CHAPTER 29
Brain Disorders
The preceding chapter considered the psychiatric complications associated
with intellectual disability, with and without known brain disorders.
This chapter is primarily concerned with the psychiatric effects of brain
disorders on individuals who do not also have an intellectual disability.
A relatively rare risk factor
Unequivocal brain disorders are relatively rare in childhood, for example,
about 0.5% of children have epilepsy and 0.2% have cerebral palsy.
Current evidence suggests that these brain disorders are usually due not
to perinatal complications, as used to be thought, but to genetic factors,
prenatal insults and post-natal insults.
There is only very limited support for the notion of a ‘continuum
of reproductive casualty’. This theory suggests that severe obstetric and
neonatal complications can result in death, cerebral palsy or intellec-
tual disability, whereas mild obstetric complications more often result in
ADHD, specific learning problems or clumsiness – a constellation some-
times referred to as ‘minimal brain damage’. Since children from socially
disadvantaged backgrounds are more likely to have experienced obstetric
and neonatal complications, it is essential to adjust for social background
when investigating the possible impact of these complications. Having
done so, most studies suggest that obstetric and neonatal complications
rarely, if ever, cause psychiatric problems in children who do not have
overt brain disorders. One exception to this rule is an increase in concen-
tration difficulties and perhaps social difficulties in neurologically intact
children who were born weighing less than 1500g, usually as a result
of marked prematurity. These very premature children are vulnerable to
periventricular white matter damage that can lead to attentional problems
in the absence of overt neurological difficulties – an effect that is probably
only partly explained by a lowering of average IQ.
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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