Gooch J L, Wolcott R, Speed J
Department of Physical Medicine and Rehabilitation, Primary Children's Medical Center, Salt Lake City, UT, USA.
Arch Phys Med Rehabil. 1997 Mar;78(3):264-8. doi: 10.1016/s0003-9993(97)90031-9.
To describe the behavioral management of conversion disorder in children and to preliminarily assess its effectiveness.
Retrospective case series.
Inpatient pediatric rehabilitation unit.
The first eight patients with conversion disorder treated on our pediatric rehabilitation unit, between 9 and 18 years of age. Six were girls. Three cases are described in detail.
All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a reward system was established for good attainment. Some patients had a "level" system instituted, with increasing privileges for goal achievement. All patients and their families had psychological assessment and instruction in pain and stress management strategies.
Restoration of normal gait and function, independence in activities of daily living (ADL), and symptom recurrence after discharge.
All patients attained normal gait and ADL function before discharge.
(1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at times a behavioral reward or "level" system may be necessary for adequate reinforcement. (2) Instruction of the patient and family in appropriate stress and pain management appears key to maintaining treatment effect over time.
描述儿童转换障碍的行为管理并初步评估其有效性。
回顾性病例系列。
儿科康复住院部。
在我们儿科康复住院部接受治疗的前8例转换障碍患者，年龄在9至18岁之间。6例为女孩。详细描述了3例病例。
所有患者均作为住院患者接受治疗，采用行为疗法。识别出对疾病行为的无意强化，并建立了良好表现的奖励系统。部分患者设立了“等级”制度，根据目标达成情况给予更多特权。所有患者及其家属均接受了心理评估以及疼痛和压力管理策略指导。
恢复正常步态和功能、日常生活活动（ADL）的独立性以及出院后症状复发情况。
所有患者在出院前均恢复了正常步态和ADL功能。
（1）儿童转换障碍的行为管理似乎与成人一样有效，尽管有时可能需要行为奖励或“等级”制度来进行充分强化。（2）指导患者及其家属进行适当的压力和疼痛管理似乎是长期维持治疗效果的关键。
