BEHAVIORAL-MANAGEMENT OF CONVERSION DISORDER IN CHILDREN

Objective: To describe the behavioral management of conversion disorde r in children and to preliminarily assess its effectiveness. Design: R etrospective case series. Setting: Inpatient pediatric rehabilitation unit. Patients: The first eight patients with conversion disorder trea ted on our pediatric rehabilitation unit, between 9 and 18 years of ag e. Six were girls. Three cases are described in detail. Interventions: All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a r eward system was established for good attainment. Some patients had a ''level'' system instituted, with increasing privileges for goal achie vement. All patients and their families had psychological assessment a nd instruction in pain and stress management strategies. Main Outcome Measures: Restoration of normal gait and function, independence in act ivities of daily living (ADL), and symptom recurrence after discharge. Results: All patients attained normal gait and ADL function before di scharge. Conclusions: (1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at time s a behavioral reward or ''level'' system may be necessary for adequat e reinforcement. (2) Instruction of the patient and family in appropri ate stress and pain management appears key to maintaining treatment ef fect over time. (C) 1997 by the American Congress of Rehabilitation Me dicine and the American Academy of Physical Medicine and Rehabilitatio n.