ABSTRACT 378

Abstract

Background and aims: Inattention and hyperactivity problems are over-represented in children with TBI, both pre- and post-injury. These attention difficulties occur across all severities of TBI, suggesting severity of injury alone does not predict individual differences in attention outcomes. Given that frontal lobe integrity is important for attention and that diffuse axonal injury (DAI) in the frontal lobes is common after TBI, we set out to investigate whether frontal lobe DAI predicts attention following TBI. Aims: To establish the trajectory of attention problems in children with TBI as rated by parents and teachers, and to gain an understanding of whether and how acute DAI in the frontal lobes is related to attention ratings. Methods: 58 children/adolescents with mild to severe TBI were enrolled and followed (2009–2013) from PICUs at 5 Canadian children’s hospitals. Institutional Review Boards provided approval of the study. Parents and teachers completed questionnaires assessing ADHD symptoms (Conners Rating Scale – 3rd Edition) at baseline, 3, 6, and 12 months post-injury. Brain MRIs, obtained within first 5 days post-injury, were classified using a novel clinical tool, developed at SickKids. Results: Children with acute frontal DAI showed a pattern of persistently elevated symptoms of inattention and hyperactivity, whereas those without frontal DAI showed initial elevations in post-injury symptoms that recovered to baseline levels. Conclusions: Children with TBI who sustain diffuse axonal injury to the frontal lobes are at risk for persisting attention and hyperactivity difficulties. MRI should be part of routine care to detect DAI with particular attention being paid to injury in the frontal lobe.