Pseudodepressive personality and mental inertia in a child with a focal, left‐frontal lesion

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Abstract
Very few pediatric cases with focal frontal lesions have been documented psychia‐trically. Orbitofrontal lesions in adults produce a pseudopsychopathic personality syndrome with impulsivity, and dorsolateral and frontomedial lesions produce a pseudodepressive personality syndrome with mental inertia. A frontal profile similar to character disorder several times has been reported in children with frontal lesions, but pseudodepression never has been reported. SC2, a 7‐year‐old girl, had a left‐frontal cavernous hemangioma partially surgically removed at age 3. Low academic achievement and concern about lack of communicativeness and initiative motivated referral. She is a strong prototype of the pseudodepressive‐inert type, but she is not at all a prototype of the pseudopsychopathic‐impulsive type, thus being the first reported pediatric focal frontal lobe lesion case displaying this particular profile. SC2 is a quiet, aloof, amorphous, trouble‐free schoolchild. She is impaired in a wide range of cognitive (executive) functions on many of the cognitive tests administered; and she requires excessive motivational and cognitive support to complete tests such as the Wechsler Intelligence Scale for Children (3rd ed.), the Auditory Verbal Learning Test, and others. All her deficits can, however, be tagged to one or another form of inertia, but never to impulsivity. On tests, she is perseverative, lacks initiative and strategy, and is slow and concrete when creative or sustained processing are required by the task. She shows no sign of depressed mood according to the Achenbach Depression subscale and numerous observations from various other sources. In short, there are 2 highly distinct syndromes of personality and cognition that result from focal frontal lobe lesions in the child, just as in the adult.

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