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Duncan M, Pearman Z, Harrold K, Warren A, Evans S, McAllister E, Heyman I, Shavel-Jessop S, Murphy T, Liang H. Evaluation of a psychoeducation group for children presenting with functional tic-like behaviours. Clin Child Psychol Psychiatry 2024; 29:1011-1025. [PMID: 38476087 DOI: 10.1177/13591045241237829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
We describe the implementation and evaluation of an online psychoeducation group for young people experiencing functional tic-like behaviours (FTLBs) - a type of functional neurological disorder (FND). Across six groups, 50 participants completed pre- and post-group goal-based outcomes (GBOs) and 36 participants completed service-user feedback, which gathered qualitative and quantitative data about participants experiences of the group. Young people and their parents reported significant improvement in their GBOs following the group and increased knowledge and confidence in managing FTLBs. The findings highlight that virtual psychoeducation group intervention is an acceptable and effective first step in treatment of young people with FTLBs. We discuss implications for future intervention development.
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Affiliation(s)
- Morvwen Duncan
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Zoe Pearman
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Katie Harrold
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Amy Warren
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Sacha Evans
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Eve McAllister
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | | | | | - Tara Murphy
- The Tic Service, Great Ormond Street Hospital for Children, UK
| | - Holan Liang
- The Tic Service, Great Ormond Street Hospital for Children, UK
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Garcia A. Pediatric Functional Neurologic Disorders. Pediatr Clin North Am 2023; 70:589-601. [PMID: 37121644 DOI: 10.1016/j.pcl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Functional neurologic disorders are common in the pediatric population. Recently, there has been a renewed focus on functional neurologic disorders, leading to improvements in diagnosis and management. This review focuses on updates in clinical presentation, diagnosis, pathophysiology (including neuroimaging), and treatment of functional neurologic disorders in the pediatric population.
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Affiliation(s)
- Angela Garcia
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15201, USA.
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Malaty IA, Anderson S, Bennett SM, Budman CL, Coffey BJ, Coffman KA, Greenberg E, McGuire JF, Müller-Vahl KR, Okun MS, Quezada J, Robichaux-Viehoever A, Black KJ. Diagnosis and Management of Functional Tic-Like Phenomena. J Clin Med 2022; 11:6470. [PMID: 36362696 PMCID: PMC9656241 DOI: 10.3390/jcm11216470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Over the past 3 years, a global phenomenon has emerged characterized by the sudden onset and frequently rapid escalation of tics and tic-like movements and phonations. These symptoms have occurred not only in youth known to have tics or Tourette syndrome (TS), but also, and more notably, in youth with no prior history of tics. The Tourette Association of America (TAA) convened an international, multidisciplinary working group to better understand this apparent presentation of functional neurological disorder (FND) and its relationship to TS. Here, we review and summarize the literature relevant to distinguish the two, with recommendations to clinicians for diagnosis and management. Finally, we highlight areas for future emphasis and research.
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Affiliation(s)
- Irene A. Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | | | - Shannon M. Bennett
- Department of Psychiatry, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10065, USA
| | - Cathy L. Budman
- Department of Psychiatry, Northwell Health, Zucker School of Medicine, Hofstra/Northwell, Uniondale, NY 11549, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Keith A. Coffman
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kirsten R. Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Julio Quezada
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | | | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Horner O, Hedderly T, Malik O. The changing landscape of childhood tic disorders following COVID-19. PAEDIATRICS AND CHILD HEALTH 2022; 32:363-367. [PMID: 35967969 PMCID: PMC9359930 DOI: 10.1016/j.paed.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The article describes classification, aetiology and features of typical tic disorders (Tourette syndrome) and their management with an additional focus on a surge in atypical tic presentations following the COVID-19 pandemic, often described as functional tics, or functional tic-like movements. We discuss what explains their atypical nature and what might underpin this increase in incidence. Lastly the article provides an overview of management of functional tics, so readers can understand how management of these differs from typical tic disorders.
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Elliott L, Carberry C. Treatment of Pediatric Functional Neurological Symptom Disorder: A Review of the State of the Literature. Semin Pediatr Neurol 2022; 41:100952. [PMID: 35450669 DOI: 10.1016/j.spen.2022.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Abstract
Functional Neurological Symptom Disorder (FNSD), or experiencing neurological symptoms incompatible with either a neurological condition or a medical condition, is a common condition presenting in children and adolescents. It is associated with impairment in quality of life for patients and their families and represents a significant burden to the healthcare system. There is currently limited research available regarding effective treatment of pediatric FNSD. Currently, only one RCT exists studying effective treatment of FNSD in children and adolescents, and it is limited to one sub-type of FNSD and only examined cognitive behavioral therapy compared to supportive therapy. Despite this, almost all published research supports good prognosis for pediatric FNSD with all studies reporting improvement either in FNSD symptoms or in the quality of life and functioning of patients with FNSD. The most support was found for the use of cognitive behavioral therapy either as a stand-alone treatment or in the context of interdisciplinary treatment. Future research should focus on increasing the rigor of research, including expanding RCTs to include additional sub-types of FNSD and comparing across various treatment modalities.
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Affiliation(s)
- Lindsey Elliott
- Department of Psychiatry and Behavioral Sciences, Univeristy of Texas at Austin, Austin, TX.
| | - Caroline Carberry
- Department of Educational Psychology, University of Texas at Austin, Austin, TX
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6
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Diagnosis and Initial Treatment of Functional Movement Disorders in Children. Semin Pediatr Neurol 2022; 41:100953. [PMID: 35450668 DOI: 10.1016/j.spen.2022.100953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
Abstract
Functional movement disorders (FMD) are complex neurobehavioral disorders that can be a significant source of disability for both children and their caregivers. While FMD in the adult population is better characterized, the aim of this paper is to review the pertinent clinical and historical features, diagnostic criteria, and multi-disciplinary management of FMD in the pediatric population. We highlight recent trends in pediatric FMD, including the increase in functional tic-like behaviors that has been observed during the COVID-19 pandemic.
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Owen T, Silva J, Grose C, Bailey A, Robinson S, Anderson S, Ludlow A, Sharp S, Toghill L, Hedderly T. Case report: Advice for schools on managing functional tic-like behaviours. Front Psychiatry 2022; 13:1001459. [PMID: 36545035 PMCID: PMC9760715 DOI: 10.3389/fpsyt.2022.1001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/21/2022] [Indexed: 12/08/2022] Open
Abstract
There has been an increase in the occurrence of sudden onset functional tic-like behaviours in adolescents during the COVID-19 pandemic, which has had a significant impact on the affected individual's ability to engage with education. The aim of this article is to generate discussion and inform practice within schools with regard to the management of functional tic-like behaviours. An advice sheet for schools has been produced based on clinical expertise and experience of consulting with schools around the management within education settings. Case examples are presented highlighting the importance and impact of these strategies. We also highlight the need for further evaluation of the effectiveness of the advice sheet in collaboration with schools and families.
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Affiliation(s)
- Tamsin Owen
- Tics and Neurodevelopmental Movements Service (TANDeM), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Juliana Silva
- Tics and Neurodevelopmental Movements Service (TANDeM), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Psychology, University of East Anglia, Norwich, United Kingdom
| | - Claire Grose
- Tics and Neurodevelopmental Movements Service (TANDeM), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alice Bailey
- Tics and Neurodevelopmental Movements Service (TANDeM), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sally Robinson
- North East London Foundation Trust, London, United Kingdom
| | | | - Amanda Ludlow
- Department of Psychology, University of Hertfordshire, Hatfield, United Kingdom
| | | | | | - Tammy Hedderly
- Tics and Neurodevelopmental Movements Service (TANDeM), Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Heyman I, Liang H, Hedderly T. COVID-19 related increase in childhood tics and tic-like attacks. Arch Dis Child 2021; 106:archdischild-2021-321748. [PMID: 33677431 DOI: 10.1136/archdischild-2021-321748] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Isobel Heyman
- Psychologcial Medicine Team, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Holan Liang
- Psychologcial Medicine Team, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Guy's King's and Saint Thomas' School of Medicine, London, UK
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