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This matched cohort study examined whether outcomes after standard treatment with hematopoietic cell transplantation (HCT) differ in patients with early stage frontal lesions as compared to parieto\u2010occipital lesions. Retrospective chart review identified seven pediatric patients with frontal cALD lesions and MRI severity score\u2009&lt;\u200910 who underwent a single HCT at our center between 1990 and 2019. Concurrent MRI, neurocognitive and psychiatric outcomes at last comprehensive follow\u2010up (mean 1.2\u2009years; range 0.5\u20102.1\u2009years) were compared with a group of seven boys with the parieto\u2010occipital variant matched on pre\u2010HCT MRI severity score. Both groups showed similar rates of transplant complications and radiographic disease advancement. Neurocognitive outcomes were broadly similar, with more frequent working memory deficits among individuals with frontal lesions. Psychiatric problems (hyperactivity, aggression, and atypical behavior) were considerably more common and severe among patients with frontal lesions. Aligned with the critical role of the frontal lobes in emotional and behavioral regulation, functional disruption of self\u2010regulation skills is widely observed among patients with frontal lesions. Comprehensive care for cALD should address needs for psychiatric care and management.<\/jats:p>","DOI":"10.1002\/jimd.12435","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T15:12:27Z","timestamp":1631200347000},"page":"1434-1440","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Differential outcomes for frontal versus posterior demyelination in childhood cerebral adrenoleukodystrophy"],"prefix":"10.1002","volume":"44","author":[{"given":"Ashish O.","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Nascene","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Minnesota  Minneapolis Minnesota 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