Psychological Medicine

Research Article

A prospective study of children with head injuries: I. Design and methods

Michael Rutter c1, Oliver Chadwicka1, David Shaffera2 and Gillian Browna3

a1 Gertrude H. Sergievsky Center, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA.

a2 Division of Child Psychiatry, College of Physicians and Surgeons of Columbia University, 722 West 168th Street, New York, NY 10032, USA.

a3 Bromley College of Technology, Rookery Lane, Bromley BR2 8HE.

Abstract

The main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia 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 post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2¼ years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing using the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

Correspondence:

c1 Address for correspondence: Professor Michael Rutter, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.

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