Psychosocial Adjustment

Behavioral and emotional problems may precede other signs and symptoms of white matter disease. Affected patients with gliomatosis cerebri and multiple sclerosis, for example, experience apathy and fatigue before signs of cognitive deficits and functional decline. Psychiatric presentations vary by disease and the subsequent cognitive and functional level of the child. The diagnosis of psychiatric disorder in these patients is complicated by the emotional impact of the disabilities. It is difficult to determine whether the patient has a primary psychiatric diagnosis or an adjustment disorder. There is no direct correlation between white matter dysfunction and the etiology of psychiatric disorder. This implies that the relationship is indirect at best. However, in studies of multiple sclerosis patients, negative thoughts that are associated with depressive syndromes are predictive of cognitive difficulties. The clinician should assume that the origins of the psychiatric symptoms are multifactorial and interrelated. In children with multiple sclerosis, more than 50% experience depression, anxiety, or adjustment disorders (Brousseau et al. 2007).

The availability of family support is a strong predictor of adjustment in children with white matter disease. Families that communicate and seek additional support from friends and health care providers are more available for their children and help them better cope with the diagnosis. The impact on school performance is particularly significant. Young patients may become disinhibited, openly opposi-tional, and disruptive in the classroom and experience a deterioration in academic performance. The sudden development of attentional difficulties in a preteen or adolescent is unusual and may be misinterpreted as defiance. Frequent redirection by the teacher leads to greater sensitivity and increasing irritability in the patient.

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