Postencephalitic Syndrome: Clinical Entity or Incorrect Diagnostic Label?

The role of central nervous system damage in the etiology of behavioral, cognitive, and emotional disorders of children is a prominent controversial issue in contemporary child psychiatry and psychology. The terms brain damage, minimally brain damaged, minimal brain dysfunction, posttraumatic syndrome, postencephalitic syndrome, behavior disorder, brain-injured, and hyperactive child have come to connote a clinical entity of disturbed functioning arising out of neural pathology. Most current discussions of this clinical entity in the literature treat it as a predictable syndrome characterized by distractibility, atypical cognitive functioning, irritability, hyperkinesis, emotional lability, perseveration, and disturbances in impulse control and perception. These symptoms have been so closely associated with neural damage that some writers have taken the manifestations of any or all of them as evidence of organic brain dysfunction, even when there is neither a history of damage nor other neurological signs or symptoms.

Although there is evidence that trauma to the central nervous system can cause damage to motor, sensory, and associational functions, solid evidence that a specific clinical behavioral and psychological entity necessarily arises is lacking. The evidence, in fact, supports the theory that any serious threat---neurologic or other---to the physical integrity of the child may lead to similar behavioral disturbances and that the degree of these disturbances varies widely, depending on the individual child's psychological makeup. Thus, although there is no question that neurologic impairment---of whatever magnitude---will evoke an emotional