Psychopatological problems in neurological disorders of children and adolescents

In neurological disorders of children and adolescents, psychiatric syndromes may occur and adaptive problems are commonly to be expected; adolescence problems may enhance difficulties to cope with chronic conditions and related disability. Prevention of these problems is often neglected in spite of good chances and remarkable know-how. Psychopathological risk depends on both medical and non-medical factors, that are examined in detail in this chapter. The former vary according to severity, timing and features of the disease and to eventual brain changes; the importance of mental retardation and of some genetic disorders is stressed. The latter are related to environment, social condition, school integration, familial relations, sex, age and life events. On the other hand some subjects show resilience to unfavourable events and environmental, educational and familial resources may play a protective role. All these aspects intersect with factors predicting either academic failure or success. Appropriate attention to such problems should be paid during clinical interview. Non-medical as well as medical features should be considered. Possible guidelines for general population and individual prevention are discussed. At individual level, a profile of risk and protection factors should be marked out and a balance between them should be struck. More significant factors should be identified; the key role of familial relations and of cognitive level is stressed. If risk should be considered high, protective factors should be exploited and possible correction of negative factors evaluated. Cognitive and behavioural effects of drugs should be carefully considered. Direct involvement of the child in diagnostic and therapeutic procedure may prevent misunderstanding, unfounded anxiety and non-compliance. Psychological support may be helpful. School performance assessment and neuropsychological evaluation should be performed to design, if necessary, rehabilitation treatment or an individual educational plan. Intervention on non-medical factors involves other professional and non-professional operators. The teachers’ role is stressed. The family has an irreplaceable role, as behaviour ruling involves upbringing and depends on parents’ ethic principles.