Functional neurological disorder (FND) is a condition where individuals experience neurological symptoms that cannot be fully explained by underlying disease or neurological abnormalities. Common symptoms of FND include episodes of blackouts, weakness, and abnormal movements. The symptoms in FND are thought to be caused by problems with how the brain functions or processes information, rather than by damage to the nervous system.

A diagnosis of FND in children and adolescents can be challenging as it requires careful evaluation by healthcare professionals experienced in paediatric neurology and mental health. The two most common symptom groups of FND are:

1. Functional Motor symptoms – limb weakness, tremors (shaking), dystonia (abnormal posturing), gait disturbance and dysphagia (issues with swallowing).
    
2. Dissociative symptoms – excessive head and body movements, altered consciousness, non-epileptic seizures, tremors, and dissociation (spaced/zoned out).

FND can also result in other symptoms such as chronic pain, fatigue, sensory symptoms (e.g., tingling, numbness) and difficulty with cognitive function (e.g., concentration/memory).

A diagnosis is typically based on a thorough clinical assessment that includes the following steps:

1. Medical history: The healthcare provider will gather information about the child’s medical history, including any previous illnesses, injuries, or stressful events that might be associated with the onset of symptoms.
   
2. Physical examination: A comprehensive physical examination is performed to rule out any underlying medical conditions that could account for the symptoms.
   
3. Neurological examination: A detailed neurological examination is conducted to assess the child’s reflexes, muscle tone, strength, coordination, and sensation. The goal is to identify any inconsistencies or abnormalities that suggest functional symptoms rather than an organic neurological disorder.
   
4. Diagnostic tests: Various diagnostic tests, such as blood tests, imaging studies (e.g., MRI, CT scan), and electroencephalogram (EEG), may be conducted to rule out other medical conditions and ensure there are no structural abnormalities or neurological diseases present.
   
5. Collaboration with specialists: Collaboration with other healthcare professionals, such as child psychiatrists or psychologists, to further assess the child’s psychological and emotional well-being.

A diagnosis of FND in children and adolescents should, where possible, be based on positive features that are noted during history taking and physical examination, rather than a process of elimination. A diagnosis is usually confirmed by a Neurologist. Symptoms of FND can fluctuate, change, and may need re-evaluation so an ongoing relationship with a Neurologist you trust is helpful.

We understand that FND is not explained by one single process or trigger. There are many interacting factors that can be considered as contributing to the onset of FND including biological, psychological, and lifestyle factors.

We don’t have all the answers yet when it comes to FND so the cause and explanation can vary from person to person. We don’t know why some people develop FND and others don’t. Most research suggests that there is often a bodily trigger for FND.

Injury, illness, and pain are common triggers as are depression, anxiety, and traumatic life experiences. In most cases, a combination of these factors and more are likely to make the brain vulnerable to FND and trigger FND episodes. These triggers can vary and will be different for everyone.

Psychologists can help manage FND and treat a range of functional symptoms. Psychologists will often work as part of a team of Neurologists, Physiotherapists, GP’s, Psychiatrists, Occupational Therapists etc to help to better understand and manage FND.

The aim of treatment is to explain and understand the triggers that led to FND and then teach strategies that will help to manage/minimise the symptoms of FND. Following a diagnosis of FND, seeing a trained Psychologist can help with:

• Learning and understanding more about FND

• Developing a deeper understanding of the symptoms and triggers that led to FND

• Teaching strategies to manage FND symptoms

• Treating any co-existing conditions (e.g., anxiety, depression, chronic illness)

• Addressing lifestyle and social factors that maintain FND

• Developing a plan to manage FND to create a purposeful and meaningful life

For more FND information and support visit:

fndaustralia.com.au

fndhope.org

neurosymptoms.org