Cognitive and behavioral outcomes for children who sustain early brain insult (EBI) were evaluated in relation to age at insult in a study at Royal Children’s Hospital, Victoria, Australia. Grouped according to age at time of focal brain insult, 36 sustained congenital (first-second trimester) injuries, 33 perinatal (third trimester to 1 month post-natal), 23 were in infancy (2 months to 2 years after birth), 19 preschool (3 to 6 years), 31 mid-childhood (7-9 years), and 19 late childhood (after age 10 years). Children were tested for intelligence, academic ability, executive function, and behavior. Children with EBI were at increased risk for impairment in all domains of cognition and behavior, with mean scores falling 1SD below expectations. Low scores in arithmetic were especially common, occurring in 63% of EBI children. EBI before 2 years resulted in global cognitive deficits, whereas injury sustained after 2 years of age was followed by near normal cognitive development. In contrast, behavior was worse in older children with EBI from 7 to 9 years compared to those sustaining injury from 3 to 6 years. The age at the time of brain insult is important in predicting risk of cognitive and behavioral outcomes in children with EBI, but patterns of vulnerability differ with respect to age at insult. 
COMMENT. Children who sustain an early brain insult are at increased risk of developing impairments of cognition and behavior. Injury in the pre- or perinatal period or in early childhood results in cognitive deficits whereas injury in later childhood is more likely to result in behavioral problems. The findings indicate an increased vulnerability of the young brain and a lack of evidence to support theories of brain plasticity. Children with a history of brain injury before, at birth or before 2 years of age are at risk of persistent impairments of learning that require early interventional therapy.