Unexplained disability: diagnostic dilemmas and principles of management

Unexplained disability in childhood challenges the physician diagnostically and therapeutically. Clinical presentation is typically that of a chronically ill and increasingly disabled child, often with positive physical findings and erratic response to usual medical management. The physician experiences great pressure to diagnose, to counsel, and to cure. Family characteristics include an inability to speak in psychological terms, denial of the family's involvement in the child's symptoms, and an emphasis on equivocal biomedical findings. Diagnostic and therapeutic tools specific to these disabilities are defined, with clinical illustrations provided.