Paeds · mental-behavioural-and-psychosomatic
Functional neurological symptoms in children
Also known as Functional neurological disorder in children · Conversion disorder in children · Paediatric FND · Psychogenic non-epileptic seizures in children · Dissociative seizures in young people
Fellowship guide to functional neurological symptoms in children and adolescents: positive diagnosis from internally inconsistent signs, the biopsychosocial 3-Ps formulation, red flags and organic mimics, a validating diagnosis conversation, and a stepped multidisciplinary plan led by physiotherapy-led functional rehabilitation and psychological therapy across ANZ, UK, US and Canada.
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Target exams
Red flags
- Acute collapse, dense paralysis, unsafe gait or inability to eat or drink needing admission
- Signs of genuine neurological disease — papilloedema, true upper motor neuron signs, fixed progression, new focal deficit
- New epileptic seizures, status epilepticus, or a mixed PNES-and-epilepsy picture needing urgent neurology
- Self-harm, suicidal ideation, or safeguarding concern (maltreatment, family violence, fabricated or induced illness)
- Diagnostic delay with escalating investigation, immobilisation, deconditioning or opioid use
- Severe entrenched school absence and social withdrawal
- Using dismissive language ('it's all in your mind', 'fake', 'attention-seeking') that breaks the therapeutic alliance
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Behavioural and mental health
- Neurology (general paediatric exposure)
- Learning goal 10 developmental and behavioural paediatrics
- Learning goal 14 adolescent and youth health
- Learning goal 15 essential general paediatrics
- Clinical Applications
- Long Cases
- Short Cases
- Communication
- Mental health and emotional wellbeing
- Neurology
- Neurodevelopment and Neurodisability
- Patient management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Clinical
- Development
- General Pediatrics Content Outline — Domain 5: Mental and Behavioral Health
- General Pediatrics Content Outline — Domain 6: Psychosocial Issues
- General Pediatrics Content Outline — Domain 14: Neurology
- General Pediatrics EPA: Assess and manage common behavioral and mental-health presentations
- Patient Care 1: History
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Medical Expert
- Communicator
- Collaborator
- Health Advocate
- Pediatrics: Foundations EPA — Assessing and managing common behavioural and mental-health presentations
Overview & Definition
A 13-year-old is admitted after two weeks of an increasingly abnormal gait. The MRI is normal. The neurology registrar says "probably functional". The family hears "probably nothing". That gap — between a real, disabling symptom and a family who feels dismissed — is where most harm in paediatric functional neurological disorder (FND) happens, and where a general paediatrician changes the outcome. [1] [2]
Functional neurological disorder describes genuine neurological symptoms (motor, sensory, seizure-like, speech, visual or cognitive) that arise from a disruption of nervous-system functioning rather than from a structural disease of the nervous system. The symptoms are experienced involuntarily. They are not imagined, and they are not produced deliberately. The sense that the movement is happening to the person, not by choice, is the defining subjective feature. [13] [6]
Two historical labels still surface and confuse families. "Conversion disorder" is the DSM psychiatric term and remains in active use; "medically unexplained symptoms" is falling out of favour precisely because it defines the problem by what it is not, and because it carries an implied message of dismissal. The current preferred, shared language across neurology and psychiatry is functional neurological disorder. [13]
The single most important reframing for a candidate to hold is this: FND is a positive diagnosis, made from features that are internally inconsistent or incongruent with recognised neuroanatomy. It is not a diagnosis you reach by running tests until everything is normal, and it is not a label of last resort. A child can have FND and still have a normal scan — but a normal scan alone never makes the diagnosis. [2] [13]
References14ShowHide
- [1]Yong K, Chin RFM, Shetty J, Hogg K Functional neurological disorder in children and young people: Incidence, clinical features, and prognosis. Dev Med Child Neurol, 2023.PMID 36752054
- [2]Weiss KE, Steinman KJ, Kodish I, Sim L Functional Neurological Symptom Disorder in Children and Adolescents within Medical Settings. J Clin Psychol Med Settings, 2021.PMID 32743729
- [3]Elliott L, Carberry C Treatment of Pediatric Functional Neurological Symptom Disorder: A Review of the State of the Literature. Semin Pediatr Neurol, 2022.PMID 35450669
- [4]Vassilopoulos A, Mohammad S, Dure L, Kozlowska K Treatment Approaches for Functional Neurological Disorders in Children. Curr Treat Options Neurol, 2022.PMID 35370394
- [5]Kim YN, Gray N, Jones A, Scher S The Role of Physiotherapy in the Management of Functional Neurological Disorder in Children and Adolescents. Semin Pediatr Neurol, 2022.PMID 35450664
- [6]Kozlowska K, Chudleigh C, Savage B, Hawkes C Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder. Harv Rev Psychiatry, 2023.PMID 36884038
- [7]Kozlowska K, Schollar-Root O, Savage B, Hawkes C Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder. Children (Basel), 2023.PMID 38002815
- [8]Kozlowska K, Nunn KP, Rose D, Morris A Conversion disorder in Australian pediatric practice. J Am Acad Child Adolesc Psychiatry, 2007.PMID 17195731
- [9]Raper J, Currigan V, Fothergill S, Stone J Long-term outcomes of functional neurological disorder in children. Arch Dis Child, 2019.PMID 31326916
- [10]Albert DV Psychogenic Nonepileptic Seizures in Children and Adolescents. Semin Pediatr Neurol, 2022.PMID 35450667
- [11]Hansen AS, Rask CU, Christensen AE, Rodrigo-Domingo M Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures. Neurology, 2021.PMID 34031196
- [12]Terry D, Enciso L, Trott K, Burch MM Outcomes in Children and Adolescents With Psychogenic Nonepileptic Events Using a Multidisciplinary Clinic Approach. J Child Neurol, 2020.PMID 32689845
- [13]Perez DL, Aybek S, Nicholson TR, Kozlowska K Functional Neurological (Conversion) Disorder: A Core Neuropsychiatric Disorder. J Neuropsychiatry Clin Neurosciences, 2020.PMID 31964243
- [14]Mink JW Conversion disorder and mass psychogenic illness in child neurology. Ann N Y Acad Sci, 2013.PMID 24138153