Conversion disorder in Australian pediatric practice.
OBJECTIVE
To describe the incidence and clinical features of children presenting to Australian child health specialists with conversion disorder.


METHODS
Active, national surveillance of conversion disorder in children younger than 16 years of age during 2002 and 2003.


RESULTS
A total of 194 children were reported on. The average age was 11.8 years; 23% were younger than 10 years of age. Presentations were complex, with 55% presenting with multiple conversion symptoms. The most common presentations were disturbance of voluntary motor function (64%), sensory symptoms (24%), pseudoseizure (23%), and respiratory problems (14%). Hospital admission was required for 70%, with an average stay of 10.2 days. Antecedent stressors were also reported in 62% and a history of mental health concerns in 42%, with 14% of children taking psychotropic medications for comorbid anxiety or depression. The incidence of conversion disorder in Australian specialist child health practice is estimated to be between 2.3 and 4.2/100,000.


CONCLUSIONS
Conversion disorder is associated with a significant burden for the child, family, and the health system. This study emphasizes the comorbidity with anxiety, depression, and symptoms of pain and fatigue. It also highlights the potential impact of "commonplace" stressors such as family conflict and children's loss of attachment figures.
Kozlowska
Kasia
K
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.. Electronic address: Kasiak@chw.edu.au.
Nunn
Kenneth P
KP
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.
Rose
Donna
D
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.
Morris
Anne
A
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.
Ouvrier
Robert A
RA
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.
Varghese
John
J
Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia.
D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D001927:Brain Diseases / Q000150:complications; D002648:Child; D003291:Conversion Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D015995:Prevalence; D012720:Severity of Illness Index