Dr. Sandra Chapman
Dr. Sandra Chapman

Delayed Pain

Delayed Pain
A new study finds enduring effects from early brain trauma

Craig Bennett, squirming out of his mother's grip and racing across the street, was 4 when the drunken driver hit him. He landed some 30 feet away, unconscious, with his shoes knocked off his feet and the swelling in his brain growing. He died three times on the way to Parkland Memorial Hospital.

Craig lapsed into a coma after the doctors repaired his ruptured colon and eased the pressure from his swollen brain. Three weeks later, in early February 1993, Craig woke up. But he woke up without knowing how to eat, dress himself or speak. Three months after that, still in a daze, still unable to talk, his mother, Adelita Avila, took him home in a wheelchair, in diapers.

"Be prepared," hospital personnel told Avila. "This is the way Craig may function for the rest of his life."

But it wasn't. Once home, Craig recognized familiar objects, and, slowly, his condition improved.

One day, Avila received a letter from the Center for Brain Health at the University of Texas at Dallas. Doctors and academics there were studying children with brain trauma, following their progress for much longer than any other study had. Avila agreed to participate.

Today, Craig is one of the roughly 850 kids the Center for Brain Health, led by Dr. Sandra Chapman, has tracked. And what Chapman has found challenges 70 years of medical thinking.

What's new is not that Craig, within a year of his accident, regained all the cognitive and mechanical functions he'd lost--science had always thought the earlier the brain injury, the more likely the recovery. What's new is what happened after that, for Craig and the 850 kids Chapman has studied: 10, sometimes 15 years later, impulsive, even violent behavior where before there was none; a decline in school performance; an inability to make sound judgments.

What's causing these erratic behaviors? The onset of puberty and the ever-changing teenage brain.

That the teenage brain is not fully developed is itself a novel discovery. Five years ago, even, the medical community thought the brain was hard-wired for life by age 12. But because of experts like Dr. Chapman, whose work contributes heavily to the recent findings on the teenage brain, the American Medical Association last week made a plea to the Supreme Court, arguing that a Missouri teen who murdered a 46-year-old truck driver should get a life sentence instead of the death penalty. The AMA says that at the time of the murder, the 17-year-old's brain wasn't fully developed.

But back to Dr. Chapman. Since medical school, she'd been interested in following children with brain injuries. Seventeen years ago she started her research with grants from the National Institute of Health, tracking 200 kids at a time, checking in with each every six months, taking on more kids when their parents consented, testing and detailing all their developments until trends emerged.

Most of the kids she followed were injured in car accidents. Much of the damage was found in the kids' frontal lobes, or prefrontal cortex, the area of the brain responsible for impulse control and abstract reasoning.

Time and again, Chapman and her collaborators would watch as children made miraculous recoveries in the year after their injuries. And then, as puberty hit, parents would report sudden, erratic behavior and poor grades.

Puberty, it turns out, is when the prefrontal cortex matures. To prove it, Dr. Jay Giedd at the National Institute of Mental Health scanned certain children's brains with an MRI every two years to show how the frontal lobes develop even into one's mid-20s.

Abigail Baird, a development neuroscientist at Dartmouth University, showed teenagers pictures of faces in different states of emotion. The adults tested in Baird's study were able to identify a fearful face as a fearful face, or a surprised face as a surprised faced. The teenagers couldn't do that. Mature frontal lobes are known for differentiating between emotional expressions.

As the evidence mounted, a new theory arose: Teenage brains undergo a biological maturation that is second only to that of infancy. As the AMA brief before the Supreme Court said last week: "Scientists can now demonstrate that adolescents are immature not only to the observer's naked eye but in the very fibers of their brains." And this is for the normal kids.

For the children with frontal-lobe brain injuries, the teenage years mean, to some extent, stagnation in the prefrontal cortex. They act more impulsive, at times more violent, than their non-injured peers. And they struggle more with abstract questions: Dr. Chapman published a study last year that showed an inability among brain-injured children to grasp important points from a story they read, or understand the story's gist, whereas children in the control group were able to decipher the story's theme.

Dr. Steven Kernie, who works in the trauma unit at Children's Medical Center in Dallas, now tells parents whose children have endured brain injuries to anticipate, at puberty, symptoms similar to the ones Dr. Chapman studied.

Chapman is still tracking children, but toward a different end. She recently secured grants to study her kids as they interact in social situations with their peers.

Craig Bennett's now a sophomore in high school. His mother views his life as a miracle of science and God, but not necessarily in that order. Craig's on the football team, though he has to wear a special helmet--with its extra padding, Avila calls it "the Troy Aikman helmet." His marks in school are good--earlier this year he was student of the week--but he struggles mightily for those good grades and is allowed extra time to work on tests.

But if you degrade Craig, even in jest, he is known to blow up and become quite angry. Sometimes, Avila's oldest son, Joey, will call her at work, unable to calm down his brother. "It's Craig," Joey will say. "He's acting up again." That's when Avila tells Joey to see if Craig's taken his prescribed medication to soothe his impulsivity. "Nine times out of 10," Avila says, "he hasn't." --Paul Kix

Viva la Alcaldesa!

Little Havana, a month-old restaurant on Greenville Avenue, boasts that it serves the most authentic Cuban food in the city. You can even get non-Cuban cigars there to smoke on one of two open-air patios. You can, that is, unless you're Mayor Laura Miller.

Miller has been barred from Little Havana, much like tobacco smoke, which was banned from Dallas restaurants by a city ordinance pushed by Miller.

The mayor may not be allowed in Little Havana, but her face is there, prominently displayed on the restaurant's version of a no-smoking sign required by the city. A doctored photo depicts Miller wearing green military fatigues and cap, one finger upraised, peering at The Man himself, Fidel Castro, who's puffing on a big cigar. "Madam No is banned from Little Havana by order of the owners. Oh, and...no smoking," the sign reads. "It's meant to be lighthearted, but the message is clear," says John Leatherwood, general partner in Little Havana. "We're all about people being able to make choices."

Lighthearted, maybe, and Little Havana is not looking to start a political movement--they want non-smokers and smokers alike as customers--but it's serious, too. The mayor really can't come in, Leatherwood says.

If you're thinking that restaurant owners know how to hold a grudge--the smoking ban is nearly two years old, after all--you may be right. Tracey Evers, executive director of the Greater Dallas Restaurant Association, says that while the ordinance has harmed some restaurants, it has left owners generally feeling dissed by the city. "We need a city government that understands we're an economic engine in this city," Evers says. "We need all the help we can get."

Nevertheless, the fact that the mayor can't get a Cuban sandwich or mojito at Little Havana isn't likely to change her mind. "The mayor has been thrilled with the smoking ordinance and the feedback we have been getting," says Crayton Webb, her chief of staff.

In fact, leaders from other communities have called City Hall, asking about replicating the smoking ordinance. Madam No's revolution may spread. --Patrick Williams

Donkey Kong

What they teach at Southern Methodist University's Guildhall is video games--how to design them, program them, critique them. This avant-garde graduate program does not teach politics, but politics has entered a Guildhall student's latest project.

Ray Barbiero, a 22-year-old programmer who's graduating next December, made political Pac-Man in his free time and released the game on the Web last week. In the game, the head of George Bush or John Kerry gobbles up bags full of campaign dollars while avoiding either donkeys or elephants, depending on party affiliation. Once the money's gone, a swing state appears for the nominee's taking. One then proceeds to the next level, where there's more money and swing states and crazed attackers.

"In writing this game," Barbiero says--"writing" serving as tech-speak for "programming"--"I kind of didn't want to stop."

No kidding he didn't. The idea to make the game came from a midterm last semester. He was told to create Pac-Man from scratch in five hours. Once Barbiero finished the test, he had a "cool" idea, stayed until midnight and worked on the game he really wanted to make.

Some three months later, between other projects and after consultations with his professors, Barbiero's Pac-Man is available for download at http://guildhall.ecsrv.smu.edu/work/BallotByte.htm.

"I made this game as bipartisan as possible," Barbiero says. "I dare anybody to catch me on it."

For the sake of the game, Barbiero won't reveal whom he's voting for. But he hopes in playing it, some people will vote who otherwise wouldn't.

And no, the game isn't a statement in support of campaign finance reform. "They'll always figure out ways around those things," Barbiero says. --Paul Kix


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