Post-concussion syndrome. Brain damage, constitutional characteristics and environmental reactions

A 9-year-old boy was referred for child-psychiatric examination because of failure in school, restlessness, impulsiveness and concentration difficulties. The symptomatology was ascribed to a previous severe head injury and defined as a post-concussion syndrome. During the examination it was found that he had an identical twin brother without a history of brain-damage. A comparison of the patient and his twin brother with the same examination methods at the age of 9 and 18 gave similar results. These indicate that factors other than brain damage also could explain a clinical picture with school failure, restlessness, impulsiveness and concentration difficulties in a schoolboy. The question arises whether a clinical picture of this kind are the symptoms of stress among vulnerable boys in reaction to excessive demands from their psychosocial environment.