital-based FND treatment programs.
- To increase awareness and standardize care for children and adolescents with FND.
Main Methods:
- The Mind-Body Program at The Children's Hospital at Westmead provides a model for FND care.
- Utilizes a consultation-liaison team for inpatient and outpatient services.
- Empowers community clinicians with diagnosis, assessment, and support for implementing biopsychosocial interventions.
Main Results:
- The described program has successfully treated hundreds of pediatric FND patients.
- Community-based clinicians can effectively implement interventions with appropriate support.
- A positive diagnosis and comprehensive assessment are key to initiating treatment.
Conclusions:
- Effective FND treatment for children and adolescents is achievable through a structured, biopsychosocial approach.
- Establishing accessible, community-based FND programs is crucial for improving patient outcomes.
- Standardizing care and increasing awareness can combat stigma and improve treatment accessibility.
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.
