Skip to main content

A prospective study of children with head injures: III. Psychiatric sequelae

  • Gillian Brown, Oliver Chadwick, David Shaffer, Michael Rutter and Michael Traub...

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. 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 21 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 I 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.

Corresponding author
1Address for correspondence: Ms Gillian Brown, Bromley College of Technology, Rookery Lane, Bromley BR2 8HE.
2Gertrude H. Sergievsky Center, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA.
3Division of Child Psychiatry, College of Physicians and Surgeons of Columbia University, 722 West 168th Street, New York, NY 10032, USA.
4Department of Child and Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
1Department of Neurology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
Hide All
Backett, E. M. & Johnston, A. M. (1959). Social patterns of road accidents to children: some characteristics of vulnerable families. British Medical Journal i, 409413.
Brown, G. W. & Davidson, S. (1978). Social class, psychiatric disorder of mother, and accidents to children. Lancer i. 378381.
Brown, G. W. & Rutter, M. (1966). The assessment of family activities and relationships: a methodological study. Human Relations 19, 241263.
Burton, L. (1968). Vulnerable Children. Schocken Books: New York.
Chadwick, O., Rutter, M., Brown, G., Shaffer, D. & Traub, M. (1981 a). A prospective study of children with head injuries: II. Cognitive sequelae. Psychological Medicine 11, 4961.
Chadwick, O., Rutter, M., Shaffer, D. & Shrout, P. (1981 b) A prospective study of children with head injuries: IV. Possible specific cognitive deficits. (Submitted for publication.)
Conners, C. (1973). Rating scales for use in drug studies in children. In Pharmacotherapy of Children, pp. 2484. Psychopharmacology Bulletin, Special Suppl. to Vol. 9.
Craft, A. W., Shaw, D. A. & Cartlidge, N. E. (1972). Head injuries in children. British Medical Journal iii, 200203.
Early Clinical Drug Evaluation Unit (ECDEU) (1976). Assessment Manual. U.S. National Institute of Mental Health, Psychopharmacology Research Branch: Rockville, Md.
Graham, P. & Rutter, M. (1968). The reliability and validity of the psychiatric assessment of the child: II. Interview with the parent. British Journal of Psychiatry 114, 581592.
Lishman, W. A. (1978). Head injury. Organic Psychiatry, chapter 5.Blackwell Scientific: Oxford.
Manheimer, D. I. & Mellinger, G. D. (1967). Personality characteristics of the child accident repeater. Child Development 38, 491513.
Partington, M. W. (1960). The importance of accident- proneness in the aetiology of head injuries in childhood.Archives of Disease in Childhood 35, 215223.
Quinton, D., Rutter, M. & Rowlands, O. (1976). An evaluation of an interview assessment of marriage. Psychological Medicine 6, 577586.
Rutter, M. (1967). A children's behaviour questionnaire for completion by teachers: preliminary findings. Journal of Child Psychology and Psychiatry 8, 111.
Rutter, M. & Brown, G. W. (1966). The reliability and validity of measures of family life and relationships in families containing a psychiatric patient. Social Psychiatry 1, 3853.
Rutter, M. & Cox, A. D. C. (1978). The Assessment of Diagnostic Interviewing Techniques in Child Psychiatry. Final Report to the SSRC.
Rutter, M. & Quinton, D. (1977). Psychiatric disorder – ecological factors and concepts of causation. In Ecological Factors in Human Development (ed. McGurk, H.), pp. 173187. North-Holland: Amsterdam.
Rutter, M., Tizard, J. & Whitmore, K. (eds.) (1970). Education, Health and Behaviour. Longmans: London.
Rutter, M., Cox, A., Tupling, C., Berger, M. & Yule, W. (1975). Attainment and adjustment in two geographical areas: I. The prevalence of psychiatric disorder. British Journal of Psychiatry 126, 403509.
Rutter, M., Chadwick, O., Shaffer, D. & Brown, G. (1980). A prospective study of children with head injuries: I. Design and methods. Psychological Medicine 10, 633646.
Schachar, R., Rutter, M. & Smith, A. (1980). Characteristics of situationally and pervasively hyperactive children: implications for syndrome definition. Journal of Child Psychology and Psychiatry (in the press).
Shaffer, D., Chadwick, O. & Rutter, M. (1975). Psychiatric outcome of localized head injury in children. In Outcome of Severe Damage to the Central Nervous System. Ciba Foundation Symposium 34 (new series) (ed. Porter, R. and FitzSimons, D. W.), pp. 191213. Excerpta Medica: Amsterdam.
Wechsler, D. (1949). Wechsler Intelligence Scale for Children (Manual). Psychological Corporation: New York.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score