Consistency of neuropsychological outcome following damage to prefrontal cortex in the first years of life.

The consistency of neuropsychological outcome following circumscribed damage to the prefrontal cortex (PFC) in the first years of life has not been systematically investigated. On the basis of a single well-studied case, Ackerly and Benton (1948) postulated that the core profile involves development of a primary social defect in the context of generally normal intellectual abilities. We evaluated the consistency of this profile across all patients in our registry who had focal PFC damage acquired between the prenatal period and 62 months of age (N = 7). Clinical ratings based on detailed evaluations, parental ratings, and neuropsychological testing confirmed this general profile in 5 of the 7 patients. The impairments of social function were evident in early childhood and persisted into adult life. Of the 2 patients who did not fit this profile, 1 had significant social impairment in the context of broader cognitive deficits, and 1 had no significant impairment of social or intellectual function. The profile was not observed in a comparison group with childhood-onset nonfrontal lesions. These findings support the notion that focal damage to PFC in the first years of life leads to the development of substantial impairment of social competencies, albeit with some variability in outcome. Further, the findings highlight the importance of emotional dysfunction and poor behavior regulation in the development of these impairments. Our studies recapitulate and confirm the core messages set forth by Ackerly and Benton more than a half-century ago.