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For two days Andrew was monitored with an EEG ambulatory monitoring device. The aim of this was to exclude any possible role of seizure discharge contributing to any period of disorientation. This was not started until Andrew had spent at least two weeks in the centre. The nurses observed that surprisingly, even for a boy of this age, he was still unable to find his way round the centre without adult help. Moreover he frequently mislaid his possessions, could not remember his place when playing board games, and games like Pelmanism that require a good recall of spatial location would reduce him to tears.

5). These results were disappointing in view of the obvious improvement in his clinical condition, and also somewhat puzzling, since one might have expected high scores from practice effects alone on those tasks without equivalent forms, namely WISC-R. Philip was seen again three years later. His clinical condition had remained steady on the drug regime introduced at the earlier admission and he was in mainstream school preparing for GCSEs. On this admission he was still slow at Coding (age-scaled score=4), and obtained a low score for Rey recall (10), but Rey copy was average (30), and Paired Associate learning was also unimpaired (initial learning score=18).

At this stage it is perhaps useful to point out that the distinction between developmental and acquired disorders is also being questioned (see Temple, 1991a). , 1985). For the clinician attempting the assessment of children’s current levels of understanding, this suggests that test results, even age-old favourites like Verbal-Performance discrepancies on IQ tests, should be interpreted with caution. In patients with early-onset lesions, irrespective of age at assessment, test results are rarely a reliable guide to the lateralization or the localization of lesions.

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