Psychiatric Disorders in Children and Adolescents After Severe Traumatic Brain Injury: A Controlled Study

Max, Jeffrey E.; Koele, Sharon L.; Smith, Wilbur L.; Sato, Yutaka; Lindgren, Scott D.; Robin, Donald A.; Arndt, Stephan

doi:10.1097/00004583-199808000-00013

Cited by 127 publications

(96 citation statements)

References 10 publications

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“…We propose that these other etiologies produce both the behavioral abnormalities reflected as symptoms of ADHD and the cognitive abnormalities reflected by longer RTs and SDs in the neuropsychological tests of the XNAT battery. For example, the observed cognitive abnormalities (i.e., slow and variable responses) are very common sequelae of brain injury (56) that may in some instances produce the symptoms of ADHD (57).…”

Section: Discussionmentioning

confidence: 99%

Attention deficit/hyperactivity disorder children with a 7-repeat allele of the dopamine receptor D4 gene have extreme behavior but normal performance on critical neuropsychological tests of attention

Swanson

Oosterlaan

Murias

et al. 2000

Proc. Natl. Acad. Sci. U.S.A.

254

214

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An association of the dopamine receptor D4 (DRD4) gene located on chromosome 11p15.5 and attention deficit͞hyperactivity disorder (ADHD) has been demonstrated and replicated by multiple investigators. A specific allele [the 7-repeat of a 48-bp variable number of tandem repeats (VNTR) in exon 3] has been proposed as an etiological factor in attentional deficits manifested in some children diagnosed with this disorder. In the current study, we evaluated ADHD subgroups defined by the presence or absence of the 7-repeat allele of the DRD4 gene, using neuropsychological tests with reaction time measures designed to probe attentional networks with neuroanatomical foci in D4-rich brain regions. Despite the same severity of symptoms on parent and teacher ratings for the ADHD subgroups, the average reaction times of the 7-present subgroup showed normal speed and variability of response whereas the average reaction times of the 7-absent subgroup showed the expected abnormalities (slow and variable responses). This was opposite the primary prediction of the study. The 7-present subgroup seemed to be free of some of the neuropsychological abnormalities thought to characterize ADHD. Dopamine plays an important role in normal attention (1) and disorders of attention (2, 3). Recently, this role of dopamine has stimulated molecular genetic studies (4) of attention deficit͞ hyperactivity disorder (ADHD), the most prevalent psychiatric disorder of childhood recognized in the United States. The dopamine receptor genes (5) have been investigated in other psychiatric disorders (e.g., schizophrenia; see refs. 6 and 7), and the background from this work set the stage for our molecular genetic investigations of ADHD.In our program of research, we adopted a candidate gene approach, focusing on the dopamine receptor D4 (DRD4) gene on chromosome 11p15.5. This gene has a polymorphism in a coding region-a variable number of tandem repeats of a 48-base pair sequence in exon 3 (8) that codes for variation in the third intracellular loop of the D4 receptor, which may have functional significance. In vitro studies suggest that the receptor encoded by the DRD4 7-repeat allele may be subsensitive to endogenous dopamine compared with the receptor encoded by the 2-repeat allele (9), although this apparently is not due merely to the length of the third intracellular loop (10). Initially, in our clinical studies we used population-based (11) and family-based (12) association designs, which suggested that the DRD4 7-repeat allele is associated with ADHD, but with a small relative risk (about 1.5). A review of the recent literature (4) revealed that two independent groups have confirmed this association in children (13,14), but one group did not (15). The pattern of replication has held up in several other case studies not yet published.The presence of the DRD4, 7-repeat allele is not a necessary condition (about half of the ADHD cases did not have a 7-repeat allele) (11, 12) or a sufficient condition (about 20% of ethnically matched control subjects d...

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Section: Discussionmentioning

confidence: 99%

Attention deficit/hyperactivity disorder children with a 7-repeat allele of the dopamine receptor D4 gene have extreme behavior but normal performance on critical neuropsychological tests of attention

Swanson

Oosterlaan

Murias

et al. 2000

Proc. Natl. Acad. Sci. U.S.A.

254

214

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“…16 All children were retrospectively recruited from a consecutive cohort of 3 universityaffiliated level I trauma centers and several rehabilitation centers in the Netherlands. Inclusion criteria were (1) age 6 to 13 years, (2) proficient in the Dutch language, (3) hospital admission with a clinical diagnosis of TBI for inclusion in the TBI group, (4) hospital admission for traumatic injuries below the clavicle 17 for inclusion in the TC group, and (5) .2 months postinjury.…”

Section: Samplementioning

confidence: 99%

Pediatric Traumatic Brain Injury and Attention Deficit

Königs

Heij

Sluijs³

et al. 2015

Pediatrics

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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.

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“…The majority of children with moderate to severe brain injuries experience some cognitive and behavioral impairment Yeates et al, 2002). Longer term follow-up studies indicate that emerging behavior problems represent the most persistent sequelae of TBI in children (Fay et al, 1994;Fletcher, Ewing-Cobbs, Miner, Levin, & Eisenberg, 1990;Max, Koele, et al, 1998;Rutter, 1981;Schwartz et al, 2003). These findings highlight the importance of social and behavioral outcomes following TBI.…”

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confidence: 99%

A Web-based family problem-solving intervention for families of children with traumatic brain injury

Wade

Wolfe

Pestian

2004

Behavior Research Methods, Instruments, & Computers

111

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We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.

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Psychiatric Disorders in Children and Adolescents After Severe Traumatic Brain Injury: A Controlled Study

Cited by 127 publications

References 10 publications

Attention deficit/hyperactivity disorder children with a 7-repeat allele of the dopamine receptor D4 gene have extreme behavior but normal performance on critical neuropsychological tests of attention

Attention deficit/hyperactivity disorder children with a 7-repeat allele of the dopamine receptor D4 gene have extreme behavior but normal performance on critical neuropsychological tests of attention

Pediatric Traumatic Brain Injury and Attention Deficit

A Web-based family problem-solving intervention for families of children with traumatic brain injury

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