Criteria for early diagnosis of brain dysfunction.

This paper is concerned with the early identification in the pre-school years of those symptoms considered to be significant for the diagnosis of minimal brain dysfunction (MBD) (6). The history through the sixties and seventies shows a growing concern on the part of psychiatrists, neurologists and psychologists for the identification of those symptoms significant for the diagnosis of MBD (1,3,6–8,23). The paucity of follow-up studies and our own concerns regarding the diagnosis of brain dys-functioning led to a follow-up study on forty children diagnosed in pre-school years. The original diagnosis was made on a cluster of symptoms classified as primary, secondary and tertiary. Primary symptoms are neurological signs. The secondary symptoms are defensive mechanisms against the intrapsychic problems such as fears, compulsiveness, etc. Some symptoms may be either primary or secondary, e.g. distractibility, mood fluctuation. Tertiary symptoms are the results of the inability to interpret and respond to the social situation effectively again because of the organic dysfunctioning and the child's reaction to the rejection and hostility which he engenders by his own inappropriate social behaviour and emotional responses, such as, diffusely hostile attitude or over-dependence. The study showed that in that group of forty, thirty seven or 93.7% had positive neurological signs, with three or more occurring frequently. Psychiatric diagnostic evaluation shows severe personality deviation in thirty-seven cases. On psychological testing sixty percent were dull normal or above (above 80 I.Q.) and forty percent below normal. Examination of school placement reveals that only thirty percent are in regular classes and the remainder in special classes. The findings confirm that the diagnosis can be made in pre-school years on the basis of behavioural symptoms in the presence of neurological signs. The neurological impairment is permanent and the dysfunctioning affects emotional, social and intellectual functioning. The severity of the dysfunctioning of the family affected the child's rate of improvement.