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

Table 6 Factors affecting prognosis of pediatric functional neurological disorder

Predictors	Favourable outcomes	Unfavourable outcomes
Time of diagnosis and treatment	Timeliness of intervention: Early diagnosis and prompt treatment are crucial for favorable outcomes. Early intervention leads to better symptom resolution and improvement. Access to specialized care: Multidisciplinary care from pediatric neurologists, psychologists, and physical therapists enhances prognosis	Late diagnosis: Delayed diagnosis, especially with extended symptom duration, is linked to poorer outcomes. Chronic symptoms are harder to treat and may become resistant
Severity of symptomatology	Less severe initial symptoms: Mild symptoms at onset are often more responsive to treatment and less likely to become chronic. Limited symptom duration: Shorter symptom duration before treatment correlates with better outcomes, reducing risk of entrenched dysfunction	High symptom severity: Severe symptoms like persistent motor dysfunction or significant sensory loss are more challenging to manage and require intensive treatment. Widespread symptomatology: Multiple, widespread symptoms affecting various aspects of functioning complicate treatment and impact prognosis negatively
Levels of family and social support	Family involvement: Active family engagement, emotional support, and a positive environment contribute to better outcomes. Supportive social environment: Understanding peers and teachers, and a supportive social environment facilitate better outcomes by reducing stress and encouraging normal activities	Inadequate family support: Lack of family involvement or a stressful home environment can worsen symptoms and hinder recovery. Negative social environment: Social isolation, bullying, or lack of peer and teacher support increase stress and decrease motivation, leading to poorer outcomes
Presence/absence of comorbid psychiatric conditions	Lack of mental health disorders: The absence of comorbid psychiatric conditions like anxiety or depression reduces complexity and allows for focused FND treatment	Co-occurring mental health disorders: The presence of psychiatric conditions such as anxiety, depression, or PTSD complicates treatment and is associated with less favorable outcomes. Psychological resistance: Difficulty accepting the diagnosis or resisting psychological interventions may lead to slower progress and persistent symptoms
Level of adherence to treatment	Consistency in following treatment plans: High adherence to therapies and medications is a strong predictor of favorable outcomes, leading to symptom improvement and long-term stability	Poor compliance: Non-adherence to treatment plans due to resistance, family challenges, or other factors results in chronic symptoms and reduced quality of life

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