240 Chapter 29
Table 29.1Isle of Wight Neuropsychiatric Study
Children with
Percentage with at least one
psychiatric disorderNo physical disorder 7
Physical disorder not affecting the brain 12
Idiopathic epilepsy 29
Cerebral palsy and allied disorders (IQ over 50) 44
Source:Rutteret al.(1970).
An extremely powerful risk factor
When present, overt brain disorders are powerful risk factors for child
psychiatric problems, having an impact that is much greater than other
physical disorders. This is well illustrated by epidemiological data from
the Isle of Wight neuropsychiatric study (see Table 29.1). The particularly
high rate of psychiatric problems associated with cerebral damage cannot
be explained simply by the degree of disability or stigmatisation; there is
convincing evidence of direct brain–behaviour links as well. It is striking,
for example, that over half of a large epidemiological sample of children
with hemiplegic cerebral palsy had psychiatric disorders, despite the fact
that the physical disability was typically mild and that most children were
of normal intelligence and attending mainstream schools. Another illustra-
tion of the importance of neurological factors is that in an epidemiological
survey of British child and adolescent mental health (described in more
detail in Box 3.1), individuals with neurodevelopmental problems made
up just 3% of the general population, but accounted for 15% of psychiatric
disorders.
At risk for which psychiatric disorders?
As a first approximation, the psychiatric problems of children and ado-
lescents with brain disorders are similar to the psychiatric problems of
children and adolescents without neurological problems: behavioural and
emotional disorders are the commonest mental health problems in both
groups. There is no single ‘brain damage syndrome’. Moving beyond this
first approximation, there are some differences in emphasis. Though all
psychiatric disorders are more common in children and adolescents with
neurological problems, autistic spectrum and ADHD disorders seem to be
particularly over-represented. For example, in the Isle of Wight study,
hyperkinesis (severe ADHD) accounted for 19% of psychiatric disorders
among children with cerebral palsy, but only 1% of psychiatric disorders
among neurologically intact children.
Parents and teachers frequently comment on the oppositionality and
irritability of children and adolescents with brain disorders. Although