Psychosocial Adjustment

Children with AIS and hemorrhagic stroke are at risk for the development of chronic seizures and a variety of psychiatric disorders including ADHD, disruptive behavior disorders, and anxiety disorders. Very few prospective studies exist on the psychiatric sequelae of stroke in pediatric patients. Based on evidence of high rates of psychiatric disorder in adults following stroke and the assumption that children with brain lesions have higher rates of behavioral and emotional problems than those patients with other medical disorders, children with congenital or acquired stroke should be at greater risk for psychiatric disorders. One study followed a group of 29 patients between the ages of 5 and 15 years who had had a focal, nonrecurrent, nonprogressive, supratentorial brain lesion caused by a stroke before age 14. An orthopedic population was selected as the control group. Fifty-nine percent of poststroke subjects experienced rates of psychiatric disorder, a rate significantly higher than the control subjects and thought to be related to the effects of the lesions. These patients also had higher rates of psychiatric comorbidity. Another interesting finding was the direct relationship between neurological severity as measured by several variables, including seizure history, head circumference, degree of hemi-plegia, and mobility on the functional side of the body, and the presence of psychiatric disorder. Patients with a family history of psychiatric disorder and with a debilitating neurological disorder were more likely to experience a poststroke psychiatric problem. Children with stroke also demonstrated more impairment in adaptive functioning, particularly socialization, an indication that interpersonal relationships may be affected by the same levels of emotional lability that are typically found in adult stroke patients (Max et al. 2002).

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