Unraveling functional neurological disorder in pediatric populations: A systematic review of diagnosis, treatment, and outcomes

Table 1 Differences between pediatric and adult functional neurological disorder pathophysiology and clinical differences

Aspect	Pediatric FND	Adult FND
Developmental factors	Symptoms reflect ongoing brain development and plasticity. Symptoms may fluctuate with developmental stages. Greater sensitivity to immediate stressors and emotional disturbances	Symptoms arise from more established neural circuits. Often involves chronic, stable symptom patterns. Symptoms may be more entrenched due to long-standing psychological factors
Brain network dysregulation	Dysregulation affects developing neural networks (e.g., motor control, sensory processing). Connectivity between brain regions may be less stable, leading to variable symptoms	Involves established, but maladaptive, brain network patterns. Persistent alterations in connectivity, especially in areas like the prefrontal cortex and limbic system. Results in more consistent symptomatology
Psychological and environmental triggers	Often linked to acute stressors, family dynamics, and school issues. Immediate life events, such as bullying or trauma, trigger symptoms. Impacted by developmental stage and coping abilities	Influenced by long-term stress, complex trauma histories, and chronic life stressors. Accumulation of stress leads to persistent symptoms. Higher likelihood of pre-existing psychiatric conditions complicating symptoms
Clinical presentation and symptom profile	Symptoms include functional movement disorders, non-epileptic seizures, and gait abnormalities. Symptoms are often variable and change with developmental progress. Presentation may fluctuate with emotional state and developmental milestones	Symptoms include persistent functional motor impairments, chronic pain, and complex dissociative symptoms. Symptoms are more chronic and stable. Higher prevalence of comorbid psychiatric conditions such as anxiety or depression
Onset of symptoms	Sudden, often linked to a stressful event or minor illness	It can be sudden or gradual, often with a clear link to psychological stressors
Symptom variability	High variability, with symptoms fluctuating throughout the day	Symptoms can vary but may be more consistent compared to pediatric cases
Common symptoms	Motor symptoms (e.g., weakness, tremors), non-epileptic seizures, sensory loss, and speech disturbances (e.g., mutism)	Motor symptoms, sensory disturbances, non-epileptic seizures, gait abnormalities, chronic pain
Triggers	Often associated with acute stressors like school pressures, family issues, or peer conflicts	Commonly linked to chronic stress, psychological trauma, or significant life changes
Psychosocial context	Frequently involves school-related stress, family dynamics, or bullying	Often involves work-related stress, relationship issues, or past trauma
Cognitive Factors	Children may exhibit magical thinking or have difficulty articulating psychological stress	Adults may have a more complex understanding of their symptoms but may also exhibit denial or minimization
Comorbidities	Higher prevalence of anxiety, depression, and other mental health issues, as well as somatic symptom disorders	Often associated with chronic pain syndromes, anxiety, depression, and PTSD
Prognosis	Generally better with early intervention, especially with multidisciplinary approaches	Prognosis can be variable; some patients improve significantly, while others may have persistent symptoms
Treatment Approach	Focuses on education, cognitive-behavioral therapy, family involvement, and physical therapy	Cognitive-behavioral therapy physical therapy, psychotherapy, and sometimes pharmacological treatment are commonly used
Response to treatment	Generally good, particularly with early and supportive intervention	Response can be slower and more variable; some patients may require long-term therapy
Social support and education	Involves significant education and support for family members and teachers	Social support is important but may focus more on workplace accommodations and relationship counseling
Legal and disability issues	Less commonly involves legal or disability claims	More likely to involve disability claims, legal issues, or workers' compensation cases

FND: Functional neurological disorder; PTSD: Post-traumatic stress disorder.