It's Not About What They Can or Can't Do — It's About the Load

Think about your teen at home. The environment is familiar. They usually have more control over the noise, the pace, their movement, and who's around them.

Now put that same teen at school. Crowded hallways, constant noise, transitions between classes, tests, social dynamics, teachers, physical movement, trying to pay attention — and on top of all of that, possibly worrying: What if my symptoms get worse in front of everybody?

That's a massive increase in load. A 2022 review of pediatric FND treatment highlights that the school environment is part of the full picture we need to understand. When your teen looks different at school than at home, it tells us something useful.

It doesn't mean school caused the FND. And it doesn't mean your teen can't handle school. It means school is asking more from their brain and body right now — not forever.

School Is Part of Recovery — Not the Finish Line

One of the most common patterns families fall into is waiting for symptoms to disappear before sending their teen back to school. It makes sense on the surface. But what we often see is that this approach actually stalls recovery.

A 2024 paper on FND in the school setting supports continued school participation and reintegration — even while symptoms are still happening — as long as the right plan and support are in place.

This is an important shift. We're not saying "get rid of symptoms first, then return to school." And we're not saying "just push through and figure it out." Neither extreme works.

What does work is helping your teen learn how to get through school even when symptoms show up. That is how recovery skills get built.

Symptoms Are the Smoke, Not the Fire

This is one of the core ideas Dr. Lee teaches families: symptoms are the smoke, not the fire. If we spend all our time trying to stop every symptom, we're chasing smoke — fanning it away without addressing what's underneath.

The bigger issue in FND is the miscommunication between the brain and the body. That's the fire.

When symptoms show up at school and the entire plan becomes make the symptoms go away, we stay focused on the smoke. Instead, the goal is for your teen to learn: I know what to do when this happens. I can use my skills. I can ride this wave and keep moving forward.

Every time your teen has symptoms and still gets through part — or all — of the school day, something powerful is happening underneath. Their brain is learning that these symptoms, while uncomfortable, are not a medical emergency. Over time, the nervous system starts reading symptoms as less dangerous and eases off the high alert.

That process — retraining the brain — is how the fire gets smaller. And when the fire gets smaller, there's less smoke.

Four Questions to Ask When Symptoms Increase at School

When symptoms flare at school, you don't want everyone making a new decision in the middle of every episode. You want a clear plan. Here are four questions to help you build one:

1. Does your teen know what to do? Do they have a regulation tool, a reset strategy, or a break plan?

2. Does the teacher know what to do? Are they aware of the plan and their role in it?

3. Does the school nurse know what to do? Is there consistency in how flares are handled?

4. Do you know when you need to get involved? Clear boundaries prevent everyone from defaulting to "come pick them up" every time.

The specifics will look different for every family. But the goal stays the same: help your teen get through the day despite symptoms, instead of letting symptoms dictate the entire day.

"Harder Right Now" vs. "Cannot Function"

If your teen seems okay at home but symptoms get worse at school, get curious. Ask yourself what's adding to the load. Is it noise? Transitions? Academic pressure? Social stress? Not knowing what their body will do in front of other people?

You don't have to remove everything — that defeats the purpose. What you want to figure out is where your teen needs more skills, more practice, or a clearer plan.

Because there's a big difference between school is harder for my teen right now and my teen cannot function at school. Those are completely different things — and the path forward depends on recognizing which one you're actually dealing with.

Moving Forward

Every time your teen gets through a hard moment, uses a skill, and keeps going, they're learning how to ride the wave. Over time, the brain starts learning that symptoms are not a medical emergency. That helps create a stronger sense of safety in the body.

That's when we stop chasing the smoke and start working on the actual fire — the miscommunication between brain and body. As the fire gets smaller, the smoke gets smaller too.

If you want help applying these principles and building a clear, structured plan for your family, visit teenfndacademy.com to learn more about Dr. Lee's program and see if it's a good fit for your family.

References

• Borner, K. B., & Laptook, R. S. (2024). Supporting children and adolescents with functional neurological disorder in the school setting. Rhode Island Medical Journal, 107(11), 29–33.

• Vassilopoulos, A., Mohammad, S., Dure, L., Kozlowska, K., & Fobian, A. D. (2022). Treatment approaches for functional neurological disorders in children. Current Treatment Options in Neurology, 24, 77–97. View study