No abstract

Requests for reprints should be sent to Harvey S. Levin, A-205, Baylor College of Medicine, 1333Moursund, Houston, TX 77030.

To investigate the relationship of severity of pediatric closed head injury (CHI), the contribution of frontal lobe lesions, and age at testing (6-10 years old vs. 11-15 years old) to cognitive deficit, 134 head-injured patients were given the Tower of London (TOL) task and underwent magnetic resonance imaging. Eighty-nine normal controls were given the TOL for comparison. Severity of CHI and age at testing were strongly related to cognitive performance on the TOL, including the frequency of breaking the rules. Volume of frontal lobe lesion (but not extrafrontal lesion) contributed to the prediction of performance on the TOL even after severity of injury was taken into account. Luria (1966) proposed that formulating a plan of action, monitoring problem-solving behaviors by verbal regulation, and verifying goal attainment are among the distinct capacities of the prefrontal region, a view that has received support from case reports of adults (Cicerone & Woods, 1987;Eslinger & Damasio, 1985) and investigation of patients following frontal excisions for intractable epilepsy (Petrides & Milner, 1982). Major gains in cognitive functions, such as planning and flexibility in reasoning, in 6-to 12-year-old children have been attributed to maturation of the prefrontal region (

No abstract

This study investigated the behavioral outcomes and adaptive functioning of 138 children with mild to severe closed head injury in the 6- to 16-year age range. Each child was evaluated with the Personality Inventory for Children-Revised. A subset of this sample (n = 77) received the Vineland Adaptive Behavior Scales. Results revealed little evidence for group differences based on severity of closed head injury on scales associated with psychopathology on the Personality Inventory for Children-Revised. However, children with severe closed head injury were viewed as experiencing more difficulties than children with mild-moderate closed head injury on those components of the Personality Inventory for Children-Revised most closely associated with cognitive functions. In addition, on the Vineland Adaptive Behavior Scales, severely injured children had lower scores on the Communication and Socialization scales than children with mild-moderate injury. Relationships between the size of frontal and extrafrontal lesions from concurrent magnetic resonance imaging and behavioral outcomes were not apparent. This study suggests that outcome measures assessing adaptive behavior and cognitive functions are more sensitive to severity of closed head injury than parent-based scales of internalizing and externalizing psychopathology.