Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-02T20:57:20.876Z Has data issue: false hasContentIssue false
  • English
  • Français

A prospective study of children with head injuries: II. Cognitive sequelae

Published online by Cambridge University Press:  09 July 2009

Oliver Chadwick ,
Michael Rutter ,
Gillian Brown ,
David Shaffer  and
Michael Traub
Get access Rights & Permissions [Opens in a new window]

Synopsis

A 2¼-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. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2¼ years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a ‘dose—response’ relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing in the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

Type
Research Article
Information
Psychological Medicine , Volume 11 , Issue 1 , February 1981 , pp. 49 - 61
Copyright
Copyright © Cambridge University Press 1981

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Annett, M. (1970). The growth of manual preference and speed. British Journal of Psychiatry 61, 545–558.Google ScholarPubMed
Becker, B. (1975). Intellectual changes after closed head injury. Journal of Clinical Psychology 31, 307–309.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Borkowski, J. G., Benton, A. L. & Spreen, O. (1967). Word fluency and brain damage. Neuropsychologia 5, 135–140.CrossRefGoogle Scholar
Brink, J. D., Garrett, A. L., Hale, W. R., Woo-Sam, J. & Nickel, V. C. (1970). Recovery of motor and intellectual function in children sustaining severe head injuries. Developmental Medicine and Child Neurology 12, 545–571.CrossRefGoogle ScholarPubMed
Brown, G., Chadwick, O., Shaffer, D., Rutter, M. & Traub, M. (1981). A prospective study of children with head injuries. III. Psychiatric sequelae. Psychological Medicine 11, 63–78.CrossRefGoogle ScholarPubMed
Chadwick, O., Rutter, M., Thompson, J. & Shaffer, D. (1981 a). Intellectual performance and reading skills after localized head injury in childhood. Journal of Child Psychology and Psychiatry (in the press).CrossRefGoogle ScholarPubMed
Chadwick, O., Rutter, M., Shaffer, D. & Shrout, P. (1981 b). A prospective study of children with head injuries. IV. Specific cognitive deficits. (Submitted for publication.)CrossRefGoogle Scholar
Craft, A. W., Shaw, D. A. & Cartlidge, N. E. (1972). Head injuries in children. British Medical Journal iii, 200–203.CrossRefGoogle Scholar
Denkla, M. B. (1973). Development of speed in repetitive and successive finger-movements in normal children. Developmental Medicine and Child Neurology 15, 635–645.CrossRefGoogle Scholar
Field, J. G. (1960). Two types of table for use with Wechsler's intelligence scales. Journal of Clinical Psychology 16, 3–7.3.0.CO;2-9>CrossRefGoogle Scholar
Field, J. H. (1976). Epidemiology of Head Injuries in England and Wales. HMSO: London.Google Scholar
Heiskanen, O. & Kaste, M. (1974). Late prognosis of severe brain injury in children. Developmental Medicine and Child Neurology 16, 11–14.CrossRefGoogle ScholarPubMed
Kagan, J., Rosman, B. L., Day, D., Albert, J. & Phillips, W. (1964). Information processing in the child: significance of analytic and reflective attitudes. Psychological Monographs 78, 1–37.CrossRefGoogle Scholar
Klonoff, H. (1971). Head injuries in children: predisposing factors, accident conditions, accident proneness and sequelae. American Journal of Public Health 61, 2405–2417.CrossRefGoogle ScholarPubMed
Mandleberg, I. A. & Brooks, D. N. (1975). Cognitive recovery after severe head injury. I. Serial testing on the Wechsler Adult Intelligence Scale. Journal of Neurology, Neurosurgery and Psychiatry 38, 1121–1126.CrossRefGoogle ScholarPubMed
Maxwell, A. E. (1959). A factor analysis of the Wechsler Intelligence Scale for Children. British Journal of Educational Psychology 29, 237–241.CrossRefGoogle Scholar
Meyer, V. & Yates, A. (1955). Intellectual changes following temporal lobectomy for psychomotor epilepsy. Journal of Neurology, Neurosurgery and Psychiatry 18, 44–52.CrossRefGoogle Scholar
Neale, M. D. (1958). Neale Analysis of Reading Ability (Manual). Macmillan: London.Google Scholar
Oldfield, R. C. & Wingfield, A. (1964). The time it takes to name an object. Nature 202, 1031–1032.CrossRefGoogle ScholarPubMed
Partington, M. W. (1960). The importance of accident- proneness in the aetiology of head injuries in childhood. Archives of Disease in Childhood 35, 215–223.CrossRefGoogle ScholarPubMed
Rosvold, H. E., Mirsky, A. F., Sarason, I., Bransome, E. D. & Lloyd, H. B. (1965). A continuous performance test of brain damage. Journal of Consulting Psychology 20, 343–350.CrossRefGoogle Scholar
Rowbotham, G. F., MacIver, I. N., Dickson, J. & Bousfield, N. E. (1954). Analysis of 1400 cases of acute injury to the head. British Medical Journal i, 726–730.CrossRefGoogle Scholar
Rutter, M., Graham, P. & Yule, W. (1970). A Neuro-psychiatric Study in Childhood. Clinics in Developmental Medicine nos. 35/36. Heinemann Medical Books: London.Google Scholar
Rutter, M., Chadwick, O., Shaffer, D. & Brown, G. (1980). A prospective study of children with head injuries. I. Design and methods. Psychological Medicine 10, 633–646.CrossRefGoogle ScholarPubMed
St, James Roberts I. (1979). Neurological plasticity, recovery from brain insult and child development. In Advances in Child Development and Behavior Vol. 14 (ed. Reese, H. W. and Lipsitt, L. P.), pp. 254–319. Academic Press: New York.Google Scholar
Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology 18, 643–661.CrossRefGoogle Scholar
Turner, R. K., Mathews, A. & Rachman, S. (1968). The stability of the WISC in a psychiatric group. Journal of Child Psychology and Psychiatry 9, 194–200.Google Scholar
Wechsler, D. (1949). Wechsler Intelligence Scale for Children (Manual). Psychological Corporation: New York.Google Scholar