The neurological examination in child psychiatry: a review of its uses.

This review is an attempt to evaluate critically some of the recent literature on the clinical utility of the neurological examination in child psychiatric practice. Three separate but related issues are discussed; the accuracy of the examination in assessing cerebral dysfunction, the strength of the association between neurological signs and behaviour disorders and finally the clinical significance of this association. It is pointed out that not all neurological signs are of equal significance, but that developmental neurological signs which indicate cerebral immaturity are weakly associated not only with hyperactivity, but possibly with other behaviour disorders as well. Some of the methodological weaknesses in this literature are pointed out. Recent studies of children with motor impairment (clumsiness) are briefly mentioned as a potentially more fruitful avenue of research. It is concluded that the neurological examination may be useful in identifying sub-groups of behaviourally disturbed children who differ from other children with behaviour disorders in terms of etiology, prognosis or treatment needs. Unfortunately, little work has been done in this specific area and further research is needed.