Abstract
Objective: To summarize existing knowledge about the characteristics of attention problems secondary to traumatic brain injuries (TBI) of all severities in children.Methods: Computerized databases PubMed and PsychINFO and gray literature sources were used to identify relevant studies. Search terms were selected to identify original research examining new ADHD diagnosis or attention problems after TBI in children. Studies were included if they investigated any severity of TBI, assessed attention or ADHD after brain injury, investigated children as a primary or sub-analysis, and controlled for or excluded participants with preinjury ADHD or attention problems.Results: Thirty-nine studies were included in the review. Studies examined the prevalence of and risk factors for new attention problems and ADHD following TBI in children as well as behavioral and neuropsychological factors associated with these attention problems. Studies report a wide range of prevalence rates of new ADHD diagnosis or attention problems after TBI. Evidence indicates that more severe injury, injury in early childhood, or preinjury adaptive functioning problems, increases the risk for new ADHD and attention problems after TBI and both sexes appear to be equally vulnerable. Further, literature suggests that cases of new ADHD often co-occurs with neuropsychiatric impairment in other domains. Identified gaps in our understanding of new attention problems and ADHD include if mild TBI, the most common type of injury, increases risk and what brain abnormalities are associated with the emergence of these problems.Conclusion: This scoping review describes existing studies of new attention problems and ADHD following TBI in children and highlights important risk factors and comorbidities. Important future research directions are identified that will inform the extent of this outcome across TBI severities, its neural basis and points of intervention to minimize its impact.
Highlights
Traumatic brain injury (TBI) is a major cause of acquired disability in children (1), and altogether accounts for over 700,000 emergency room visits annually in the United States (2)
Attention problems that arise along with hyperactivity and impulsivity after TBI may contribute to new diagnoses of attention deficit hyperactivity disorder (ADHD) (16)
The final search strategy used the following search terms to search in title and abstract text in scholarly literature: “ADHD” or “attention deficit disorder” or “attention deficit hyperactivity” and “secondary” or “after” or “following” and “concussion” or “concussions” or “concussive” or “TBI” or “TBIs” or “mTBI” or “mTBIs” or “brain injury” or “brain injuries” or “brain damage” or “head impacts”
Summary
Traumatic brain injury (TBI) is a major cause of acquired disability in children (1), and altogether accounts for over 700,000 emergency room visits annually in the United States (2). Emergency room visits underreport the true incidence of TBI as the majority of injuries are at the mild end of the spectrum (referred to as mild TBI or concussion) and children with mild injuries may seek medical attention from family doctors, other medical professions or not at all. TBI in children is associated with many different types of adverse outcomes as TBI to the developing brain impacts ongoing developmental processes (5). These include behavioral (6) and social problems (7), difficulties with academic achievement (8), and persistent cognitive deficits (9) that can occur across the spectrum of severities. The similarities and differences between primary and SADHD in youth are not fully understood and may represent very different disorders. ADHD is a risk factor for TBI (16), as children with ADHD are more likely to be injured, so disentangling preexisting ADHD from SADHD is important for understanding the etiology of attention problems and ADHD in children with TBI
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