Impact of Secondary ADHD on Long-Term Outcomes After Early Childhood Traumatic Brain Injury

Abstract

Objective: To examine the impact of secondary attention-deficit/hyperactivity disorder (SADHD) on long-term global and executive functioning in adolescents after traumatic brain injury (TBI). Setting: Three tertiary cared children's hospitals and 1 general hospital. Participants: One hundred twenty children (TBI: n = 54; orthopedic injury: n = 66) without preinjury ADHD evaluated approximately 6.8 years postinjury. Design: Cross-sectional data analysis from a prospective, longitudinal study. Main Measures: Outcomes included functional impairment (Child and Adolescent Functional Assessment Scale) and executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]). Results: SADHD moderated the association of injury type with the BRIEF-Behavioral Regulation Index (F 1,113 = 4.42, P = .04) and the Child and Adolescent Functional Assessment Scale (F 1,112 = 8.95, P = .003). TBI was only associated with poorer outcomes in the context of SADHD. SADHD was also associated with poorer outcomes on the BRIEF-Global Executive Composite (F 1,113 = 52.92, P < .0001) and BRIEF-Metacognitive Index scores (F 1,113 = 48.64, P < .0001) across groups. Adolescents with TBI had greater BRIEF-Global Executive Composite scores than those with orthopedic injury (F 1,113 = 5.00, P = .03). Conclusions: Although SADHD was associated with poorer functioning across groups, its adverse effects on behavioral regulation and overall functioning were amplified following TBI. TBI + SADHD may confer an elevated risk for significant impairments in early adolescence.

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

“…Long term follow up studies examining EF outcomes from 3 to 10 years after injury have also shown persistent problems, with EFs not returning to pre-injury levels ( 35 , 62 – 64 ). Executive dysfunction after TBI has serious consequences for post-traumatic adjustment ( 65 ) and contributes to poorer educational outcomes ( 66 , 67 ) and reduced social competence ( 68 ). TBI may exacerbate pre-existing EF problems in children and may magnify vulnerability to an array of poorer outcomes.…”

Topological Aberrance of Structural Brain Network Provides Quantitative Markers of post-TBI Attention Deficits in Children

“…Neurocognitive impairments and behavioral abnormalities have been consistently observed in children with TBI (Konigs et al, 2015;Poslinder et al, 2015;Dewan et al, 2016;Lumba-Brown et al, 2018). Among the most common cognitive consequences, significant attention deficits were reported in about 35% of children within two years of their TBI (Max et al, 2005), and were observed to strongly contribute to elevated risk for severe psychopathology and impairments in overall functioning in late adolescence, with the pathophysiological underpinning yet to be fully elucidated (Le Fur et al, 2019;Narad et al, 2019). The post-TBI attention problems in children have been evaluated and treated based on endorsements of behavioral symptoms from subjective observations, and have resulted in largely divergent results regarding effectiveness (Backeljauw and Kurowski, 2014;Kurowski et al, 2019;LeBlond et al, 2019).…”

A Histological and Morphometric Assessment of the Adult and Juvenile Rat Livers after Mild Traumatic Brain Injury

“…When analyzing the coverage in the modern literature of extracranial complications of TBI, most of the sources we have encountered describe changes in the organs in moderate and severe TBI [ 51 , 52 , 53 ]. Simultaneously, changes in cognitive functions and psycho-emotional state are mainly described in mild TBI [ 54 , 55 , 56 ]. Our results signalto search for a possible connection between the pathology of the internal organs and previous TBI in children and adolescents, even with a mild TBI.…”