Cognitive Behavioral Therapy May Enhance Rehabilitation of Conversion Disorder in Children

An individually tailored, family-based cognitive behavioral therapy (CBT) program comprised of joint family sessions on psychoeducation and seizure management may be an effective component of rehabilitation inchildren with functional neurological symptoms (FNS).  Findings were published in the European Journal of Pediatric Neurology.

A total of 22 children (mean age, 14.5; range, 6 to 17) with FNS who completed a CBT program implemented in routine child and adolescent clinical/systemic practice were included in the pilot study. The definition of FNS included neurologic symptoms with no known medical cause. Children with medically explained neurologic conditions such as epilepsy and FNS, including non-epileptic seizures, were enrolled. During CBT, no patient received additional psychotherapy.

At baseline and following intervention, the researchers measured treatment outcomes using the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO), and Revised Child Anxiety and Depression Scale (RCADS). From baseline to immediately after treatment, scores on the CGAS significantly improved (43 vs 66, respectively; P <.001). Approximately 82% of participants experienced a “reliable change.” Fewer children experienced reliable improvements on the SDQ, GBO, and RCADS.

Limitations of the analysis include the small patient population, the lack of a control group, and the lack of follow-up data for 5 patients whose treatment was considered incomplete.

“Our preliminary case experience appears to confirm that a primary focus on the impact of the physical symptoms and their rehabilitation is crucial,” the researchers wrote, “although following engagement of the family, the incorporation of CBT seems to offer opportunities to address a range of underlying issues, which might prevent a re-emergence of the same or new symptoms in the future.”

Reference

McFarlane FA, Allcott-Watson H, Hadji-Michael M, et al. Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series [published online December 13, 2018]. Eur J Paediatr Neurol. doi:10.1016/j.ejpn.2018.12.002