Principles of Assessment and Treatment

Abstract

In this chapter we outline the key principles that are built into the structure of our Mind-Body Program and into the interventions we undertake with any particular child. The principles are especially useful in the following circumstances: in assessing a referral for treating functional somatic symptoms; in setting up the multidisciplinary team around a given patient; in explaining to the child and family the overall goals and structure of the treatment approach to be used; in determining the details of the therapeutic interventions to be used; in discussing and initiating those particular interventions with the child and family; in periodically assessing the success or failure of ongoing therapeutic interventions; and when confronting situations in which the therapy feels stuck and the treatment interventions that should be working are not working. In addition, the principles make key processes explicit and can be used as touchstones for teaching and for learning. As touchstones, the principles can be used to identify dynamics both within the family and between the clinician and the family, and to help to open space for reflection about 13

Neuromodulation Using Computer-Altered Music to Treat a Ten-Year-Old Child Unresponsive to Standard Interventions for Functional Neurological Disorder

“…She also acknowledged that MT had a long history of stress at school and that she had experienced stress-related headaches (see above). Using a visual metaphor the psychiatrist explained the current medical understanding of FND and comorbid pain (see Figure 1 ), 2 , 3 adding that changes in cognitive function were seen in approximately 10% of pediatric cases and were understood to be related to the release of brain stress hormones and to hyperventilation. 4 The psychiatrist noted that throughout the assessment, MT’s breathing rate had ranged from 30–50 breaths per minute (≥99th percentile).…”

“…In this context her parents and the family doctor became increasingly anxious that the diagnosis of FND was incorrect. Because the Mind-Body Program does not accept children whose diagnosis has not been clarified or whose parents do not accept the diagnosis—everyone has to be on the same page 2 —our team put the mind-body admission on hold and supported the family to seek re-review from the neurologist and second opinions from a second neurologist and a neurosurgeon. During the resulting four-week period—which included two additional presentations to the Emergency Department because of MT’s symptoms of worsening gait, back pain, nausea, difficulty swallowing, and difficulties talking (visit 1) and a 40-minute functional seizure (visit 2)—the diagnosis of FND was reaffirmed at all consultations.…”

“…(5) The therapeutic relationship now established between MT’s parents and the team would enable the team to support the parents via weekly telehealth meetings. And (6) it was clear that MT was unable to benefit from any of the active regulation interventions—whether bottom-up and top-down 2 , 10 – 12 —that helped most children.…”

“… 19 Our team trained in the Safe and Sound Protocol because it was available in Australia and because we thought that a passive music intervention would be a good addition to our Mind-Body Program. 2 , 7 …”

“…These interventions facilitate the individual’s capacity to track body state, tolerate states of activation, and facilitate states of calm. 2 , 11 , 12 …”