The biopsychosocial model in paediatric clinical practice—An interdisciplinary approach to somatic symptom disorders

Førde, Stein; Herner, Linn Breen; Helland, Ingrid B.; Diseth, Trond H.

doi:10.1111/apa.16517

Cited by 5 publications

(19 citation statements)

References 36 publications

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“…Other clinicians undertake the biopsychosocial assessment over a number of sessions 58,59 . In this scenario, the length of the assessment with the child and family can be varied to meet both clinical need (what the family can manage) and the available clinical resources (e.g., hospital or community) in which the assessment takes place.…”

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

“…Other clinicians undertake the biopsychosocial assessment over a number of sessions. 58,59 In this scenario, the length of the assessment with the child and family can be varied to meet both clinical need (what the family can manage) and the available clinical resources (e.g., hospital or community) in which the assessment takes place. Variations include one long session over a day (3-6 hours); 3-4 shorter sessions over 3-4 days (3-6 hours); and multiple sessions with the family, parents, and child over a week (including assessments of psychological, cognitive, and physical function (8-10 hours) (Helene Helgeland, personal communication).…”

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

“…Because clinical examples of the biopsychosocial assessment are available in case studies published by our team [60][61][62][63][64] and have been described in detail elsewhere, 39,40,58,59,65 here we summarize the key pieces of information to be generated by the initial assessment:…”

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

“…In children with FND, the biopsychosocial approach pays particular attention to adverse childhood experiences (ACEs), the manner in which these experiences are biologically embedded, and the cumulative effect of these experiences on body systems and on health and well-being. 39,40,58,59 In children with FND, ACEs include a broad range of physical stressors (illness, injury, or medical procedures), emotional stressors (friendship problems, bullying, problems in the family), and academic stressors (expectations that exceed the child's capacity, grueling academic schedules, learning difficulties). While maltreatmentphysical, emotional, and sexual abuse, and exposure to domestic violence-is reported by a percentage of children and families (5%-29% in our team's clinical cohorts), 8,71-73 commonplace cumulative stressors are much more typical, as noted above.…”

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

“…39 When working with children and families, many clinicians use visual metaphors 39,40 or a visual representation of the formulation on a white board (see Figures 3, 4, and 5). 58,59 STEP 5: USING THE FORMULATION TO DEVELOP THE TREATMENT PLAN The co-constructed formulation is used to develop the individualized treatment plan for the child and family. When a formulation has been done well, the interventions needed to help settle the child's stress system (what we often call the brain stress systems when talking to children) † † and neural network dysregulation are usually readily apparent.…”

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

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Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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Learning objectives:• Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND) • Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions Abstract: Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.

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Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

Section: Step 3: Clinical (Biopsychosocial) Assessment With the Child...mentioning

confidence: 99%

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

Section: Step 4: Co-constructing the Mind-body Formulation With The C...mentioning

confidence: 99%

See 3 more Smart Citations

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Kozlowska

Chudleigh

Savage

et al. 2023

Harv Rev Psychiatry

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Principles for delivering improved care of people with functional seizures: Closing the treatment gap

Winton-Brown

Wilson

Felmingham

et al. 2023

Aust N Z J Psychiatry

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Patients diagnosed with functional (psychogenic nonepileptic) seizures have similar or greater levels of disability, morbidity and mortality than people with epilepsy, but there are far fewer treatment services. In contrast to epilepsy, the current understanding of pathophysiological mechanisms and the development of evidence-based treatments for functional seizures is rudimentary. This leads to high direct healthcare costs and high indirect costs to the patient, family and wider society. There are many patient, clinician and system-level barriers to improving outcomes for functional seizures. At a patient level, these include the heterogeneity of symptoms, diagnostic uncertainty, family factors and difficulty in perceiving psychological aspects of illness and potential benefits of treatment. Clinician-level barriers include sub-specialism, poor knowledge, skills and attitudes and stigma. System-level barriers include the siloed nature of healthcare, the high prevalence of functional seizures and funding models relying on individual medical practitioners. Through the examination of international examples and expert recommendations, several themes emerge that may address some of these barriers. These include (1) stepped care with low-level, brief generalised interventions, proceeding to higher level, extended and individualised treatments; (2) active triage of complexity, acuity and treatment readiness; (3) integrated interdisciplinary teams that individualise formulation, triage, and treatment planning and (4) shared care with primary, emergency and community providers and secondary consultation. Consideration of the application of these principles to the Australian and New Zealand context is proposed as a significant opportunity to meet an urgent need.

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Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder

Kozlowska,

Schollar-Root,

Savage

et al. 2023

Children

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Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00−17.08 years) admitted to the Mind–Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58–17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes. Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND—disabled enough to be admitted for inpatient treatment—illness-promoting psychological processes are part of the clinical presentation. They contribute to the child’s ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.

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The biopsychosocial model in paediatric clinical practice—An interdisciplinary approach to somatic symptom disorders

Cited by 5 publications

References 36 publications

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

Principles for delivering improved care of people with functional seizures: Closing the treatment gap

Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder

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