Management Considerations for Pediatric Functional Movement Disorder

Abstract

Treatment of children (including adolescents) with functional movement disorder involves a biopsychosocial (holistic) approach. In a well-conducted medical assessment for FND, the pediatric neurologist establishes a good therapeutic alliance, makes a positive diagnosis of functional neurological disorder (FND), provides a clear explanation, and directs the child onto the appropriate outpatient or inpatient treatment pathway. A biopsychosocial assessment with the child and the family enables the clinician to elicit a detailed developmental history and to understand the emergence of functional neurological symptoms in the context of the child’s life story, including adverse childhood experiences that have activated the child’s stress system. The assessment also provides information about the “somatic narrative”—the symptoms, signs, and subjective experience that mark an activated or dysregulated stress system. The formulation, constructed with the child and family at the end of the assessment, provides a synthesis of the predisposing, precipitating, and perpetuating factors that contribute to the child’s presentation. The clinical team use the formulation to guide a treatment intervention that addresses the specific needs of the child and family on multiple system levels (the individual child, the family, the school context, and so on). With prompt (positive) diagnosis and appropriate multidisciplinary, multimodal treatment, children presenting with functional movement disorder have good clinical outcomes.