Organicity in child psychiatry. Signs, symptoms, and syndromes.

The diagnosis of organicity in child psychiatry requires a high index of suspicion. For the beginning clinician, the idea that there are specific signs and symptoms associated with organicity has a certain appeal. However, a careful review of the literature reveals that except for a few instances, there are no specific signs, symptoms, or syndromes of organicity. Children with organic brain damage tend to exhibit the whole range of behavioral symptoms. The diagnosis of organicity can be supported with a thorough medical and psychiatric examination. The use of psychological testing to diagnose brain damage is unwise. Psychological tests can best be used as guides for the detection of associated learning problems and for the evaluation of outcome. The development of new laboratory techniques such as computerized EEGs and brain imaging seem promising aides for the future, but their exact role has not yet been established. There is suggestive evidence that children with organic brain disorders are more susceptible to environmental stresses, family disharmony, and toxicity from psychotropic medications. The attitude that the problems of the brain damaged child are fixed and untreatable seem unjustified. Psychotherapeutic and psychopharmacologic techniques are being developed to help the brain-damaged child and its family to cope with their handicaps.