Journal of the International Neuropsychological Society



Personality change disorder in children and adolescents following traumatic brain injury


JEFFREY E.  MAX a1c1, SHARON L.  KOELE a2, CARLOS C.  CASTILLO a7, SCOTT D.  LINDGREN a3, STEPHAN  ARNDT a6, HIROKAZU  BOKURA a8, DONALD A.  ROBIN a4, WILBUR L.  SMITH  JR. a9 and YUTAKA  SATO a5
a1 Department of Psychiatry, University of California, San Diego, and Children's Hospital, San Diego
a2 Department of Psychiatry, University of Iowa, Iowa City
a3 Department of Pediatrics, University of Iowa, Iowa City
a4 Department of Communicative Disorders, San Diego State University
a5 Department of Radiology, University of Iowa, Iowa City
a6 Departments of Psychiatry; Preventive Medicine and Environmental Health; and Mental Health Clinical Research Center, University of Iowa, Iowa City
a7 Cedar Centre, Cedar Rapids, Iowa
a8 Yasugi Daiichi Hospital, Department of Neurology, Shimane, Japan
a9 Department of Radiology, Children's Hospital of Michigan, Wayne State University

Abstract

The occurrence of personality change due to traumatic brain injury (PC), and its clinical and neuroimaging correlates were investigated. Ninety-four children, ages 5 through 14 at the time of hospitalization following traumatic brain injury (TBI; severe TBI N = 37; mild–moderate TBI N = 57), were assessed. Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, family psychiatric history, severity of injury, and neuroimaging assessments were conducted. The Neuropsychiatric Rating Schedule (NPRS) was used to establish a diagnosis of PC. Approximately 40% of consecutively hospitalized severe TBI participants had ongoing persistent PC an average of 2 years postinjury. An additional approximately 20% had a history of a remitted and more transient PC. PC occurred in 5% of mild–moderate TBI but was always transient. Interrater reliability for the diagnosis of PC was good (Kappa = .70). In severe TBI participants, persistent PC was significantly associated with severity of injury, particularly impaired consciousness over 100 hr, adaptive and intellectual functioning decrements, and concurrent diagnosis of secondary attention deficit hyperactivity disorder, but was not significantly related to any psychosocial adversity variables. These findings suggest that PC is a frequent diagnosis following severe TBI in children and adolescents, but is much less common following mild–moderate TBI. (JINS, 2000, 6, 279–289.)

(Received August 3 1998)
(Revised April 6 1999)
(Accepted May 19 1999)


Key Words: Traumatic brain injury; Children and adolescents; Personality change disorder.

Correspondence:
c1 Reprint requests to: Jeffrey Max, Children's Outpatient Psychiatry, 3665 Kearny Villa Road, Suite 101, San Diego, CA 92123. E-mail: jmax@ucsd.edu


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