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A prospective study of children with head injuries: III. Psychiatric sequelae
Insights
Severe head injuries in children significantly increase psychiatric disorder risk. Mild head injuries (less than 1 week post-traumatic amnesia) do not appear to raise this risk, even with pre-existing behavioral issues.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Neuropsychology
Background:
- Head injuries are common in children.
- The long-term psychiatric sequelae of pediatric head trauma require further investigation.
- Understanding the relationship between injury severity and behavioral outcomes is crucial.
Purpose of the Study:
- To prospectively assess the psychiatric outcomes of pediatric head injuries.
- To differentiate the impact of mild versus severe head injuries on behavior.
- To identify factors influencing psychiatric risk post-head injury.
Main Methods:
- Prospective study over 2.25 years involving 3 groups: severe head injury (PTA ≥7 days), mild head injury (1 hr < PTA < 1 week), and matched orthopedic controls.
- Retrospective assessment of pre-accident behavior via parental/teacher reports.
- Psychiatric assessments at 4 months, 1 year, and 2.25 years post-injury.
Main Results:
- Mild head injury group showed pre-existing behavioral disturbance but no increase post-injury.
- Severe head injury group exhibited a marked increase in psychiatric disorders.
- A dose-response relationship between brain injury severity and psychiatric risk was observed.
- Pre-accident behavior, intellectual level, and psychosocial factors influenced psychiatric outcomes in severe head injury cases.
Conclusions:
- Head injuries with post-traumatic amnesia (PTA) less than one week do not significantly increase psychiatric risk in children.
- Severe head injuries causally linked to increased psychiatric disorders, influenced by injury severity and individual child factors.
- Disorders following head injury generally lack specific features, except for social disinhibition and persistence.
Abstract:
A 2 1/4-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with 'severe' head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with 'mild' head injuries resulting in a PTA exceeding 1 hour but less than 1 week. A retrospective assessment of the children's pre-accident behaviour was obtained by parental interview and teacher questionnaire immediately after the accident and before the behavioural sequelae of the injury could be known. Further psychiatric assessments were undertaken 4 months, 1 year and 2 1/4 years after the initial injury. The mild head injury group showed a raised level of behavioural disturbance before the accident but no increase thereafter. It was concluded that head injuries resulting in a PTA of less than 1 week did not appreciably increase the psychiatric risk. By contrast, there was a marked increase in psychiatric disorders following severe head injury. The high rate of new disorders in children with severe head injuries who were without disorder before the accident, together with the finding of a dose-response relationship with the severity of brain injury, indicated a causal relationship. However, the development of psychiatric disorders in children with severe head injuries was also influenced by the children's pre-accident behaviour, their intellectual level, and their psychosocial circumstances. With the exception of social disinhibition and a slight tendency for the disorders to show greater persistence over time, the disorders attributable to head injury showed no specific features.