Post-concussive Symptoms and Neuropsychological Performance in the Post-acute Period following Pediatric Mild Traumatic Brain Injury (original) (raw)
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Pediatric Traumatic Brain Injury and Attention Deficit
Background. We aimed to elucidate the impact of pediatric TBI on attention, a prerequisite for behavioral and neurocognitive functioning. Methods. Children aged 6-13 diagnosed with TBI (n=113; M=1.7 years post-injury) were compared to children with traumatic control (TC) injury (n=53). TBI severity was defined as mild TBI without or with risk factors for complicated TBI (mildRF- TBI: n=24 and mildRF+ TBI: n=52, respectively) or moderate/severe TBI (n=37). Behavioral functioning was assessed using parent and teacher questionnaires, while the Attention Network Test assessed alerting, orienting and executive attention. Ex-Gaussian modeling determined the contribution of extreme slow responses (lapses of attention) to mean reaction time (MRT). Results. The TBI group showed higher parent and teacher ratings of attention and internalizing problems, higher parent ratings of externalizing problems and lower intelligence than the TC group (Ps<.05, ds≥0.34). No effect of TBI on alerting, orienting and executive attention was observed (Ps≥.55). MRT was slower in the TBI group (P=.008, d=0.45), traced back to increased lapses of attention (P=.002, d=0.52). The mildRF- TBI group was unaffected, whereas the mildRF+ TBI and moderate/severe TBI groups showed elevated parent ratings of behavior problems, lower intelligence and increased lapses of attention (Ps≤.03, ds≥0.48). Lapses of attention fully explained the negative relation between intelligence and parent rated attention problems in the TBI group (P=.02). Conclusions. Lapses of attention represent a core attention deficit in children with mildRF+ TBI -even in absence of intracranial pathology- or moderate/severe TBI, and relate to daily life problems after pediatric TBI.
JAMA pediatrics, 2018
After traumatic brain injury (TBI), children often experience impairment when faced with tasks and situations of increasing complexity. Studies have failed to consider the potential for attention problems to develop many years after TBI or factors that may predict the development of secondary attention-deficit/hyperactivity disorder (SADHD). Understanding these patterns will aid in timely identification of clinically significant problems and appropriate initiation of treatment with the hope of limiting additional functional impairment. To examine the development of SADHD during the 5 to 10 years after TBI and individual (sex, age at injury, and injury characteristics) and environmental (socioeconomic status and family functioning) factors that may be associated with SADHD. Concurrent cohort/prospective study of children aged 3 to 7 years hospitalized overnight for TBI or orthopedic injury (OI; used as control group) who were screened at 3 tertiary care children's hospitals and 1...