The neurologist’s and child psychiatrist’s perspectives of the diagnosis and treatment of pediatric nonepileptic seizures (NES) were discussed at a multidisciplinary workshop sponsored by the National Institutes of Neurological Disorders and Stroke and of Mental Health, and the American Epilepsy Society, May 2005. The term ‘psychogenic’ was avoided, since this might be considered prematurely dismissive of possible biological disorders. Childhood paroxysmal “spells,” from a neurologist’s perspective, have a broad differential diagnosis, and require video EEG, MRI, cardiology evaluation, and various laboratory tests to exclude an organic cause. Events that occur in stressful social situations are suggestive of NES, whereas those occurring during sleep are suggestive of sleep-related events or epileptic seizures. The diagnosis is determined by exclusion and negative video-telemetry and by evidence for an underlying conversion disorder. Alexithymia (difficulty talking about negative feelings), and presence of conflict (eg. school difficulties, social, and family problems) should be elicited by interviewing the child and parents, sometimes separately. Parents often minimize the child’s psychological problems and are convinced of an “organic” cause for the symptoms. Clinician acumen and sensitivity are essential to elicit stressors and coping style of the child and to penetrate a denial barrier of a parent. A clinician’s explanation and understanding of the impact of stress on the patient’s symptoms is a helpful technique in gaining the family confidence. Initial feedback is presented first to the parent and then the child. The word ‘seizure’ is avoided and is replaced by ‘episode’ and ‘event’. Multidisciplinary management is emphasized, including the child’s school staff. 
COMMENT. The management of non-epileptic paroxysmal “spells” (NES) in a child with a conversion disorder is difficult, and requires the skill of an experienced and understanding clinician. To inform the parent and child that the symptoms are ‘psychogenic’ will lose their confidence and trust and will probably exacerbate the disorder. The acceptance of the symptoms as real, however unconvincing, and the exclusion of an organic etiology is the first responsibility of the neurologist. NES are often associated with epileptic seizures, compounding the difficulties in differentiation. A behavioral approach to reduce the reinforcement the patient receives during a NES or event at home or school, if introduced promptly, may prevent escalation of symptoms and the need for psychiatric admission. As advised by the panel, a supportive, calm, and reassuring stance is required in dealing with the patient and parent during an episode or event.