NEUROBEHAVIORAL OUTCOME OF CHILDRENS MILD TRAUMATIC BRAIN INJURY

This article offers an overview of children's and adolescents' neuropsychologic dysfunctions after mild brain injury, organized according to a taxonomy of neurobehavioral systems. Neurobehavioral outcome of children's brain injury differs from adults' because of developmental implications and substantial anatomic differences between the neonate and adult, but not in range of dysfunctions. It is a disturbance of adaptation-that is, integrated coping with one's environment.1 Mild head injury (MHI) implies minimal loss of consciousness (LOC) and lack of focal neurologic findings (although soft signs may exist) after an acceleration or impact injury, or both. MHI may be established by neuropsychologic study of higher processes,2 deviation from baseline functioning, and impaired development. Without wide range and precise study of neuropsychologic outcome, cases may be described as ''asymptomatic.''3 Traumatic brain injury (TBI) is a process that is primary: Mechanical forces causing injury; secondary: Mass effects that may be initiated by the initial injury; tertiary: Late-developing neurobehavioral symptoms; quaternary: Late developing symptoms due to a damaged hypothalamic-pituitary-endocrine axis. Relatively, MHI is the most common injury sustained by children.4 Occult brain damage is common: parents may be unaware of an accident; physicians may not recognize it in their office or the emergency room; children may conceal or be unable to report it; there may be no LOC; deficits appear years later. Therefore it is difficult to attribute symptoms to a particular incident. Even ''trivial'' head trauma alerts the physician to the need for monitoring later development.5-7 Undocumented injuries as high as 89% have been reported.8