Evaluation of a psychoeducation group for children presenting with functional tic-like behaviours.

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.

We describe 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 goal-based outcomes (GBOs) before and after the intervention. A total of 36 participants completed service-user feedback, which gathered 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.

Applying an Established Exposure Response Prevention Protocol for Young People With Tourette Syndrome in an Intensive, Group Format: A Feasibility Study.

BACKGROUND: The motor and vocal tics that characterise Tourette syndrome are stigmatizing and impact on quality of life. Behavioural interventions such as Exposure Response Prevention or Comprehensive Behavioural Interventions for Tics are first line treatment for Tourette syndrome, but availability is limited. This study is the first to explore the impact of an established manualised Exposure Response Prevention treatment protocol, developed for individual therapy, but here uniquely delivered intensively, to a group. METHODS: A naturalistic study comprised of a consecutive series of children (N = 20), aged 8-16 years (M = 12, SD = 2.17) were offered Exposure Response Prevention in one of two groups, delivered in series within a specialist clinic. Young people received the equivalent of 12 sessions (matching the manualised individual protocol). RESULTS: The YGTSS and Giles de la Tourette Syndrome Quality of Life Scale for Children and Adolescents (Satisfaction Scale) showed significant improvement following treatment with moderate to large effect sizes. Thirty-five percent of children demonstrated a reliable improvement on the YGTSS Global Tic Severity score. CONCLUSIONS: These data suggest an established Exposure Response Prevention protocol can be delivered in an intensive, group setting with a positive clinical outcome. Replication in a randomized controlled trial is an important next step.

Group-based parent training programme for children with neurological conditions: a feasibility study.

OBJECTIVE AND DESIGN: This study aimed to determine the feasibility and effectiveness of a parent training programme for parents of children with neurological conditions and behaviours that challenge. SETTING: Child and adolescent mental health service within a specialist children's hospital. PARTICIPANTS: Parents of 31 children with neurological conditions and behaviours that challenge. INTERVENTIONS: Parents attended a 6-week evidence-based behavioural parenting programme delivered in a group format, either face-to-face or remote. MAIN OUTCOME MEASURES: Feasibility was determined by attendance rates. Effectiveness was analysed primarily using parent-reported measures of child behaviour (Strengths and Difficulties Questionnaire, Paediatric Quality of Life and Goal-Based Outcomes). Secondary measures of parental well-being were also reported (Brief Parental Self-Efficacy Scale, Depression Anxiety Stress Scale Short Form and Parental Sense of Competence). Paired t-tests or Wilcoxon rank-sum tests were conducted to analyse differences preintervention and postintervention. RESULTS: The attendance rates for the face-to-face and remote groups were 80% and 79%, respectively. Medium to large effect sizes were reported for most measures of child behaviour and parental well-being. There were statistically significant improvements found postintervention in children's behaviour (p=0.014), quality of life (p<0.001), goal-based outcomes (p<0.001), parental self-efficacy (p<0.001) and parental anxiety (p=0.030). Anecdotal feedback showed that parents indicated the group format was acceptable. CONCLUSIONS: The group parenting intervention for parents of children with heterogeneous neurological conditions and behaviours that challenge appears feasible and effective in improving child behaviour and parental well-being.

Improved understanding of non-epileptic seizures and reduced emergency health care usage following a single psychoeducational group for children and their parents.

RATIONALE: The aim of this study was to evaluate the effectiveness of a three-hour psychoeducation group in improving understanding of non-epileptic seizures (NES), health outcomes and quality of life in young people with NES. BACKGROUND: Multi-session psychoeducational groups for adults with NES have reported improved psychosocial functioning and reduced NES compared to those who do not receive psychoeducational interventions. To date there have been no studies in young people examining the effects of a single session of psychoeducation. METHOD: 15 young people with NES and their families attended a psychoeducation group within a specialist hospital following a multidisciplinary assessment. The group's effectiveness was evaluated in terms of perceptions of seizure controllability, seizure severity, the management of the condition and health-related quality of life measures. RESULTS: A significant decrease in accident and emergency (A&E) visits and ambulance call outs was observed following the psychoeducation group. Young people additionally reported increased knowledge of NES and ability to cope with the condition which was maintained at 6-week follow-up. Significant reduction in NES occurrence or quality of life was not observed. CONCLUSION: Significant reduction in A&E attendance and ambulance use was found following group psychoeducation and improvements in psychosocial functioning and knowledge about NES. Group psychoeducation has the potential to increase child and parental understanding of NES and reduce inappropriate healthcare usage.

Alexithymia in children with medically unexplained symptoms: a systematic review.

OBJECTIVE: Adult research investigating the link between alexithymia and medically unexplained symptoms (MUS) has found a significant relationship between increased alexithymia and MUS. This difficulty in expressing emotions is likely to begin in childhood so the objective of this paper is to present a quantitative review of studies focussing on the association between MUS and alexithymia in children. METHODS: Databases were searched with predefined terms relating to alexithymia and MUS in children (0-17 years). Two reviewers independently assessed abstracts, extracted data and undertook quality analyses. Systematic review methods were used in accordance with Cochrane guidelines. RESULTS: Ten studies met the criteria for inclusion in the review. Seven of the eight studies which focused on a comparison between children with MUS and healthy controls, found higher levels of self-reported alexithymia in the children with MUS. However, in the two studies where children were asked to complete tasks that objectively measure alexithymia, significant differences were not found. Results of studies comparing alexithymia in children with MUS and children with medical/psychiatric controls were inconsistent; there was some evidence of increased anxiety and depression in young people with alexithymia and MUS but inconsistency of measures across studies makes drawing conclusions difficult. CONCLUSION: There is preliminary evidence that children with MUS have significantly higher levels of alexithymia than controls based on self-report measures; however, this finding was not replicated in objective tasks of alexithymia. Future studies should include validated tasks that objectively measure emotion recognition abilities and focus on possible mediating factors such as neurodevelopmental and mental health difficulties.

Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series.

AIM: To describe a cognitive-behavioural treatment and clinical outcomes in a series of children with functional neurological symptoms (FNS). METHOD: Thirty-six children with FNS were assessed and of these twenty-two (13 male, 9 female) with a mean age 14.5 years (SD = 2.6, range 6-17 years) completed treatment with cognitive behaviour therapy embedded in routine child and adolescent clinical/systemic practice. Treatment outcomes were measured at baseline and post-intervention on the Child Global Assessment Scale (CGAS), Strengths and Difficulties Questionnaire (SDQ), Goal Based Outcomes (GBO) and Revised Child Anxiety and Depression Scale (RCADS). RESULTS: Scores on the CGAS improved significantly post-intervention (p < 0.001) with 82% of participants showing reliable change. Individualised goals (GBO) also showed clinically meaningful gains. Standard measures of emotional and behavioural symptoms (SDQ and RCADS) did not correlate well with clinical diagnoses, were usually subthreshold at baseline, and did not show significant improvement post-intervention. INTERPRETATION: The outcome of this pilot study suggests that CBT can be effective in the rehabilitation of young patients with FNS. Detection of common comorbid psychiatric disorders was not assisted by use of standardised measures, although most participants were clinically anxious or depressed. More research is needed to understand why children with FNS and their parents may not endorse mental health symptoms on questionnaires, and to further evaluate interventions within randomised controlled trials.