Brain Impairment in Child Psychiatric Disorders: Correspondencies

between Neuropsychological and CT Scan Results

MICHAEL G. TRAMONTANA, PH.D., AND STEVEN D. SHERRETS, PH.D.

Computed tomography (CT) results for a mixed sample of child psychiatric patients were
compared with results on both the Halstead-Reitan Neuropsychological Battery and the
newly developed Children's Version of the Luria-Nebraska Neuropsychological Battery.
Although the subjects comprised a "nonreferred" sample for whom brain dysfunction was
not suspected, at least 50% were identified as neuropsychologically impaired. Neuropsy-
chological abnormality appeared to be associated with two general patterns of correspond-
ence with the CT results-one suggestiveof brain damage, per se, whereas the other seemed
to reflect a delay in normal brain maturation. Implications with respect to the detection of
brain dysfunction among child psychiatric patients are discussed,and guidelines for further
study are outlined.
Journal of the American Academy of Child Psychiatry, 24,5:590-596, 1985.

Inquiries into the relationship between brain im-
pairment and psychopathology in childhood are not
new (Hertzig and Birch, 1968; Seidel et aI., 1975;
Shaffer, 1974; Rutter, 1977). However, studies incor-
porating recent advances in noninvasive neurodi-
agnostic technology-such as computed tomography
(CT)-have only begun to appear, as much of the
work in this area has been almost exclusively with
adults (e.g., Golden et al., 1980, 1981; Weinberger et
aI., 1979). The focus of study thus far with children
has been on youngsters with autism or other major
developmental handicaps-for whom enlarged ventri-
cles and other structural deficits have been found in
subgroups of the subjects examined (Campbell et al.,
1982; Caparulo et al., 1981; Damasio et al., 1980;
Rosenbloom et al., 1984). Reiss et a1. (1983) likewise
found ventricular enlargement in a controlled com-
parison of CT scans for a mixed group of child psy-
Received April 16, 1984; revised June 21, 1984; accepted Sept. 6,
1984.
Dr. Tramontana is Director of Psychology at Bradley Hospital and
Assistant Professor in the Department of Psychiatry and Human
Behavior, Brown University. Dr. Sherrets is Director of the Day
Hospital Program at Bradley Hospital and Assistant Professor in the
Department of Psychiatry and Human Behovior, Brown University.
This study was conducted while the authors were at the University
of Nebraska Medical Center and was supported, in part, through
Unioersity research funds and received Institutional Review Board
approval on September 14, 1979.
This report represents an extended and more detailed version of a
paper presented at the 90th Annual Convention of the American
Psychological Association, Washington, D.C., 1982.
The authors gratefully wish to acknowledge the a.~sistance of Dr.
Brian Wolf in helping to organize and summarize the data collected
in this study.
Reprint requests should be sent to Dr. Michael G. Tramontana,
Department of Psychology, Bradley Hospital, lOll Veterans Memo-
rial Parkway, East Providence, RI02915.
0002-7138/85/2405-0590 $02.00/0 «» 1985 by the American Acad-
emy of Child Psychiatry.
590
chiatric patients, but their subjects also tended to be
among the more impaired with respect to psychiatric
and developmental status, with about half of the group
having a confirmed neurological disorder and a third
showing mild mental retardation.
No study, to our knowledge, has yet examined CT
scan results for a less obviously impaired sample of
psychiatrically disordered children for whom brain
impairment is not suspected, but who nonetheless may
show various neuropsychological difficulties when
comprehensively assessed. High rates of neuropsy-
chological abnormality have been found in child and
adolescent psychiatric patients without known brain
damage (Tramontana et al., 1980). Questions arise,
however, as to the meaning of these functional abnor-
malities-especially with respect to whether they may
be associated with subtle irregularities in brain struc-
ture that would otherwise be missed in a routine
neurological examination or review of history. These
issues were addressed in the present study, in which
CT results were compared with results on both the
Halstead-Reitan Neuropsychological Battery and the
newly developed Children's Version of the Luria-Ne-
braska Neuropsychological Battery for a mixed sample
of psychiatric youngsters without known brain dam-
age. The study also permitted the application of more
extensive methods for quantifying CT scan results
than have appeared in other studies with children.
Method
Subjects
A sample of 20 hospitalized child and adolescent
psychiatric patients ranging from 9 to 15 years of age
(M = 11.99, S.D. = 1.94) served as subjects in the
study. Consecutive admissions in this age range were
 BRAIN IMPAIRMENT IN CHILD PSYCHIATRIC DISORDERS
selected if there was neither a documented history of
a neuropathological condition nor positive findings on
a routine neurological examination performed by the
admitting psychiatrist. From a neuropsychological
standpoint, therefore, these were "nonreferred" cases
for whom brain dysfunction was not suspected. The
sample consisted of 13 boys and 7 girls, as no attempt
was made to equalize the sex ratio among the subjects
selected. Full Scale IQs ranged from 70 to 130 (M =
92.45, S.D. = 16.83), and most of the subjects were
classified as right handed (16 versus 4) on the basis of
hand preference for writing. The majority of the sub-
jects were white (80%), coming from lower- to middle-
class socioeconomic backgrounds, with approximately
30% of their families receiving welfare assistance. The
group was heterogeneous in terms of severity and
chronicity of psychiatric disturbance, but with all
subjects nonetheless having presented difficulties suf-
ficient to warrant an inpatient level of treatment.
Diagnoses ranged from various adjustment reactions
to psychosis, with Conduct Disorder comprising the
largest single diagnostic category assigned among the
subjects (35%). Using an arbitrary cutoff of 2 years
since estimated time of onset (i.e., when treatment
was first sought), almost one-third of the subjects were
classified as chronic (M = 1.37 years, S.D. = 1.93
years). Seventy percent of the subjects were being
treated with psychotropic medication when tested; of
those who were, most were receiving some form of
major tranquilizer. Last, although no subject carried
a primary diagnosis of mental retardation or learning
disability, 40% had a lag of 2 grades or more between
grade-equivalent total score on the Peabody Individual
Achievement Test and age-expected grade level.
Procedures
Each subject was administered both the newly de-
veloped Children's Version of the Luria-Nebraska
Neuropsychological Battery (LNNB-C) and the Hal-
stead-Reitan Neuropsychological Battery for Older
Children (HRNB), with the order of administration
of the two batteries alternated consecutively among
the subjects tested. (See Golden (1981) and Reitan
and Davison (1974), respectively, for a complete de-
scription of each battery.) Each subject was tested
individually, usually within the first 2 weeks of hos-
pitalization, by a thoroughly trained technician ac-
cording to standardized procedures. Upon completion
of the testing, each subject then received a CT scan of
the head (without contrast) using the 1010 EMI scan-
ner.
Quantification of Findings
Results on the 11 LNNB-C scales were converted
to T-scores derived from the initial standardization
591
sample of 125 normal children. Summary values were
also computed for each subject, including: the profile
mean and the number of scales elevated at or beyond
T-60 and T-70 (indicators of overall impairment), the
profile standard deviation (an index of inter-scale
variability), as well as differences between the right
and left hands on the motor and tactile scales (indices
of lateralized impairment in lower functions). Results
on the HRNB were converted to scaled scores (0 =
normal or better, 1 = slightly below normal, 2 =
probably impaired, and 3 = definitely impaired) and
summed according to the system of normative rules
developed by Selz and Reitan (1979). Besides the sum
of scaled scores (an index of overall impairment),
several other summary values were computed for each
subject, including: level of performance sum, right-left
differences sum, as well as total number of symptoms
on the Aphasia Screening Test.
The CT scan yielded a total of 12-14 films (slices)
for each subject, each providing a cross-sectional im-
age (160 X 160 pixels) of the brain at successive levels
of depth. Each cut represented a thickness of about 8
mm. No scan showed indications of movement artifact
or any other procedural problems. The CT results
were examined through indices of both ventricular
size and regional density as described by Golden and
his colleagues (Golden et al., 1980, 1981). First, a
ventricular-brain ratio (VBR) was computed for each
subject. This involved selecting the CT slice in which
the lateral ventricles were most prominent (generally
the 8th or 9th from the bottom). A fixed planimeter
was then used in determining the area of the lateral
ventricles and the inner table of the skull, respectively,
by tracing around the perimeter of each. The area of
the lateral ventricles (and actually the third ventricle
as well) was then divided by the total area of the
intracranial space in arriving at the VBR. This pro-
cedure was performed separately by two raters (who
were blind to the neuropsychological results) until
each independently reached the criterion of obtaining
three VBRs that differed by no more than 0.005 point.
These values were averaged for each rater (inter-rater
agreement: r = 0.96), and then averaged between
raters in arriving at a single VBR for each subject.
Next, the method for computing regional densities
involved subdivision of the intracranial space (5 pixels
inward from the inner edge of the skull on the 160 x
160 CT density printout) into 8 sections: 2 anterior
and 2 posterior for each hemisphere. The approximate
localization of these regions was as follows: region 1
= frontal; region 2 = premotor, sensorimotor, and
anterior temporal; region 3 = posterior temporal and
parietal; region 4 = parietal-occipital. The numerical
values corresponding to tissue densities were sampled
592 MICHAEL G. TRAMONTANA AND STEVEN D. SHERRETS

within each region by having the computer count every our method of measuring ventricular size (like that of
fourth point from the midline outward on each hori- Golden et al. (1980)) would tend to yield larger ratios
zontal line of the CT printout. These were then aver- due to inclusion of the third ventricle. With respect
aged to yield a representative density value for each to brain density, our group had a mean total density
of the 8 regions analyzed. This was done for each of 3 of 39.58, with left density = 39.80 and right density =
CT slices: the one in which the lateral ventricles were 39.35. These values were somewhat smaller than what
most prominent (slice A) and the two immediately Golden et al. (1981) found for adult controls (the
higher (slices B and C). Besides these individual den-: comparative values being: total density = 42.34, with
sity measurements, various summary values were left density = 42.81 and right density = 41.86), and
computed for each subject, including: total density, were more like the results obtained for their chronic
left density, right density, and regional density (based schizophrenics (total density = 39.93, with left density
on the weighted means for the regional values across = 40.20 and right density = 39.66). These, however,
the 3 CT slices); total, left, and right density for each may have simply reflected developmental differences
CT slice; total, left, right, and regional variability with respect to the present study sample.
(these being weighted average S.D. values based on Total brain density tended to correspond very
individual S.D. values for the regional densities within highly with the other density variables, even when
each of the 3 CT slices); as well as the relative density broken down according to region and level (slice).
of the two cerebral hemispheres (based on the differ- Lesser but moderate correlations were also found be-
ence in overall weighted and unweighted mean den- tween mean density and density variability, with
sity). greater density values being associated with greater
structural variation within and across different brain
Results
regions. The VBR, however, apparently provided a
Neuropsychological Results largely independent appraisal of brain structure, as it
On the HRNB, the subjects demonstrated an inter- showed little correspondence with the other CT vari-
mediate level of impairment in the overall perform- ables.
ance (M = 26.21 vs. values of 10.60 and 40.60 previ-
ously found by Selz and Reitan for normal and brain
Neuropsychological] CT Correspondencies
damaged groups, respectively), with 60% of the sub- Table 1 shows the differences obtained between
jects being classified as impaired on the basis of the HRNB impaired and non impaired subjects with re-
Selz-Reitan cutoff for designating abnormal perform- spect to their CT results, age, academic achievement
ance (i.e., Sum of Scaled Scores of 20 or higher). and intellectual performance. (Subjects were classified
Likewise, on the LNNB-C, the psychiatric youngsters as impaired on the HRNB according to the Selz-
produced an average T-score elevation (M = 59.69, Reitan cutoff-i.e., a Sum of Scaled Scores of 20 or
S.D. = 11.86) across the 11 scales that was almost 1 higher.) There was some tendency for the impaired
S.D. beyond the normative mean. Application of dif-
TABLE 1
ferent cutoffs with respect to their Luria profiles (i.e.,
Differences between HRNB Impaired (N = 12) and
2 or more scale elevations at or beyond T-70; 3 or
Nonimpaired (N = 8) Subjects"
more scale elevations at or beyond T-60) yielded im-
Non-
pairment rates ranging from 50% to 70% for the Impaired
Variable M impaired p"
sample. M
Overall, therefore, at least half of the sample of Age (months) 1:~5.8:3 156.00 -2.05 0.06
psychiatric youngsters were identified as neuropsy- PlAT
chologically impaired, with there being 80% to 90% General information 87.50 101.00 -2.16 0.05
agreement in impairment cutoffs between the two Total test 83.17 96.38 -1.93 0.07
batteries (better with the 3 T-60 rule for the Luria). WISC-R
Performance IQ 90.00 103.25 -1.74 0.10
Moreover, overall results on the two batteries (HRNB
Pattern (intersubtest 1.11 .81 2.94 0.01
Sum of Scaled Scores vs. LNNB-C Profile Mean) were scatter)
found to correlate quite highly-i.e., 0.92. CT Densities
Left/Right relative 1.17 1.75 3.05 0.01
CT Results density
The VBRs for the subject sample ranged from 3% Note. HRNB = Halstead-Reitan Neuropsychological Battery;
to 10%, with a mean of6.17%. Although this appeared PlAT = Peabody Individual Achievement Test; WISC-R = Wechs-
to be considerably larger than the mean VBR that ler Intelligence Scale for Children-Revised.
a Using the Selz and Reitan (1979) cutoff: Impaired = a sum of
Reiss et al. (1983) reported for child controls (1.3%), scaled scores of 20 or higher.
these values are not directly comparable, insofar as b Only differences with p = 0.10 or better are listed.
 BRAIN IMPAIRMENT IN CHILD PSYCHIATRIC DISORDERS 593
TABLE 2
Differences between LNNB-C Impaired (N = 14) and Nonimpaired (N = 6) Subjects"
Impaired Nonimpaired
Variable
M M
Age (months) 137.86 158.00 -1.89 0.08
PlAT
Reading recognition 88.21 105.00 -2.19 0.04
Total test 84.21 98.33 -2.25 0.04
WISC-R
Pattern (intersubtest scatter) 1.08 0.78 2.63 0.02
CT Densities'
Left/Right relative density 1.21 1.83 3.01 0.01
Left 1 42.97 45.18 -1.83 0.08
Right 1 42.32 45.16 -2.48 0.02
Right 2 35.84 37.52 -1.80 0.09
Slice B/Left 1 42.68 45.72 -2.09 0.05
Slice A/Right 1 40.39 42.95 -2.44 0.03
Slice B/Right 1 41.90 45.90 -2.89 0.01
Slice C/Right 1 44.90 47.63 -2.08 0.05
Slice C/Right 2 38.17 40.75 -2.30 0.03
Slice C/Right 3 38.19 40.52 -1.86 0.08
Slice A/Right 36.16 38.17 -1.86 0.08
s.D.-Left 6.60 7.11 -2.37 0.03
S.D.-Right 6.53 7.09 -2.25 0.04
S.D.-Total 6.57 7.10 -2.44 0.03
S.D.-Left 2 6.46 7.03 -1.77 0.09
S.D.-Left 3 6.34 7.32 -3.33 0.004
S.D.-Right 2 6.27 7.10 -2.74 0.01
s.D.-Right 3 6.34 7.11 -2.09 0.05
Note. LNNB-C = Children's Version of the Luria-Nebraska Neuropsychological Battery; PlAT = Peabody Individual Achievement Test;
WISC-R = Wechsler Intelligence Scale for Children-Revised.
• Using the cutoff: impaired = 3 or more scale elevations above T-60.
b Only differences with p = 0.10 or better are listed.

c See text for a definition of each of the CT variables listed.

subjects on the HRNB to be younger and to have
poorer overall academic achievement, but neither of
these trends was strong enough to be statistically
significant. Moreover, although they were more vari-
able in their intellectual performance, they only
showed a marginal tendency to have lower perform-
ance IQs. Last, in terms of the CT results, impaired
subjects on the HRNB were more likely to show lesser
right hemispheric density relative to left hemispheric
density. This was the only CT variable on which they
differed.
Table 2, in contrast, shows the more striking differ-
ences that were obtained with the LNNB-C. (Subjects
were classified as impaired or nonimpaired in their
overall LNNB-C results using the 3 T-60 cutoff rule.)
As with the HRNB, the impaired subjects on the
LNNB-C also tended to be younger and were more
variable in their intellectual performance, but were
more clearly lagged in their academic achievement
(especially in reading recognition). They also showed
lesser right hemispheric density relative to left hemi-
spheric density, but were distinguished on a host of
other CT variables as well. Specifically, they showed
less right-frontal density at all levels (A, B, and C), as
well as differences involving central regions of the
right hemisphere at higher cortical levels (slice C).
There were also differences in left-frontal density, but
these were limited to slice B. Moreover, they showed
less density variation in both hemispheres-mainly in
the more central regions, but especially in left-region
3 (parietal).
It is important to emphasize that, as with the
HRNB, impaired youngsters on the LNNB-C did not
differ with respect to overall intelligence. Thus, intel-
ligence as a factor cannot account for the differences
that were obtained. However, whereas subjects with
poorer overall performance on the LNNB-C (Profile
Mean) were more chronic (r = 0.45, p < 0.05), this did
not reach significance in the case of the HRNB (r =
0.36, p < 0.12). Moreover, male subjects as compared
with female subjects were more likely to be impaired
on the LNNB-C (t = 2.61, p = 0.02) but not on the
HRNB.
Although the subjects classified as neuropsycho-
594 MICHAEL G. TRAMONTANA AND STEVEN D. SHERRETS

logically impaired did not show an overall difference TABLE 4

with respect to ventricular size, there were correspon- Neuropsychological Correspondencies with Left/Right Relative
dencies between ventricular size and more specific Density"
aspects of neuropsychological performance. These are Variable rb p
shown in Table 3. It appears that difficulties on an PlAT general information -0.45 0.05
assortment of neuropsychological tasks-perhaps es- WISC-R
pecially those having a spatial and/or motor compo- Digit span -0.52 0.02
nent-were associated with smaller VBRs. The only Picture arrangement -0.46 0.05
Coding -0.57 0.01
exception to this general pattern was in the case of Performance IQ -0.52 0.02
lateralized dysfunction on the tactile scale of the HRNB
LNNB-C, which for the present subjects was appar- Tactual Performance Test- 0.45 0.05
ently related to larger ventricular size. total time
Table 4 provides a more detailed examination of the Tapping-nonpreferred hand 0.46 0.05
Level of performance-sum 0.56 0.01
neuropsychological correspondencies involving differ- Sum of scaled scores 0.53 0.02
ences in hemispheric density-the only CT variable LNNB-C
which distinguished impaired subjects on both the Expressive speech 0.45 0.05
HRNB and LNNB-C. Not only was the presence of Math 0.45 0.05
Memory 0.44 0.05
lesser right hemispheric density (relative to left hem-
T-60 elevations 0.46 0.05
isphere density) associated with poorer overall per- Profile M 0.44 0.05
formance, it also showed specific relationships with
Not e. PlAT = Peabody Individual Achievement Test; WISC·R
performance difficulties in tasks that are generally = Wechsler Intelligence Scale for Children-Revised; HRNB = Hal-
thought to tap right hemispheric functions (Picture stead-Reitan Neuropsychological Battery; LNNB-C = Children's
Arrangement, Performance IQ, Tactual Performance Version of the Luria-Nebraska Neuropsychological Battery.
Test, Tapping-nonpreferred hand, as well as the " Relatively greater den sity of left vs. right hemisphere based on
Math scale on the LNNB-C). It should be noted that difference in unweighted mean density; positive differences (greater
left hemisphere density) were assigned a score of 1, whereas negative
this was the only analysis where reported results were differences (greater right hemisphere density) were assigned a score
based on unweighted mean values for hemispheric ofO.
density, and that the obtained relationships largely b For the sake of brevity, only correlations that were significant

disappeared when weighted values were instead used. at p = 0.05 or better are listed.
This was probably because the weighting process
would tend to favor lower brain regions (because of appeared to involve higher cortical regions (see Table
the greater number of data points counted) but, as 2).
was indicated before, the reductions in right hemi- Discussion
spheric density among the impaired subjects mainly
Once again, this study found a fairly high rate of
TABLE 3
neuropsychological abnormality among hospitalized
N europsychological Correspondencies with Ventricular-Brain Ratio
(VBRJ child and adolescent psychiatric patients. These were
all "nonreferred" cases for whom brain dysfunction
Variable
--.-- - - _._._-_._- r" p
had not been suspected, who nonetheless showed at
WISC-R coding 0.48 0.05
least a 50% rate of impairment when existing cutoffs
HRNH
Tactual Performance Test -0.55 0.02 on either neuropsychological battery were applied.
(TPT)- total time With respect to the structural findings, there appeared
TPT- loca lizat ion -0.46 0.05 to be two general patterns that characterized the
Speech-errors -0.45 0.05 correspondences between the neuropsychological re-
Tapping-s-preferred hand -0.47 0.05
sults and CT data for the present subject sample.
Tapping-c-nonpreferred hand -0.48 0.05
Level of performance-sum -0.49 0.05 First, in terms of brain density, neuropsychological
LNNH -C abnormality among the subjects tended to be associ-
Math -0.55 0.02 ated with lesser right hemispheric density, particularly
Right-Left differences: tactile 0.46 0.05 in frontal and higher cortical regions. It was particu-
scale
- - ---- - - -- --
- -- - - ~-- _.. -
~ . _-- --_._- larly interesting that this pattern of CT results showed
Not e. WISC-R = Wechsler Intelligence Scale for Children-Re- a specific relationship to performance difficulties on
vised; HRNB = Halstead-Reitan Neuropsychological Battery;
neuropsychological tasks that are generally thought
LNNH-C = Children's Version of the Luria-Nebraska Neuropsy-
chological Battery. to tap right hemispheric functions. Involvement of the
• For the sake of brevity, only correlations that were significant left hemisphere was comparatively less, and appeared
at p = lUll) or hetter are listed. to be limited to lower anterior regions. The greater
 BRAIN IMPAIRMENT IN CHILD PSYCHIATRIC DISORDERS
apparent involvement of right hemispheric impair-
ment among the subjects may have been a result of
the selection process which screened out youngsters
with "known" brain dysfunction. That is, to the extent
that left hemispheric impairment is manifested in
more obvious symptoms (e.g., speech difficulties), it
may have been preferentially excluded in the selection
of subjects.
The other general pattern among the subjects
seemed to involve the correspondence between neu-
ropsychological abnormality and both smaller ventric-
ular size and reduced density variation of the brain.
These relationships may have been specific to the
restricted range of the present subject sample on these
dimensions. That is, we would expect larger VBRs to
occur with diffusely brain-damaged children, whereas
indices of greater density variability would likely exist
among children with localizing lesions. Except as
noted above, most of our subjects probably fell in
neither of these categories, but perhaps stood at the
lower end of the normal distribution with respect to
ventricular size and density variation. In this regard,
Barron et al. (1976) have reported almost a twofold
increase in the VBR of normal subjects from the first
to second decade of life. As sharp an increase appar-
ently does not occur again until the 70s, possibly in
conjunction with shrinkage of white matter. In earlier
years, ventricular growth is likely a concomitant of
the increased differentiation of cerebral structures
that occurs with normal development. Within limits,
this differentiation would likely be manifested on the
CT in terms of increased density variation within and
across different cerebral regions. It would appear that,
as a group, our subjects may have been delayed in this
process. Thus, rather than damage, neuropsychologi-
cal abnormality among a number of our psychiatric
youngsters may have instead reflected a delay in nor-
mal brain maturation. This interpretation would have
been further strengthened had we actually obtained
an overall correlation between ventricular size and
density variability among the subjects, as well as be-
tween each of these variables and age. It was notewor-
thy, however, that neuropsychological impairment
tended to be more likely among the younger subjects
and, on the LNNB-C, was more common among boys.
Indications were that the HRNB and LNNB-C yield
very similar neuropsychological results for older chil-
dren. Indeed, overall results on the two batteries were
found to correlate as highly as 0.92 (see Tramontana
et al. (1983) for a more detailed discussion on the
comparability of these two batteries). Of the two bat-
teries, however, it was the LNNB-C that showed a far
greater correspondence with the more localized struc-
tural variables that were examined. Perhaps this re-
595
fleeted the relatively greater emphasis that the
LNNB-C purportedly gives to the assessment of spe-
cific component skills underlying broader neuropsy-
chological functions (Golden, 1981).
This study provided only a preliminary analysis of
the particular relationships that were examined. The
sample size was small and it was heterogeneous with
respect to psychiatric diagnosis. Thus, apart from the
observed relationship involving chronicity and im-
pairment on the LNNB-C, the findings of this study
cannot be related to any particular type of child or
adolescent psychopathology. The fact that many of
our subjects (70%) were receiving psychotropic medi-
cation when tested may be viewed as a potentially
confounding factor in evaluating their neuropsycho-
logical performance. However, in an attempt to ex-
amine possible medication effects, we found that sub-
jects not receiving medication scored significantly bet-
ter on tapping-preferred hand (t = 3.26, p = 0.004)
and coding (t = 2.67, p = 0.016). No other differences
were obtained on any of the remaining neuropsychol-
ogical variables. Although this did not constitute a
controlled test of medication effects, the findings were
compatible with the results of other studies which
have failed to show major medication effects on neu-
ropsychological test results (Heaton and Crowley,
1981).
Perhaps the major limitation of the study was the
fact that CT results for suitable control subjects
within this age range were not available for direct
comparison. Thus, the CT results of our psychiatric
youngsters-although associated with neuropsycho-
logical abnormality-were not themselves necessarily
abnormal according to any established normative
standards. In fact, clinical review of the CT films by
a neuroradiologist (who was blind to the neuropsy-
chological findings) resulted in only one subject's scan
being read as definitely abnormal (a right parietal
lesion) and another six as "questionable." The nor-
mative data presently available for children (Barron
et aI., 1976; Fukuyama et aI., 1979; Pedersen et aI.,
1979) are far too limited to permit the evaluation of
subtle irregularities in CT results. Also, as emphasized
by Luchins (1982), results across studies are often not
comparable due to differences in equipment or mea-
surement technique. The recruitment of age-matched
controls for direct comparison will be particularly
important in future CT studies of this kind, especially
in evaluating the possibility of delays in normal brain
maturation. However, because of the ethical con-
straints involved in obtaining CT scans on normal
children, control groups will likely have to consist of
youngsters who are referred for a CT scan in a rule-
596 MICHAEL G. TRAMONTANA AND STEVEN D. SHERRETS
out situation, and whose scans are later judged as
normal according to well-defined criteria.
Perhaps the most important conclusion to be drawn
from the present study is that the neuropsychological
irregularities found among the psychiatric youngsters
did show a correspondence to variations in brain struc-
ture-an important finding in view of the relatively
restricted range of the sample on this dimension and
their "nonreferred" status. Further study will ob-
viously be needed in more precisely defining the nature
and extent of neuropsychological abnormalities in
more homogeneous subgroups of child psychiatric dis-
order.
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