Long-term sequelae of prefrontal cortex damage acquired in early childhood

Frontal lobe dysfunction is often invoked as a contributing factor in devel opmental disorders characterized by chronic maladaptive behavior, but inter pretation of relevant neuropsychological findings has been hampered by the limited information available regarding the consequences of focal prefronta l damage early in life. We describe here the long-term behavioral and cogni tive sequelae of damage to prefrontal cortex in two young adult patients wh o had sustained their brain damage prior to 16 months of age. In the contex t of normal neurological examinations, both cases had remarkable histories of impaired decision making, behavioral dyscontrol, social defects, and abn ormal emotion. Performances were primarily normal on a broad range of neuro psychological measures (intellect, memory, language, academic achievement, visual perception, and visuoconstruction), but selective impairments of exe cutive function were evident. Early dysfunction in the prefrontal region ma y result in severe and chronic social maladjustment despite largely normal cognitive abilities. These findings can help inform neuropsychological eval uation of patients with possible prefrontal dysfunction in the setting of d evelopmental disabilities or early brain trauma.