Research Reports - Pediatric traumatic brain injury and attention deficit

Pediatrics. 2015 Sep;136(3):534-541. Epub 2015 Aug 3.

Königs M(1), Heij HA(2), van der Sluijs JA(3), Vermeulen RJ(4), Goslings JC(5),
Luitse JS(6), Poll-Thé BT(7), Beelen A(8), van der Wees M(9), Kemps RJ(10),
Catsman-Berrevoets CE(11), Oosterlaan J(12).

BACKGROUND: We investigated the impact of pediatric traumatic brain injury (TBI)
on attention, a prerequisite for behavioral and neurocognitive functioning.
METHODS: Children aged 6 to 13 years who were diagnosed with TBI (n = 113; mean
1.7 years postinjury) were compared with children with a trauma control injury
(not involving the head) (n = 53). TBI severity was defined as mild TBI with or
without risk factors for complicated TBI (mild(RF+) TBI, n = 52; mild(RF-) TBI, n
= 24) or moderate/severe TBI (n = 37). Behavioral functioning was assessed by
using parent and teacher questionnaires, and the Attention Network Test assessed
alerting, orienting, and executive attention. Ex-Gaussian modeling determined the
contribution of extremely 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 control group (P < .05, d ≥ 0.34). No effect of TBI
on alerting, orienting, and executive attention was observed (P ≥ .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 mild(RF-) TBI group was unaffected, whereas
the mild(RF+) TBI and moderate/severe TBI groups showed elevated parent ratings
of behavior problems, lower intelligence, and increased lapses of attention (P ≤
.03, d ≥ 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 mild(RF+) TBI (even in the absence of intracranial pathology) or
moderate/severe TBI, and relate to daily life problems after pediatric TBI. 

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