A 12-year old male with a severe TBI developed SADHD and significant problems with pragmatics of communication. Regulation of anger and sadness was unremarkable. Six months postinjury he was challenged more at school and fell behind his class. He experienced irritability, anger, and sadness and a diagnosis of an adjustment disorder with mixed emotional features was made. The clinician's formulation was that his affective instability was an indirect result of his TBI i.e. cognitive challenges led ultimately to school failure and his response included irritability and sadness.
A 13-year old male with a severe TBI developed SADHD and significant challenges with pragmatics of communication. He was diagnosed with PC, affective instability subtype because regulation of anger and sadness was impaired in the hospital and persisted throughout the first year after the TBI. Six months postinjury he was challenged more at school and fell behind his class. He became even more irritable and sad but did not meet criteria for a major depression. The clinician's formulation was that his affective instability was a direct result of his TBI i.e. poor mood regulation and cognitive problems led to school failure and reduced his teacher's effectiveness in working with him.