Child and Adolescent Psychiatry

Brain Disorders 243

purely psychosocial problems (such as sexual abuse), a dementing disor-
der should be considered in any child who presents with loss of skills. A
full physical examination is mandatory, and special investigations may
be indicated. The presence of psychosocial stressors does not rule out an
organic disorder. For example, a child who has been sexually abused, or
who has a drug-abusing mother, may also (and not coincidentally) have
HIV encephalopathy.
2 Frontal lobe seizures are easily misdiagnosed as pseudoseizures: move-
ments, postures and vocalisations may be bizarre; episodes may be brief;
the termination may be abrupt with prompt return to responsiveness;
and ordinary EEGs may be unhelpful. Combined video and EEG moni-
toring can be extremely useful.
3 It is not yet clear if mild head injuries (which are very common in
childhood) have adverse psychiatric consequences. It is clear, however,
that serious cognitive and psychiatric sequelae are common after severe
head injuries, for example, after closed head injuries resulting in at least
two weeks of post-traumatic amnesia. Roughly half of the survivors of
severe head injuries develop psychiatric disorders, particularly if they
had minor emotional or behavioural problems prior to the head injury,
or if they are exposed to psychosocial adversities such as maternal de-
pression or overcrowding. The risk of psychiatric disorder is not related
to age, gender or locus of injury. Though the psychiatric disorders that
follow severe head injury mostly involve the sorts of emotional and
behavioural problems that dominate ordinary child psychiatric practice,
severe closed head injury sometimes results in a distinctive syndrome of
social disinhibition (resembling the adult ‘frontal lobe syndrome’).

Subject review

Harris J. (2008) Brain disorders and their effect on psychopathology.In:
Rutter Met al.(eds)Rutter’s Child and Adolescent Psychiatry,5thedn.
Wiley-Blackwell, Chichester, pp. 459–473.

Further reading

Goodman R, Yude C. (2000) Emotional, behavioural and social conse-
quences.In: Neville B, Goodman R (eds)Congenital Hemiplegia: Clinics in
Developmental Medicine. No. 150, Mac Keith Press, London, pp. 166–178.
Rutter M et al. (1970)A Neuropsychiatric Study in Childhood: Clinics in
Developmental Medicine. No. 35/36. SIMP/Heinemann, London.
Rutter Met al.(1983) Head injury. In: Rutter M. (ed.)Developmental
Neuropsychiatry. Guilford Press, New York, pp. 83–111.