#7182 A pilot study evaluating the outcomes of a therapeutic neuropsychiatry assessment for paediatric functional symptoms at great Ormond street hospital (GOSH)

<h3>Objectives</h3> There is a huge shortage of specialised services available to patients with functional neurological disorder (FND). This is even more stark in the paediatric population. Young people with FND often have a high degree of morbidity, poor quality of life and comorbid mental health conditions. Our aim was to perform a service evaluation for a pilot CAMHS FND therapeutic assessment clinic at GOSH. We aimed to establish the demand for the service and investigate the benefit to outcomes from a one-off neuropsychiatric consultation. <h3>Methods</h3> A non-randomised pilot study was conducted for patients with FND referred within GOSH between May 2022-Oct 2023. Accepted patients received a one-off outpatient MDT clinic consultation with a CAMHS psychiatrist, neurologist, physiotherapist and OT to discuss FND symptoms and background history. Level of functioning was scored using the Children’s Global Assessment Scale (CGAS). Clinicians provided psychoeducation, devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. Follow-up data was collected using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Interviewers collected information about FND symptoms and daily activities, and assigned CGAS scores (raters were blinded to CGAS scores at assessment). <h3>Results</h3> 20 patients diagnosed with FND were seen in the pilot clinic, presenting with a range of functional syndromes. The mean age was 12, Male to Female ratio was 1:4. Comorbid psychiatric diagnoses were ADHD (6); ASD (6); Anxiety (3); Depression &amp; Anxiety (2); PTSD (2). 14 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5). They were very dissatisfied with follow-up care (median score 1.5). The mean improvement in CGAS scores at follow-up was 5.3. 5 referrals had been rejected by CAMHS, 3 patients were awaiting assessment, 3 patients had brief intervention through CAMHS and were now discharged, only 1 patient remained open to a CAMHS team. 3 families had sought private support. <h3>Conclusions</h3> Families felt the pilot FND clinic was helpful. However, their negative experience of follow-up highlights an area of unmet need. Patients who struggled to access support from CAMHS/school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning. Further provision of specialist neuropsychiatric services and improved liaison with local CAMHS would benefit outcomes and reduce morbidity-cost for young people with FND.