So you’ve just heard of this diagnosis – FND. Your child or teen may have just been diagnosed in hospital or by a specialist, but you’ve never heard of it. What now?
Well, what is FND?
Functional neurological disorder (FND) is a diagnosis describing a problem with the functioning of the nervous system and the brain’s interaction with the body and its surroundings. This may look like limb weakness, tremors, black-outs, movements of limbs or changes to sensation. Investigations may be performed, however diagnosis is also based on the presence of positive diagnostic features (positive signs) by a knowledgeable clinician.
FND Symptoms
As FND is an issue with the functioning of the nervous system, your child may show changes in movement or their sensory systems (sensation, sight, hearing). This may look like increases in function – involuntary tic-like movements or changes to the way they walk. Or decreases in function – paralysis, inability to move a limb or walk, loss of sensation or non-epileptic seizures (also known as dissociative episodes).
Here is a list of potential symptoms that may present:
| Limb weakness | Dizziness |
| Movement disorder (fixed positions) | Drop attack (sudden falling) |
| Speech/Swallow | Gait disorder (swaying or dragging leg gait) |
| Dystonia | Facial symptoms |
| Non-epileptic seizures / functional seizures / dissociative episodes | Muscle jerks |
| Sensory change | Bladder/bowel (IBS) |
| Tremor | Visual changes |
| Cognitive difficulties | Tics |
Which symptom your children or teen experiences may stay the same, but can also shift to different symptoms altogether. This can be worrying but does not indicate worsening of FND.
Myth Busting
Unfortunately FND has been misunderstood in broader society and in the medical world. This stems from the lack of changes to scans or investigations, with it then being put down to as being ‘put on’ or purely ‘a psychological issue’. However, it is now understood that this is due to the changes to nervous system function, rather than pathology in structure of the nervous system.
We know FND is not just a psychological issue. While there are links with increased symptoms and signs in stressful situations – there does not need to be an occurrence of psychological trauma and stress. It is recognised that the brain does not function as well when it experiences stress, and with this – FND can be exacerbated in moments of stress.
FND usually does present following a trigger that stresses the body’s protective systems such as an illness, migraine, persistent fatigue, persistent pain, injury or stressful situation/s. This is not always required and for some simply experiencing FND symptoms can be enough to cause distress.
Software vs Hardware Problem
An analogy that is often used to understand how FND works is that the body’s “hardware” is in normal condition. In this way – if it is scanned with an MRI and other medical investigations are performed, it will confirm there is no damage or pathology. However, the functioning or “software” is not working as it should. This is likened to a computer that has all its parts working, however the software requires updating.
How can symptoms be not consistent or distractible?
When an individual with FND is in a non-threatening and familiar context (engaging in an activity they know well), there can be momentary reductions in symptoms. This is a key part of rehabilitation.
How can multidisciplinary team help?
- Understand the diagnosis of FND with appropriate age-related information.
- Understand the nature of symptoms and how to manage them.
- Develop practical physical strategies to facilitate recovery.
- Focus on and work towards goals that are meaningful such as getting back to school.
A healthcare team will work with the child or teenager to recognise warning signs, develop strategies to increase engagement and participation within school or the things they enjoy.
Check out this video by Neurosymptoms, a site started by FND researcher and consultant neurologist Dr Jon Stone.
To access the Neurosymptoms website click here.
To download the Neurosymptoms app for Apple click here.
To download the Neurosymptoms app for Android click here.
Want to read the evidence supporting our approach to FND?
Gilmour, G. S., Nielsen, G., Teodoro, T., Yogarajah, M., Coebergh, J. A., Dilley, M. D., … & Edwards, M. J. (2020). Management of functional neurological disorder. Journal of Neurology, 267(7), 2164-2172. Link
Gray, N., Savage, B., Scher, S., & Kozlowska, K. (2020). Psychologically informed physical therapy for children and adolescents with functional neurological symptoms: the wellness approach. The Journal of Neuropsychiatry and Clinical Neurosciences, 32(4), 389-395. Link
Rajabalee, N., Kozlowska, K., Lee, S. Y., Savage, B., Hawkes, C., Siciliano, D., … & Torbey, S. (2022). Neuromodulation Using Computer-Altered Music to Treat a Ten-Year-Old Child Unresponsive to Standard Interventions for Functional Neurological Disorder. Harvard Review of Psychiatry, 10-1097. Link
