By Jay Wellons, M.D. and David Nilsson, Ph.D.
Article first appeared in Pathways, Fall edition 2008
From a developmental perspective, hydrocephalus, as with other forms of neurologic compromise, demonstrates its most prominent disruption to ongoing neurodevelopmental progression of the individual child. As such, many of the developmental consequences of childhood are less obvious, but as the child progresses into adolescence, neurocognitive and neurobehavioral consequences (e.g., emotional disorders, reactive irritability, emotional volatility) become more apparent. Children with neurologic compromise progress adequately with some support through early grade school, but with progression to middle school and the increasing demand for speed and complexity, problems become more apparent in learning.
Given the subtlety and complexity of social interaction, children with neurologic compromise begin to struggle to a much greater degree and often do not receive sufficient educational or developmental support to optimize social interaction. It becomes critical to begin neurodevelopmental support early, usually before problems become more apparent. Helping the child “be the best he can be” is the goal of all parents.
Children with a history of hydrocephalus commonly are of normal intellectual ability, but the specific nature of their genetic predisposition and neuropathy leads to a variety of educational problems that need to be addressed individually and as early as possible in developmental progression. Often these children are able to acquire basic skills, but the inherent difficulty is that of conceptually integrating and organizing the information into more complex conceptual units. For example, children with hydrocephalus often have reading skills within normal limits, but they children with hydrocephalus often do not comprehend easily what they read or are particularly slow in processing the information. As such, children with hydrocephalus tend to require specific educational accommodations to reduce stress and facilitate optimal performance. Often they may also require a lot more specific information in explaining circumstances, consequences, and other details.
As for any teenager, the child with hydrocephalus has a strong desire to participate in activities with peers, but may struggle to keep up. Most prominent areas are sports, dating, and driving. Sports may present problems given the physical limitations for some patients with shunts and their vulnerability to more severe consequences of concussion. Many sports require visual-spatial orientation, judgment, and problem solving, which are routinely difficult for children with any neurologic injury or neurodevelopmental disorder. Given the visual-spatial compromise and decreased speed of processing, driving becomes a particular difficulty, given the difficulty finding their way around and the demands for multisensory processing required for driving, both within and outside the car. Dating is another problem given the difficulty reading nonverbal social cues, anticipating consequences, and organizing more complex social interactions than children with hydrocephalus have been required to perform earlier in their development.
Each child is unique, and many of the consequences of a child’s ability to perform are highly dependent on his or her hydrocephalus and genetic disposition. A child’s learning environment, the developmental support a child receives, as well as the complexity and severity of their neurologic insult all contribute to developmental outcome. Key factors in the developmental progression are anticipating and recognizing areas of difficulty, intervening early and providing optimal levels of neurodevelopmental and educational support.