Functional Movement Disorder
Functional Movement Disorder
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Functional Movement Disorder

Authors: Jamie Klein; Kathryn Elkins, MD  
Emory University School of Medicine

Jamika L. Hallman-Cooper, MD
Children’s Healthcare of Atlanta 

Reviewed: July 2021


In functional movement disorder (FMD), a child has abnormal, involuntary body movements.  FMD movements are not caused by something physically wrong with a patient’s brain, spinal cord, or muscles. There may or may not be a psychological cause present. FMD is also known as psychogenic movement disorder and falls under the umbrella of “functional neurological disorders.” 

There are three common abnormal movements that appear in FMD. The first is tremor, or shaking. The second is dystonia. Dystonia appears as spasms, abnormal posture, or twisting of arms and legs, torso, head, or combination of different body parts. The third is myoclonus. Myoclonus appears as jerky limb or trunk movements. FMD can also include tics, speech problems, and more.  

Physical exams, neuroimaging, and laboratory data usually do not explain FMD symptoms. The cause of the movements is not clear. Sometimes, they seem to be a reaction to stress. However, stressful events do not need to be present for a child to have FMD. 

Several features can point to a FMD diagnosis. 

Three are the most common: 

  1. An abrupt onset of symptoms 
  2. Symptoms that disappear when the patient is distracted 
  3. A combination of several symptoms not typically seen together when symptoms come from a physical cause 
Functional Movement Disorder


Disorder Overview


Children with FMD have unusual movements. These movements may intensify when focus is on the patient’s symptoms and may go away when the patient is distracted.  Patients with this disorder are usually not at risk for serious injury due to the movements; however, falls can happen. Children with FMD may have other symptoms other than unusual movements such as transient speech difficulties that cannot be explained by a physical cause. Laboratory data, neuroimaging, and other tests are usually normal in patients with FMD, and they do not explain the symptoms. 

Stress is thought to play a large role in FMD. FMD may be a severe reaction to stress. Everyone experiences stress. Many people have physical reactions to stress. Common reactions include an upset stomach or sweaty palms. However, those with FMD have more exaggerated stress reactions.  


Diagnosing Functional Movement Disorder  

FMD is diagnosed by the presence of several features. These features might be noted in a patient’s story or in a physical exam. 

They include: 

Sudden onset

The child’s symptoms or dysfunctions begin suddenly. 

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Rapid progression

Symptoms progress rapidly. A child’s functional status quickly transitions from normal to abnormal.

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child’s symptoms disappear when focusing on other tasks. 

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Attention-dependent symptoms

Symptoms get worse when someone focuses on them. 

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Episodic history

There have been periods of remission in the child’s symptoms.

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Unusual movement patterns

Movement patterns are inconsistent with a typical neurologic disease. 

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La belle indifference

A child may seem unconcerned about the disorder when describing it. La belle indifference is a lack of emotional distress when talking about concerning symptoms. 

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Functional Movement Disorder 1

Symptoms of Functional Movement Disorder 

The physical symptoms of FMD consist of abnormal body movements. A variety of movements are common in FMD.

These include: 


A shaking movement most often affecting the hands. 

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A state of abnormal muscle tone. It can result in muscular spasm, abnormal posture, or twisting. 

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A spasmodic jerky contraction of groups of muscles.

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Gait disturbance

A difficulty walking or balancing.

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Sudden and repeated movements. It can be something simple like frequent eye blinking or more complex movements that occur frequently. People can also have vocal tics with grunting, humming, or saying words.  

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Difficulty speaking

Inconsistent stuttering or speech difficultiesUsually if a person has difficulty speaking from a physical cause, the speech issues do not change over a short amount of time. These changes in speech may last for short periods of time and patterns may change quickly. It is important to note that some neurologic conditions, including transient ischemic attacks (TIAs) which is a precursor to stroke, may also present with intermittent speech difficulties; these difficulties are more commonly slurred speech and often associated with weakness on one side of the body 

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A loss of control over a muscle or muscle group. 

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The causes of FMD movements are poorly understood. However, they may be triggered by stressors. These stressors can be physical or psychological in nature. 

Stressors may include: 

  • Physical injury 
  • Infection 
  • Surgery 
  • Depression or anxiety in a child or parent 
  • School-related problems, such as bullying or missing school 
  • Parental conflict (parents fighting, divorce, etc.) 
  • Domestic violence 
  • Sexual abuse 
  • Death of a loved one 
  • Participation in competitive sports or dance 

Something stressful to the patient may not seem significant to others. The family or doctor may not think the stressor is significant. In some cases, no significant stressor is identified at all. 

It is hard to say why FMD occurs in some children and not others.  

Spinal Muscular Atrophy 1


Sometimes, a clinician uses laboratory investigations and neuroimaging to confirm a diagnosis. This is not always necessary. However, FMD is further supported when other test results are normal. These tests can rule out other diseases

Testing methods include: 


Magnetic resonance imaging (MRI) is a common form of imaging. It can look for structural or nerve problems in the brain. 

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Blood work

Blood tests can rule out thyroid, kidney, or liver problems that may cause abnormal movements. 

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Electroencephalogram (EEG)

An EEG can look at electrical activity in the brain, and it is used to test for seizures as cause for the movements 

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Electromyogram (EMG)

An EMG can look at the health of muscles and nerves 

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The goal of treatment is to restore normal movement and function. Identifying a stressor can be helpful. Developing skills to cope with stress can be helpful, too. Therapy may be needed to treat FMD.

Treating FMD is multidisciplinary and may involve: 

  • Neurologists 
  • Psychiatrists 
  • Psychologists 
  • Physical therapists 
  • Occupational therapists 
  • Speech-language pathologists 

There is usually no medication used to treat FMD movements. However, there are exceptions. Sometimes a patient suffers from another mental health disorder. Anxiety and depression are common examples. These disorders can contribute to FMD. When they do, a patient may be offered medication. Families and treatment teams usually discuss medication decisions together.  

When a patient is diagnosed with FMD, it is very important that their support system agrees with the diagnosis and therapies. This support system may include parents, guardians, siblings, and friends. 

The duration of a FMD treatment is different from patient to patient. It often depends on how the patient responds to the treatment. 

Functional Movement Disorder 2


What Is the Prognosis of Functional Movement Disorder?

The prognosis of FMD is generally good with treatment. Still, the success of treatment varies. It is more successful when the time between when symptom onset and treatment is shorter.

Features that signal a better prognosis: 

  • Onset in childhood 
  • Earlier diagnosis 
  • Depression or anxiety also diagnosed 
  • Stressors are eliminated 

Features that signal a worse prognosis: 

  • Onset at older age 
  • Delayed diagnosis 
  • Longer duration of symptoms 

Children with FMD typically lead normal lives as older children and adults. It is possible to cure this disorder.

Functional Movement Disorder 3



Functional Neurological Disorder 
The Functional Neurological Disorder private Facebook group is an international group whose mission is to help patients with functional neurological disorder (FND) get support. The group of almost 10,000 includes family members and caregivers. They host support subgroups for professionals, caregivers, the USA, and Canada who are living with FND. Since children are increasingly being diagnosed with this disorder, parents/guardian/caregiver are encouraged to join the private online communities. 

Functional Neurological Disorder (FND) — A Patient’s Guide to FND 
The Functional Neurological Disorder (FND) — A Patient’s Guide to FND, is a self-help website for patients with FND. The website, originally created in 2009 by Professor Jon Stone, a neurologist with a special interest in these problems, aims to give a better understanding of these symptoms. The updated, comprehensive website includes a list of symptomscausestreatment, videos, and fact sheets for FND. 


JCN: Functional Neurological Disorders
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). Dr. Christy talks with Dara Albert, DO, pediatric epileptologist, associate professor and medical director of the multi-disciplinary Psychogenic Non-epileptic Events Clinic at Nationwide Children’s Hospital talks about the presentation, work-up, diagnosis and treatment of functional neurological disorders.

Childhood Stroke 1

Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 

Research for Functional Movement Disorder are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently. is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.  

Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits. 

Family Stories

On the Functional Neurological Disorder (FND) — A Patient’s Guide to FND website, patients have written their own stories and have kindly agreed to let them appear in the hope that they can help others understand their own symptoms. The main Personal Stories page, groups the stories by main symptoms and includes a Functional Movement Disorders section.  

The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only.  CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. 


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Galli S, Béreau M, Magnin E, Moulin T, Aybek S. Functional movement disorders. Rev Neurol (Paris). 2020 May;176(4):244-251. doi: 10.1016/j.neurol.2019.08.007. Epub 2019 Oct 9. PMID: 31606137.

Harris SR. Psychogenic movement disorders in children and adolescents: An update. European Journal of Pediatrics. 2019 Apr 1;178(4):581–5.

Hinson VK, Haren WB. Psychogenic movement disorders. The Lancet Neurology. 2006 Aug;5(8):695–700.

Thenganatt MA, Jankovic J. Psychogenic movement disorders. Neurologic Clinics. 2015 Feb;33(1):205–24.

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