Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series

Fiona A McFarlane; Hannah Allcott-Watson; Maria Hadji-Michael; Eve McAllister; Daniel Stark; Colin Reilly; Sophie D Bennett; Andrew McWillliams; Isobel Heyman

doi:10.1016/j.ejpn.2018.12.002

Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series

Eur J Paediatr Neurol. 2019 Mar;23(2):317-328. doi: 10.1016/j.ejpn.2018.12.002. Epub 2018 Dec 13.

Authors

Fiona A McFarlane¹, Hannah Allcott-Watson¹, Maria Hadji-Michael¹, Eve McAllister¹, Daniel Stark¹, Colin Reilly², Sophie D Bennett¹, Andrew McWillliams³, Isobel Heyman⁴

Affiliations

¹ Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK.
² UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK; Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK.
³ Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, 16 de Crespigny Park, London, SE5 8AF, UK.
⁴ Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK. Electronic address: Isobel.Heyman@gosh.nhs.uk.

PMID: 30594458
DOI: 10.1016/j.ejpn.2018.12.002

Abstract

Aim: To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS).

Method: Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD = 2.6, range 6-17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS).

Results: Scores on the CGAS improved significantly post-intervention (p < 0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention.

Interpretation: The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials.

Keywords: Adolescents; Children; Conversion disorder; Functional neurological symptoms; Treatment.

MeSH terms

Adolescent
Anxiety / complications
Child
Cognitive Behavioral Therapy / methods*
Conversion Disorder / psychology
Conversion Disorder / therapy*
Depression / complications
Female
Humans
Male
Pilot Projects
Treatment Outcome