Earlier, I had mentioned the problem created by negative expert opinion, when dealing with children who are missing all or parts of their brain. A friend kindly sent me this in response, from one of the Cambridge Journals.
Note the line in the abstract below, “The relative rarity of manifest consciousness in congenitally decorticate children could be due largely to an inherent tendency of the label ‘developmental vegetative state’ to become a self-fulfilling prophecy.”
Developmental Medicine & Child Neurology (1999), 41: 364-374 Copyright © 1999 Mac Keith Press
Consciousness in congenitally decorticate children: developmental vegetative state as self-fulfilling prophecy
D Alan Shewmon MD a1c1, Gregory L Holmes MD a2 and Paul A Byrne MD FAAP a3
a1 Pediatric Neurology, UCLA Medical Center, Los Angeles, CA, USA.
a2 Department of Neurology, Harvard Medical School Children’s Hospital, Boston, MA, USA.
a3 Pediatrics (Neonatology) Medical College of Ohio, St Charles Hospital, Oregon, OH, USA.
According to traditional neurophysiological theory, consciousness requires neocortical functioning, and children born without cerebral hemispheres necessarily remain indefinitely in a developmental vegetative state. Four children between 5 and 17 years old are reported with congenital brain malformations involving total or near-total absence of cerebral cortex but who, nevertheless, possessed discriminative awareness: for example, distinguishing familiar from unfamiliar people and environments, social interaction, functional vision, orienting, musical preferences, appropriate affective responses, and associative learning. These abilities may reflect ‘vertical’ plasticity of brainstem and diencephalic structures. The relative rarity of manifest consciousness in congenitally decorticate children could be due largely to an inherent tendency of the label ‘developmental vegetative state’ to become a self-fulfilling prophecy.
(Accepted November 13 1998)
The problem will be apparent to anyone who has worked with people with neurological deficits: Like any complex organ, the brain has multi levels of compensation for injuries. Now that neuroscientists can image the brain, many striking cases have come to light, demonstrating ways in which people adapt as best they can. It’s no surprise that this would be especially true of children.
But it’s also no surprise that dumping children in a fourth rate facility and leaving them unvisited can reliably produce a very low functioning individual in only a few years. In fact, a child of average intelligence can deteriorate under those conditions, and many have.
Denyse O’Leary is co-author of The Spiritual Brain.