Background: Functional neurological symptom disorders (FND) are frequently encountered in practice, with significant medical and socioeconomic burden^1,2. Severe stressors, including sexual/physical abuse, are frequently described. ^3–7 Pediatric epidemiological and outcome data remain scarce.^1,2,8,9

Objective: Assess diagnostic accuracy of trainee’s first impression of FND in our pediatric emergency room (ER); describe manner of presentation, demographic data, socio-economic impact and clinical outcomes, including parental satisfaction.

Methods: 1) Over one year, psychiatry consultations for neurology patients with FND were retrospectively reviewed to assess the diagnostic accuracy of neurology trainees. 2) For three months, we prospectively collected all children whose ER presentation suggested the diagnosis of FND. 3) 3-6 months following prospective collection, families completed a structured phone interview on outcome measures.

Results: Twenty-seven patients were retrospectively assessed, thirty-one patients were prospectively collected. Diagnostic accuracy was 93-94%. Mixed presentations were most common (usually sensory-motor changes). Associated stressors were mundane and ubiquitous, rarely severe. Families were substantially affected, with mean 7.4 weeks of symptoms, 21 missed school days, and 8.9 days of parental missed work. At follow-up, 78% were symptom-free. Parental dissatisfaction was infrequent; insufficient information and poor rapport were the most common reasons.

Conclusions: Trainees’ clinical impression was accurate in predicting a later diagnosis of FND. Extraordinary life stressors are not required to trigger these disorders. Though prognosis is favorable, families incur substantial economic and educational burden. Improving recognition and appropriately communicating the diagnosis of FND may speed access to treatment and potentially reduce the substantial disability and cost of this disorder.