Abstracts

Rationale: This paper introduces a clinical psychology approach to the diagnosis and management of paediatric NES. The consensus position is that Video EEG monitoring is the gold standard. As neurologists rule out epileptic seizures, patients and families need help to shift from using somatic symptoms to express psychological distress. Traditional psychological approaches access the child’s cognitive and personality functioning via objective tests and questionnaires that require verbal contributions. NES Somatoform children have excessive emotional turmoil but are unable to express it verbally. If the psychological issues are not being addressed, the patient will continue to have NES and unnecessarily use hospital resources. Methods: The BCCH team in British Columbia has developed a battery of projective techniques to tap into the child’s unconscious to facilitate access to underlying conflicts to rule in NES. This directly fosters emotional expression and helps parents understand and manage the condition. This battery of tests has evolved from 15 years of clinical experience and the tools include the use of drawings, imagery and buttons to access the child’s level of maturity, integration, perception of the internal and external world, coping, trauma, ego functioning and family relations. These were described in a previous paper by our team (Ho, Ransby, Farrell, Connolly & Thornton, 2000). In this paper, 46 charts and the ratings of the clinician were reviewed and results demonstrated an increased affect availability and cognitive awareness of the psychological issues and the mind-body connections (p <.0001). The same team studied and found the instruments to be sensitive to pre-post treatment differences using blind raters (Krawczyk et al, 2005). In this study, 37 NES from 6 to 17 years’ charts were reviewed and the pre- and post treatment projective drawings were scored by blind raters. The raters were effective in discriminating the pre- from the post treatment drawings and after the treatment 86% of patients showed complete remission with a significant decrease in the intensity and frequency of NES symptoms for all. Results: Recently we have added the traditional Rorschach (Exner Scoring) to our battery and have found that it is effective in distinguishing affective processing and coping ability in 8 children of siblings and NES patient-pairs with the latter group being much less expressive pre treatment. For example, there were comparable rates of depression in both siblings and patients (DEPI Rorschach Index) but 100% of NES patients were processing affect differently than their sibling controls. The latter finding is comparable to Shapiro and Rosenfeld (1987) when comparing Conversion Disorder patients with Rorschach age norms. Conclusions: We will deliver a slide presentation of the battery of tests for ruling in NES and the related findings (Krawczyk et al, 2005) with photographs of pre and post drawings. We would provide the audience an experiential session to rate the pre and post artwork. Results strongly indicate that this battery of tests is effective in the diagnosis of NES by inclusion.