PSEUDODEPRESSIVE PERSONALITY AND MENTAL INERTIA IN A CHILD WITH A FOCAL LEFT-FRONTAL LESION

Very few pediatric cases with focal frontal lesions have been document ed psychiatrically. Orbitofrontal lesions in adults produce a pseudops ychopathic personality syndrome with impulsivity, and dorsolateral and frontomedial lesions produce a pseudodepressive personality syndrome with mental inertia. A frontal profile similar to character disorder s everal times has been reported in children with frontal lesions, but p seudodepression never has been reported. SC2, a 7-year-old girl, had a left-frontal cavemous hemangioma partially surgically removed at age 3. Low academic achievement and concern about lack of communicativenes s and initiative motivated referral. She is a strong prototype of the pseudodepressive-inert type, but she is not at all a prototype of the pseudopsychopathic-impulsive type, thus being the first reported pedia tric focal frontal lobe lesion case displaying this particular profile . SC2 is a quiet, aloof, amorphous, trouble-free schoolchild. She is i mpaired in a wide range of cognitive (executive) functions on many of the cognitive tests administered; and she requires excessive motivatio nal and cognitive support to complete tests such as the Wechsler intel ligence Scale for Children (3rd ed.), the Auditory Verbal Learning Tes t, and others. All her deficits can, however, be tagged to one or anot her form of inertia, but never to impulsivity. On tests, she is persev erative, lacks initiative and strategy, and is slow and concrete when creative or sustained processing are required by the task. She shows n o sign of depressed mood according to the Achenbach Depression subscal e and numerous observations from various other sources. In short, ther e are 2 highly distinct syndromes of personality and cognition that re sult from focal frontal lobe lesions in the child, just as in the adul t.