Psychiatric outcome of localized head injury in children

Psychiatric disorders and MND in non-handicapped preterm children. Prevalence and stability from school age into adolescence

In preterm children (N = 66) without major physical and/or mental handicaps the prevalence of psychiatric disorders and minor neurological dysfunction (MND) was assessed at school age (8-10 years). In adolescence (15-17 years) 43 children were reassessed. The study sample was drawn from a cohort of non-handicapped preterm children (N = 218) hospitalised in a Neonatal Intensive Care Unit because of serious neonatal complications. The findings in the preterm group were compared with two control groups (N = 20 and N = 20) matched for age and sex ratio. The association between psychiatric disorders on the one hand and group status (preterm versus control), MND, IQ and family adversity on the other was explored. At both ages the preterm children exhibited more psychiatric disorders and MND than controls. The very preterm and/or very low birth weight children contributed to the differential psychopathological findings between the preterm and control groups. Besides preterm birth, the prevalence of psychiatric disorders was positively associated with MND and negatively associated with VIQ and family adversity. In the preterm group there was a shift from school age into adolescence into a predominance of anxious and depressive disorders. No significant changes with age were found with respect to the prevalence of MND and psychiatric disorders. Thus, very preterm and/or very low birth weight children are at increased risk of persistent psychiatric disorders, especially anxious and depressive disorders. In preterm children the development of psychopathology seems to be mediated by MND, decreased verbal abilities and family adversity.

Sources of unreliability of DSM-III Axis IV

Lists of stressors recorded for 159 adolescents and rated by two judges showed poor agreement on stressor identification but good concordance for the most severe stressor identified for each patient. Good agreement was also found for a short checklist of chronic stressors. When individual stressors were rated by four judges for 27 patients, global Axis IV ratings were largely determined by the rating of the most severe event. Those results suggest that Axis IV can be made more reliable and easier to use by concentrating on the identification of severe events.

Childhood head injuries in Israel: epidemiology and outcome

Results are reported of a regional survey of hospitalized head injuries in Israeli children aged 0-7 years during the period 1970-1976. There were 370 such cases surveyed. Incidence of head injury requiring hospitalization was 1.71/1000 per year. Follow-up examination 4-10 years after injury was achieved in 50 per cent of the cases. Late seizures and focal neurological deficit were rare, while school failure and various neuropsychiatric symptoms were common. Prevalence of seizures and new nervous habits was significantly related to severity of injury, while the prevalence of fears, nightmares, dizziness and school failure was not.

Recovery of intellectual ability after closed head-injury

Seven children with intellectual and personality changes after closed head-injury were followed-up with neuropsychological and psycho-educational evaluations. Two cases are presented in detail. Persistent intellectual changes documented on standardized tests were not always apparent to parents or physicians, and recovery of intellectual abilities lagged behind the disappearance of neurological abnormalities. Some of the children required special class placement for several years after the injury. Personality changes were thought to be secondary to stress on impaired perceptual and cognitive abilities, and the desirability of limiting such stress is emphasized.

Institute of Psychiatry Department of Child and Adolescent Psychiatry

There has been a child psychiatry research group within the Institute of Psychiatry since 1952. At first it constituted a section of the Department of Psychiatry and for a while it formed part of the MRC Social Psychiatry Research Unit. However, in 1973 London University established a Chair of Child Psychiatry and since that time there has been a separate Department of Child and Adolescent Psychiatry. The research in this field undertaken up to 1967 has been described previously (Rutter, 1968a) and the present report brings the account up to date with a summary of work carried out during the last eight years.