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resentment because of lost play time; and repeated hospitalisations can
disrupt family interactions.
Prognosis
Is the prognosis for any given psychiatric disorder worse if the child or
adolescent also has a brain disorder? Clinicians and parents often suppose
so, and this pessimism may be self-fulfilling if it leads to inappropriately
low expectations or half-hearted therapy. The evidence is so limited at
present that it is often preferable to work on the more optimistic as-
sumption that the prognosis of the psychiatric disorder is independent of
the presence or absence of coexistent neurological problems. Indeed, the
families of children with brain disorders are often particularly receptive
to professional advice, and may consequently be easier to help than the
average family seen by child mental health services.
Treatment
In general, the psychiatric problems of children with brain disorders
should be treated in just the same ways as the psychiatric problems of
neurologically intact children. Biological treatments are neither more nor
less useful than in ordinary psychiatric practice. However, since anti-
epileptic medication may have behavioural effects, a change in dose
or type can sometimes be helpful. Individual, family, and school-based
treatments can all be useful. Parents are often helped by hearing that
their child’s problems are common consequences of neurological damage:
the energy previously wasted on self-blame can then be diverted into
more profitable channels. Equally, access to a parents’ support group for
children and adolescents with the same disorder can reduce the family’s
sense of isolation and powerlessness. Neuropsychological assessments of
the individual’s cognitive strengths and weaknesses can provide a helpful
basis for advice to the school and education authority. Emotional and
behavioural problems often improve dramatically when unrecognised
learning problems are finally addressed, whether by provision of extra help
in a mainstream school or by transfer to a special school.
Three specific points
1 A variety of rare dementing disorders – such as Sanfilippo syndrome
(a lysosomal storage disease due to an autosomal recessive enzyme defi-
ciency) and subacute sclerosing panencephalitis (a persisting infection of
a resistant measles virus) – present in childhood with loss of established
skills and a variety of additional emotional and behavioural abnormal-
ities. Although the early symptoms of dementia can be mimicked by