Pediatric Traumatic Brain Injury and Attention Deficit

Abstract

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 RF2 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 RF2 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. WHAT'S KNOWN ON THIS SUBJECT:Attention is a prerequisite for neurocognitive and behavioral functioning, having a crucial role in academic and social child development. Children with traumatic brain injury have pronounced deficits in attention, but the nature and consequences of these deficits remain unclear.WHAT THIS STUDY ADDS: Lapses of attention represent a core attention deficit after pediatric mild traumatic brain injury with risk factors for complicated traumatic brain injury, or moderate/severe traumatic brain injury. Importantly, lapses of attention explain the relation between intelligence and parent-rated attention problems.

New method to induce mild traumatic brain injury in rodents produces differential outcomes in female and male Sprague Dawley rats

“…One way to interpret their increased center activity is that injured females are less anxious and more exploratory. However, the finding is also consistent with a possible deficit in impulse control and disinhibition (Königs et al, 2015; Max et al, 2005; Konrad et al, 2000). Also, it is plausible to attribute the declines in hippocampal neurogenesis to the memory deficit, but that decline was only observed in female rats, though male rats also showed memory deficits.…”

The structural connectome of children with traumatic brain injury

“…This study compared a group of 36 children with TBI to a group of 27 children with trauma control (TC) injury not involving the head, in order to control for pre‐injury risk factors of traumatic injury [Max et al, ]. Data were collected as part of a follow‐up on a consecutive cohort that was retrospectively recruited from three university‐affiliated level I trauma centers and three rehabilitation centers in the Netherlands [Königs et al, ]. Inclusion criteria were: (1) age 8–14 years at time of follow‐up; (2) proficient in the Dutch language; (3) children in the TBI group were required to have a history of hospital admission with a clinical diagnosis of either: (a) mild TBI (GCS = 15–13, loss of consciousness [LOC] duration ≤ 30 min, post‐traumatic amnesia [PTA] duration ≤ 1 h) with at least one of the following risk factors for complicated TBI (mild RF+ TBI) according to the European Federation of Neurological Societies guidelines on mild TBI: impaired consciousness (GCS = 13–14), focal neurological deficits, persistent vomiting (≥ 3 episodes), post‐injury epileptic seizure, progressive headache and abnormal head CT‐scan [Vos and Battistin, ]; or (b) moderate/severe TBI (GCS = 12–3, LOC duration > 30 min, PTA duration > 1 h [Teasdale and Jennett, ]); and (4) children in the TC group were required to have a history of hospital admission for traumatic injuries below the clavicles [American College of Surgeons, ].…”

Brain volumetric correlates of inhibition and cognitive flexibility 16 years following childhood traumatic brain injury

“…In contrast, Faber et al (2016) and Muscara et al (2008) operationalized inhibition and cognitive flexibility abilities by taking completion time and total number of errors on the CWIT inhibition and inhibition/switching tasks. Of note, there were suggestions that EF deficits in childhood TBI survivors may be confounded by impaired processing speed (Ginstfeldt & Emanuelson, 2010;K€ onigs et al, 2015).…”