Functional neurological disorder and functional tic-like behaviours: what do paediatricians need to know?

Functional neurological disorders (FNDs) affect voluntary motor or sensory systems disrupting function without an identifiable underlying disease. FNDs are common in children and young people and are associated with significant distress and disability. The symptoms of FND are genuine, and FND is no longer a diagnosis of exclusion, yet clinicians often lack education in diagnosis and management. In this short article FND is discussed from both a historical context and the current neuroscientific understanding. Functional Tic-Like Behaviour (FTLB) is an example of FND, and key differences with Tourette syndrome are summarised to enable differential diagnosis. FTLB is discussed in the context of the Covid-19 pandemic and the influence of social media on young people. The management of FTLB should include addressing underlying neurodevelopmental diversity. Management suggestions including the use of Antecedent, Behaviour and Consequence charts, Formulation, CBT and psychological techniques such as grounding are outlined.