Brain-damaged Children Research Articles

A Personal Matter

A Personal Matter is the story of Bird, a frustrated intellectual in a failing marriage whose utopian dream is shattered when his wife gives birth to a brain-damaged child.

Phylogeny, ontogeny, and brain-damaged children

Phylogeny, ontogeny, and brain-damaged children

Phylogeny, Ontogeny, and Brain-Damaged Children

To the Editor:— I note with interest that the AMA discredits the unwarranted growing use of the Doman-Delacato treatment for brain-damaged children (205, Aug 19, 1968, adv p10). Doman and Delacato quote ontogeny recapitulates phylogeny as the basis of their theory. Applied to the development of reading and handedness, Doman and Delacato have things reversed.1 Phylogenetically, writing originated about 5,000 BC, but handedness developed during the Bronze age (1500 to 700 BC) Ontologically, the ability to read, may come as late as 10 to 12 years of age but right-left orientation may be as late as 12 to 15 years of age. Investigation of the tonic neck reflex for determination of cerebral dominance showed neither hemisphere dominant in 50% of the 500 children in the first three elementary grades1(total population done), and at the seventh-grade level 40% showed neither hemisphere dominant. Controlled studies by Freeman

Performance and reminiscence of brain-damaged, behavior-disordered, and normal children on four psychomotor and perceptual tests.

Performance and reminiscence of brain-damaged, behavior-disordered, and normal children on four psychomotor and perceptual tests.

Identification of variables useful in prognosis for brain-injured children.

For 335 brain-damaged children only gross muscle tone, one item of a 155-item case history form, was related to improvement on the Doman-Delacato-Doman profile.

The Brain-Damaged Child and Writing Problems

The Brain-Damaged Child and Writing Problems

Persistent dystonia in a brain-damaged child after ingestion of phenothiazine

Persistent dystonia in a 10-year-old mentally retarded girl followed an assumedintoxication with trifluoperazine and chlorpromazine. It would appear that in children, as in adults, this infrequent event of irreversible neurotoxicity occurs almost exclusively in subjects with antecedent brain damage. Persistent dystonia in a 10-year-old mentally retarded girl followed an assumedintoxication with trifluoperazine and chlorpromazine. It would appear that in children, as in adults, this infrequent event of irreversible neurotoxicity occurs almost exclusively in subjects with antecedent brain damage.

Group therapy with brain-damaged children.

tions, giving me valuable information about how they saw themselves in their family constellations. They also were able to talk about their parents' attitudes toward them when the parents visited the hospital and when the boys were home on visits. It is especially significant that the boys could point out one another's inappropriate behavior. In the fifth session, they told Jimmy, who was angry because he couldn't do what he wanted to, that he couldn't always have his own way, that he probably acted like that at home, and that his behavior was pretty foolish. Another time Frank said that he was wetting the bed, which immediately brought teasing from Harry. The other two boys came to Frank's defense, saying that he couldn't help wetting the bed, because of the medicine he was taking. The teasing ended, with agreement that teasing was not the proper thing to do. A third example of insight occurred when Harry began to pester me; Bill, the 10-year-old, told Harry he was just trying to get attention, and Harry stopped. Of equal importance was the boys' ability, through verbal interaction in the group, to develop an awareness of the behavior that led to their admission. For instance, Harry said that when he first came to the hospital he “? howled and made more noise than a dog.―He said he thought his stepmoth er didn't like him, but he guessed he was the one who was “? goofed up.― He ran away because he thought his stepmother didn't want him, but he guessed she did, as she sent him packages. Jimmy said he beat up his sisters and brothers, wouldn't mind his mom and dad, and wrecked his dad's car. He said he came to the hospital because of his temper. All four boys recognized that when they left the hospital, they couldn't continue such behavior. We made additional observations that might be helpful. The group should be composed of an uneven number of youngsters; otherwise the members tend to break up into pairs. The group should meet at the same time and same place for each session, with as few cancellations and interruptions as pos. sible, because continuity is extremely important. The chairs should always be set up before the members arrive, to prevent the horseplay that often occurs when boys of this age begin arranging furni 4 HEPROGRAM foremotionally ill childrenatNew berry State Hospital at one time included four boys aged 10 through 13 who were brain-damaged, retarded, or both, and who had behavior problems. We decided to use group psychotherapy to see if it would benefit such patients. The meetings would also be used as a teaching device, with each one re corded and then discussed with the treatment team. The boys' IQs ranged from 61 to 75. Two of the four had diagnoses of chronic brain syndrome with behavioral reaction, the third a diagnosis of chronic brain syndrome with psychotic reaction, and the fourth a diagnosis of psychotic reaction without chronic brain syndrome. All had shown some of the secondary symptoms of inability to get along with their peers, physical abusiveness to them, poor self control and judgment, thievery, fire-setting, other destructiveness, pathological lying, disobedience, hy peractivity, impulsivity, and a prolonged history of running away. Fifteen weekly hour-long sessions were sched uled, with myself as therapist. I had some previous experience in group psychotherapy with teen-agers, and an experienced group therapist observed each session. While the boys were attending the sessions, they were also receiving chemotherapy and taking part in recreation therapy and the school program. * Duringthe sessions the boyssaton straight backed chairs in a circle. They were not allowed to bring anything to hold, play with, or eat. The group was the catalytic agent, and I took a passive role except to use gestures and facial expressions to stimulate or control the group when necessary. It was clear that the boys wanted the sessions. On two or three occasions when I was late, they came looking for me. When it was necessary to cancel a session, they greeted me the following week with “? Why didn't we have group therapy @ast week?― or “? Where were you last week?― Seldom was it necessary for me to directly control their physical activity. It was usually controlled by the group itself, more often than not by one of its members who had emerged as a leader. The boys became aware that it was their group, and that they were there to talk. They were able to discuss and express feelings about their home situa

Performance of Neurologically Impaired Children Copying Geometric Designs with Sticks

The visual-motor performance of 34 brain-damaged children was compared with that of an equal number of children without neurological impairment but matched for IQ, age and sex. Performance involved the copying of geometric designs with sticks rather than drawings. A 14-category rating system was used to evaluate performance. Results indicated statistically significant performance decrement for the brain-damaged Ss, variations in sensitivity among designs and scoring categories for registering performance decrement, and low-to-moderate correlations between test performance and intelligence, age, and mental age. Such results encourage further development of a stick test for young and neurologically impaired children.

DOMINANCE HIERARCHY AND CLINICAL COURSE OF PSYCHIATRICALLY HOSPITALIZED BOYS

Patient contact rank order, quantitatively defined, reflects the dominance hierarchy in a psychiatric treatment cottage. The patient's position in this hierarchy was correlated with staff impressions of his behavior and with clinical variables. Diagnosis correlates with contact rank order: children with primary behavior disorders rank highest; brain-damaged children rank lowest. Children in the upper half of the rank order appear to have a better prognosis than those in the lower half, both in incidence of discharge and in average time spent in the hospital. A high contact rank-order position is positively related to ward privileges and to school social adjustment. Clinically relevant insight, obtained from geographic mapping and from the patient's rank order in his peer group, may be used to test treatment hypotheses, especially attempts at resocialization.

Dominance Hierarchy and Clinical Course of Psychiatrically Hospitalized Boys

Patient contact rank order, quantitatively defined, reflects the dominance hierarchy in a psychiatric treatment cottage. The patient's position in this hierarchy was correlated with staff impressions of his behavior and with clinical variables. Diagnosis correlates with contact rank order: children with primary behavior disorders rank highest; brain-damaged children rank lowest. Children in the upper half of the rank order appear to have a better prognosis than those in the lower half, both in incidence of discharge and in average time spent in the hospital. A high contact rank-order position is positively related to ward privileges and to school social adjustment. Clinically relevant insight, obtained from geographic mapping and from the patient's rank order in his peer group, may be used to test treatment hypotheses, especially attempts at resocialization.

DIAGNOSIS AND TREATMENT: RECURRENT ABDOMINAL PAIN IN CHILDREN—A SURGEON'S VIEWPOINT

MUCH has been written in recent years about the importance of psychogenic disturbances as causes of abdominal pain in childhood. Yet, by no means all recurrent abdominal pain is so caused. A recent article in Pediatrics on nonorganic abdominal pain therefore promised this subsequent paper on pain of organic origin. I would like to caution the reader that his "surgeon's viewpoint" tends to exclude consideration of organic abdominal pain not surgically treated. Perhaps a third paper is indicated. Abdominal pain of whatever origin requires a planned approach to diagnosis. While it is only too easy for the clinician to submit a patient to innumerable investigations of varying degrees of unlikelihood of revealing disorders of differing degrees of rarity, a detailed history and searching interview with the parents, together with a complete physical examination, will go very far to reduce the number of cases submitted to any but quite simple tests. The diagnosis of psychogenic pain, no less than that of organic pain, must rest on positive findings. To make a diagnosis of psychogenic pain, there must be something more than the absence of demonstrable organic disease. There must be significant psychopathology. If there is evidence of neither this nor organic disease, one must resolve to be irresolute and decide to be undecided. One must not make a diagnosis of psychic disease simply because one can find no organic cause. One must also remember that psychic disturbance does not confer immunity from organic disease. A neurotic, psychotic, or brain-damaged child can have appendicitis.

Communication Disorders in Brain-Damaged Children

Communication Disorders in Brain-Damaged Children

SYMBOL AND SYNTHESIS IN EXPERIMENTAL "READING"

80 children, 30 of whom were brain damaged, learned pictographs and logographs for 8 words and then read simple sentences composed of the logographs. Their ability to synthesize the ideas represented by the logograph sentences was tested; they demonstrated the meaning of each sentence. Very young children (ages 3-4 to 4-3) and all brain-damaged children (4-4 to 7-4) easily mastered the pictographs but had difficulty learning the logographs. Normal children could not synthesize the sentence concepts until ages 6-8 to 7-3. Brain-damaged children did not achieve a comparable level of synthesis proficiency until age 13.

Hypo-Responsiveness as a Behavioral Correlate of Brain-Damage in Children

It is hypothesized that hypo-responsiveness is a behavioral correlate of brain-damage in children. This hypothesis, which contradicts the concept of distractibility, is that brain-damaged children demonstrate fewer and less varied responses per unit of time for a given stimulus situation than normal children of comparable intelligence. The hypothesis is general and relevant variables such as time, locus, and extent of injury have yet to be investigated for their effect on this proposed behavioral correlate. Hypo-responsiveness evolved from the observation that distractibility was more characteristic of normal than of brain-damaged children and from previous studies of discrimination learning, test performance, responsiveness to illusions, stimulus generalization, and drugs. The procedures utilized in activation research, psychophysical assessment of stimulus thresholds for different modalities need exploration as do the environmental stimulus conditions under which brain-damaged Ss perform optimally.

Effect of irrelevant peripheral visual stimuli on discrimination learning in minimally brain-damaged children.

Effect of irrelevant peripheral visual stimuli on discrimination learning in minimally brain-damaged children.

The questionably brain-damaged child.

Minimal or diffuse brain damage in a child may be detected by (1) the history, (2) results of psychologic tests, (3) certain characteristics of behavior, (4) various minimal neurologic manifestations, and (5) electroencephalographic findings. The Bender gestalt test and study of graphomotor disturbance in the child's drawings and handwriting samples are especially helpful. Proper diagnosis requires correct interpretation of all of the findings, viewed collectively.

Judgments of simple geometric figures by children.

In order to compare perceptual visual performance of brain-damaged children and normal children, a series of perceptual studies was undertaken. Modified paired-comparison judgments were obtained from the following groups: (1) normal (kindergarten through fourth grades), (2) pre-school cerebral palsied, (3) two special classes of brain-damaged, (4) emotionally disturbed children, and (5) retarded adults (MA 5 through 11). Errors and types of error were related to age, IQ, clinical group, MA level, etc. Developmentally speaking the decline of left-right reversal errors is most striking. Organic involvement relates more to type than to sheer frequency of error. Relevant literature is discussed in relation to the findings.

The speech and language abilities of emotionally disturbed children.

The speech and language disorders of these severely disturbed children can be divided into two categories which relate to the type of psychiatric disturbance. The autistic-schizophrenic children used bizarre forms of language or did not use communicative language at all. The non-autistic-schizophrenic, the neurotic, the primary behaviour disorder, and the minimally brain-damaged children as a group, had similar speech and language problems to normal children but of a more severe and frequent nature. Their problems were predominantly in the areas of speech and language development, articulation, rate of speech and fluency. The children with primary behaviour disorders had the more severe speech and language problems.

Brain Damage in Children: The Biological and Social Aspects.

This fascinating volume consists of the papers presented at Childrens Hospital of Philadelphia in 1962 on social and biological problems of childhood brain damage. Since the problems arising from this condition are multidisciplinary, contributors and discussants were selected from psychiatry, neurology, sociology, and biochemistry. The mood of this conference is recaptured, and one can feel the excited reactions in the abbreviated discussions. The authors emphasize that the fact of brain damage in children and the concept of the brain-damaged child are different. There are many children with known brain damage who do not exhibit brain-damaged behavior. On the other hand, there are children with no known brain damage who exhibit brain-damaged behavior. The characteristics of brain-damaged behavior are hyperkinetic motor activity, limited attention span, emotional lability, impulsiveness, and social disarticulation. One contributor described the research going on in this area. The current view of disruptive behavior as a consequence of