Abstracts

RATIONALE: NES have not been extensively studied in children. Wyllie et al., 1999 described psychiatric features of 34 children and adolescents with NES. All were found to have conversion disorder and no NES were due to malingering or factitious disorder. 5 had comorbid attention deficit/hyperactivity disorder (ADHD) and 1 oppositional defiant disorder (ODD). METHODS: The records and video EEG studies of 2 children with intentional NES were reviewed with consideration given to classification by DSM-IV criteria for conversion reaction, malingering, factitious disorder, and ODD. Conversion disorder with seizures or convulsions requires that the latter are "not intentionally produced or feigned." Malingering involves intentional production of physical or psychological symptoms motivated by a clear external reward. Factitious disorder involves intentional production of physical or psychological symptoms motivated by the desire "to assume the sick role" and the absence of external reward. According to DSM-IV, ODD is "a pattern of negativistic, hostile, and defiant behavior of at least 6 months'duration" that meets specific criteria. RESULTS: A 6 year old girl with a history of complex partial seizures, generalized tonic-clonic seizures, ADHD,and ODD underwent video EEG monitoring for staring spells intractable to sodium valproate. The patient had 2 episodes of staring and lack of response to tactile and verbal stimulation. When the mother turned her back in order to press the event button, the patient smiled. An 11 year old boy with a history of ADHD, ODD, and previous generalized tonic-clonic seizures had several spells recorded during video EEG. He smiled behind his hand and made purposeful movements at times despite staring and not responding to his mother's verbal entreaties. Ictal EEG was normal in both children. CONCLUSIONS: The intentional lack of responsiveness during the 2 children's events most closely fits the condition of ODD. Lack of obvious external reward and assumption of the sick role rule out malingering and factitious disorder. These 2 cases suggest that the differential diagnosis of childhood NES should be expanded to include ODD.