Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments.
- functional neurological disorder
- speech therapy
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Contributors LM, JS and AC developed the concept of the paper and together with JB defined the scope and assembled a group of expert coauthors. All authors contributed materially and substantially to a detailed online survey establishing the content of the manuscript, attended a zoom meeting for discussion of issues arising, and contributed to multiple subsequent rounds of comments and revision as per the methods described in the paper. LM coordinated this process. JB wrote the initial draft, which was sequentially revised by LM and JB as per this process. JS revised the long version to produce an abbreviated version to submit for print publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests LM is funded by a University of Edinburgh Clinical Research Fellowship funded philanthropically by Baillie Gifford. LM provides independent medical testimony in court cases regarding patients with functional disorders. AC is a director of a limited personal services company that provides independent medical testimony in Court Cases on a range of neuropsychiatric topics on a 50% pursuer 50% defender basis, is an associate editor of the Journal of Neurology Neurosurgery and Psychiatry, and is the treasurer of the International Functional Neurological Disorder Society. JS reports personal fees from UptoDate, outside the submitted work, runs a self help website for patients with functional neurological symptoms (www.neurosymptoms.org) which is free and has no advertising, provides independent medical testimony in personal injury and negligence cases regarding patients with functional disorders, and is secretary of the International Functional Neurological Disorder Society. JS is a Chief Scientists Office NHS Research Scotland Career Researcher.
Provenance and peer review Not commissioned; externally peer reviewed.
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