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Updated: Jan 30, 2026
Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Clinical Features of Disorders of Consciousness in Young Children
Gabrielle Alvarez1, Stacy J Suskauer2, Beth Slomine3
1Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia.
Insights
This study on pediatric brain injury found that visual and motor skills are key for assessing consciousness levels in young children. Many children improved from vegetative state (VS) to minimally conscious state (MCS), but none improved directly from VS to conscious state (CS).
Area of Science:
- Pediatric Neurology
- Neurorehabilitation
- Developmental Neuroscience
Background:
- Disorders of Consciousness (DOC) in young children following brain injury present unique diagnostic and prognostic challenges.
- Established guidelines for assessing consciousness levels (conscious state [CS], minimally conscious state [MCS], vegetative state [VS]) require adaptation for pediatric populations.
- Understanding the recovery trajectory in children with DOC is crucial for guiding clinical care and rehabilitation strategies.
Purpose of the Study:
- To investigate the behavioral and demographic features associated with different levels of consciousness (CS, MCS, VS) in young children with brain injury.
- To examine the course of recovery and emergence from disorders of consciousness in this pediatric cohort.
- To identify the most relevant assessment tools for consciousness in very young children.
Main Methods:
- Retrospective chart review and post hoc analysis of 54 children (6 months to 5 years) admitted to a pediatric inpatient rehabilitation unit.
- Behavioral features and levels of consciousness (CS, MCS, VS) were abstracted at admission and discharge based on Aspen Neurobehavioral Conference Workgroup guidelines.
- Data analysis focused on demographic factors, observed behaviors, and changes in consciousness state over the rehabilitation period.
Main Results:
- Children in MCS were younger than those in CS. Commonly observed behaviors in VS included motor posturing and startle responses, while MCS featured contingent affect and visual pursuit.
- No children in MCS demonstrated command following or intelligible speech. All children in CS exhibited functional object use.
- Significant recovery was observed: over half of children in VS improved to MCS, and a third progressed from MCS to CS. No child transitioned directly from VS to CS.
Conclusions:
- Visual and motor skills appear most pertinent for assessing disorders of consciousness in very young children, whereas language-based skills may be less reliable.
- Accurate classification of consciousness levels holds significant prognostic value for children with brain injury.
- Further research is essential to develop refined guidelines for the assessment of disorders of consciousness in this vulnerable pediatric population.
Objectives:
To investigate behavioral and demographic features of levels of consciousness in young children with brain injury, including the classifications of consciousness: conscious state (CS), minimally conscious state (MCS), and vegetative state (VS), and to investigate the course of recovery in children with disorders of consciousness (DOC).
Design:
Retrospective chart review and post hoc analysis.
Setting:
Pediatric inpatient rehabilitation unit.
Participants:
Children aged 6 months to 5 years (N=54) admitted for inpatient rehabilitation directly from an acute care hospital following new neurologic injury from 2011 to 2016.
Interventions:
Not applicable.
Main Outcome Measures:
Clinically abstracted behavioral features of DOC and levels of consciousness at admission and discharge, based on established guidelines from the Aspen Neurobehavioral Conference Workgroup.
Results:
Children in MCS were younger than children in CS. Commonly observed behaviors in children in VS were mouth movements or vocalizations, flexion withdrawal or motor posturing, visual or auditory startle, and localization to sound. Common features of MCS were contingent affect, visual fixation or pursuit, automatic motor behavior, and contingent communicative intent. No children in MCS showed command following or intelligible verbalizations. All children in CS showed functional object use, while functional communication was observed in a subset. By discharge, more than half of children in VS emerged to MCS, and a third emerged from MCS to CS. No child emerged from VS to CS.
Conclusions:
Visual and motor skills may be most applicable, and language-based skills may be least applicable for the assessment of DOC in very young children. Accurate classifications of consciousness may have important prognostic implications, and additional research is needed to develop clear guidelines for assessment of DOC in this population.
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