When Psychological Tests Do Not Detect Test-Detectable Brain Damage: A Case Report

Abstract

In a previous presentation1), I discussed some of the problems in detecting and measuring the psychological effects of brain damage. This paper is a report and discussion of the case of a child whose easily detectable brain-damaged state was a significant factor in the production of a psychiatric disturbance. Yet, it had gone undetected in preceding medical, psychiatric, and psychological examinations. There is a sizable group of both children and adults whose personality difficulties are rooted in a variety of unrecognized brain-damage conditions. Many of these hidden conditions are referable to pre-natal malformation, developmental error, congenital or very early childhood traumata, febrile or pediatric diseases affecting cerebral functioning. Frequently these conditions are simply not recognizable on routine medical and neurological examination. Yet, such unsuspected states of central neuropathology often constitute a large silent sector of the psychopathology which confronts us at the point of diagnostic evaluation. Alertness to the existence of this group of cases and the practice of certain standards of careful clinical study will help uncover some of the less cryptic cases which might otherwise pass by undiscovered. The diagnostic study of all children seen in the Department of Child Psychiatry of The Menninger Foundation includes extensive psychiatric assessment, a full scale psychological test battery, medical examination, laboratory studies, and neurological consultation including X-rays and electroencephalographic tracings. This may seem unnecessarily elaborate. But experience has shown that in the long run the principle of diagnostic insurance pays off periodically in the discovery of brain-centered disorders of crucial consequence to the understanding of the case and its ultimate therapeutic possibilities. Bypassing of subtle or marginal organic brain conditions is more frequent in children, since comprehensive diagnostic facilities are generally not available to pediatricians and family physicians to whose at-