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Persistent Psychiatric Disorders after Head Injuries in Children

University of Birmingham Department of Experimental Psychiatry and The Uffculme Clinic

ABSTRACT

This study was undertaken to investigate the long-term psychiatric sequelae of head injuries in children. Thirty-one head injured children attending a child psychiatric clinic were compared with 32 children of similar age who had been admitted with head injuries to a surgical ward some years previously. The children from surgical sources had sustained more severe head injuries as judged by the presence of skull fracture, duration of unconsciousness, and neurological sequelae, but, as had been predicted, they showed far less psychiatric disorder than those examined at the child psychiatric clinic. A wide variety of symptoms were encountered but few appeared to be specific or causally related to the head injuries. The fracture site had no clear relationship to subsequent behaviour disorder. The pre-traumatic personality and family setting were far more important for the psychiatric outcome than the nature and severity of the head injury. A generally favourable outcome even after severe head injury in previously well-adjusted children was confirmed, but where children showed evidence of marked emotional disturbance before the accident, the outcome was far less favourable and dependent on the persistence of adverse factors at home. The families of children who showed chronic post-traumatic disorders showed a high incidence of psychiatric disturbances. Accident proneness was twice as frequent in the psychiatric clinic cases, and there was evidence that this was related to emotional disorder. In the management of the psychiatrically disturbed cases the educational aspects were found to be of primary importance and in these cases full psychological investigation and special remedial teaching was an important aspect of treatment.