Return to school after brain injury.

AIMS: To examine return to school and classroom performance following traumatic brain injury (TBI). METHODS: This cross-sectional study set in the community comprised a group of 67 school-age children with TBI (35 mild, 13 moderate, 19 severe) and 14 uninjured matched controls. Parents and children were interviewed and children assessed at a mean of 2 years post injury. Teachers reported on academic performance and educational needs. The main measures used were classroom performance, the Children's Memory Scale (CMS), the Wechsler Intelligence Scale for Children-third edition UK (WISC-III) and the Weschler Objective Reading Dimensions (WORD). RESULTS: One third of teachers were unaware of the TBI. On return to school, special arrangements were made for 18 children (27%). Special educational needs were identified for 16 (24%), but only six children (9%) received specialist help. Two thirds of children with TBI had difficulties with school work, half had attention/concentration problems and 26 (39%) had memory problems. Compared to other pupils in the class, one third of children with TBI were performing below average. On the CMS, one third of the severe group were impaired/borderline for immediate and delayed recall of verbal material, and over one quarter were impaired/borderline for general memory. Children in the severe group had a mean full-scale IQ significantly lower than controls. Half the TBI group had a reading age > or =1 year below their chronological age, one third were reading > or =2 years below their chronological age. CONCLUSIONS: Schools rely on parents to inform them about a TBI, and rarely receive information on possible long-term sequelae. At hospital discharge, health professionals should provide schools with information about TBI and possible long-term impairments, so that children returning to school receive appropriate support.

Sequelae of minor head injury: the natural history of post-concussive symptoms and their relationship to loss of consciousness and follow-up.

The character and natural history of post-concussive symptoms were studied in two subject groups: patients admitted to hospital for observation following brief loss of consciousness (LOC) as a result of head injury and patients who attended the accident unit after head injury but not were not admitted. Follow-up data were obtained from the hospitalized group at standardized out-patient interview and from the non-hospitalized group by postal questionnaire. Two- and 12-week data are presented on 24 hospitalized and 58 non-hospitalized patients. The type and frequency of symptoms was similar in the two groups and rank ordering was significantly correlated. However, the reduction in symptom scores (number of symptoms) 12 weeks post-injury was significantly greater in the hospitalized than the non-hospitalized group. The possible significance of this is discussed.

Patterns of attendance at developmental assessment clinics.

A random sample of 489 children was collected at birth. There were clinic records for only 356 (73 per cent) of these children, and from this number 30 left the district or died. The parents of those with record cards were invited to bring their children to clinic when they reached the age of four years. Only 152 children (47 per cent) attended. Of the non-attenders, 129 were traced to schools in the borough when they reached the age of five years, as were 67 (51 per cent) of the 133 children without record cards. The children seen only at school were compared with the children seen at a Local Authority developmental assessment clinic. The clinic group were judged to come from the higher social classes and to have higher IQs than the school group, which suggests that clinics may be catering for those whose need is least.

Prenatal progesterone. I. Its effect on development and on intellectual and academic achievement.

The development of two groups of children whose mothers had been given progesterone supplements during pregnancy to relieve symptoms of toxaemia was assessed, one group at 2 yr of age and the other at 16 yr of age. There was no evidence that progesterone supplements accelerated development in the 2-yr-old age group or enhanced intellectual and academic attainment in the 16-yr-old age group. In addition, the evidence regarding the reported beneficial effects on intellectual attainment of in utero exposure to excess sex steroids is discussed.

Prenatal progesterone II. Its role in the treatment of pre-eclamptic toxaemia and its effect on the off-spring's intelligence: a reappraisal.

Dalton's results concerning the beneficial effect of progesterone supplementation in preventing pre-eclamptic toxaemia [16] and in enhancing intellectual potential [17,18] were reappraised. We could find no evidence in the data that progesterone supplementation was any better at preventing pre-eclamptic toxaemia than treating the disorder symptomatically. Nor could we find any convincing evidence that excess progesterone enhances development at 1 yr of age, academic attainment at 9--10 yr of age, or success in school leaving examinations and improves the chances of continuing further full-time education after leaving school.