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Clinical Observation of Self-Injurious Behavior Correlated With Changes in Scalp Morphology in a Child With Congenital Hydrocephalus

University of Minnesota, Minneapolis

Elizabeth Gilles, MD

University of Minnesota, Minneapolis, Children's Hospitals and Clinics, and Gillette Children's Specialty Healthcare, St. Paul, Minnesota

Jennifer J. McComas, PhD

University of Minnesota, Minneapolis

Stacy E. Danov, MA

University of Minnesota, Minneapolis

Frank J. Symons, PhD

University of Minnesota, Minneapolis, symon007{at}umn.edu

We report the case of a 12-year-old girl born with cerebral dysgenesis and congenital hydrocephalus first shunted shortly after birth. She had severe tissue-damaging self-injurious behavior, profound mental retardation, quadriparesis, as well as multiple cranial anomalies including turricephaly. After stage 1 cranial remodeling, a bone window was left pending second stage remodeling. Episodic changes in fluctuation of the scalp overlying the bone window were easily observed. During the course of a behavioral assessment for her self-injury, it was observed that the overall frequency of occurrence of self-injury increased significantly (P < .01) when the scalp was protruding and bulging compared with when the scalp was flush with the skull table. Periods of increased scalp protrusion were also associated with higher scores on a pain scale developed for children with communicative impairments associated with severe neurological impairment. After shunt replacement, there was remarkable improvement in functional status and decreased episodic self-injury.

Key Words: self-injury • pain • functional analysis

Journal of Child Neurology, Vol. 23, No. 9, 1062-1065 (2008)
DOI: 10.1177/0883073808314155


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