Behavioural profiles of children and adolescents after pre- or perinatal unilateral brain damage
D A Trauner1, R Nass, A Ballantyne
1Department of Neurosciences, UCSD School of Medicine, La Jolla, California 92093-0935, USA. dtrauner@ucsd.edu
Insights
Early focal brain damage in children did not lead to significant behavioral or emotional problems. This suggests other factors may influence brain-behavior relationships in development.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Case reports suggested early prefrontal cortex damage may impair social behavior and moral reasoning.
- The impact of early focal brain insults on childhood behavioral and emotional problems requires further investigation.
Purpose of the Study:
- To determine if early focal brain damage in children results in clinically significant behavioral or emotional problems.
- To compare behavioral outcomes between children with unilateral brain lesions and controls.
Main Methods:
- A cohort of 39 children with pre- or perinatal-onset unilateral brain damage (focal lesion) was studied.
- The Achenbach Child Behavior Checklist assessed behavioral and emotional difficulties.
- Analyses compared focal lesion groups (left vs. right hemisphere, frontal vs. non-frontal) with 54 control children, controlling for IQ.
Main Results:
- No significant differences in behavioral or emotional problems were found between children with focal brain lesions and controls.
- Left hemisphere lesions were present in two-thirds of subjects, right hemisphere in one-third.
- Even with frontal lobe involvement, no clinically significant behavioral or emotional problems were observed.
Conclusions:
- Early focal brain damage, including in the frontal lobe, did not result in clinically significant behavioral or emotional problems in this cohort.
- More extensive or bilateral brain damage may pose a higher risk.
- Future studies should consider multifactorial causes (genetic, environmental, toxins) when examining brain-behavior relationships.
Abstract:
Recent case reports of individuals with early-onset damage to the prefrontal cortex have suggested that such early insults could result in severely impaired social behaviour in later childhood and adolescence. The investigators speculated that the acquisition of complex social conventions and moral rules had been impaired. In a large cohort of children, we sought to determine whether early focal brain insults might result in clinically significant behavioural or emotional problems. This study reports on 39 children with pre- or perinatal-onset unilateral brain damage (focal lesion) from cerebral infarction or intraparenchymal haemorrhage, using the Achenbach Child Behavior Checklist to assess the presence or absence of behavioural and emotional difficulties. Two-thirds of the subjects had left hemisphere (LH) lesions and one-third had right hemisphere (RH) lesions. Age range was 4.0-15.4 years at the time of questionnaire completion. Their results were compared with those of 54 control children. Analyses were conducted on focal lesion versus controls, RH versus LH lesion, frontal versus non-frontal lesion, and seizure versus non-seizure groups. When the effect of IQ was partialled out, there were no significant differences on the nine Behavior Problem scales, the Internalizing-Externalizing dichotomy or the Total Problem score for any of the group comparisons. Our subjects showed no evidence of clinically significant behavioural or emotional problems, even when the frontal lobe was involved. Individuals with more extensive and bilateral damage may be at higher risk of significant behavioural and emotional dysfunction than were those in our study population. In future studies of brain-behaviour relationships in developing children, all potential causes for any observed behavioural abnormalities, such as genetic and environmental factors and toxin exposure, must be considered before concluding that specific anatomical lesions are causally related to specific behavioural outcomes.
