Traumatic brain injury (TBI) is a common cause of disability among children in the United States, and attention deficits are frequently observed in both the acute and chronic phases of injury. The current study investigated models of attention in children with TBI and examined differential sensitivity of various components of these attention models to the severity of the brain injury. Participants included 151 children and adolescents (mean age 12.9 years, SD=2.6) who had suffered TBI, and 50 normal controls (mean age 12.5 years old, SD=2.2). All children were administered neuropsychological tests of attention as part of a comprehensive neuropsychological battery for brain injury (TBI group) or for the purposes of the current investigation (normal controls). Confirmatory factor analysis (CFA) of the attention tests indicated that a four-factor model of attention composed of Shift, Focus, Encode, and Sustain factors provided the best fit of the TBI group data. Factor scores were subsequently created and used to predict the severity of brain injury. All four factors were sensitive to TBI in that those with TBI performed significantly worse than the controls, but regression analysis indicated that only the Shift and Focus factors were significant predictors of TBI severity. These findings support the utility of a multicomponent model of attention to understand attention deficits resulting from TBI, and may be useful in determining those aspects of attention that are differentially impacted by TBI, in order to assist in assessment and rehabilitation planning.

Individuals with acquired and neurodevelopmental brain disorders often exhibit deficits in attention. Recent models of attention have conceptualized it as a multicomponent system. One influential model proposed by Mirsky et al. (1991) consists of factors that include focus, sustain, shift, and encode components. This model has been used to examine the structure of attention in a variety of clinical populations although few studies have contrasted performance of various clinical groups in order to determine whether these components are differentially affected. To address this issue, the current study investigated the differential sensitivity of these attention components in 90 children: 30 who had sustained traumatic brain injury (TBI), 30 who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 30 normal controls. Results demonstrated that the TBI group had significantly lower focus factor scores, the ADHD group had significantly lower sustain scores, and that both clinical groups had lower encode factor scores than controls. Stepwise discriminant function analysis (DFA) retained the focus and encode factors in predicting clinical groups from controls with 75.6% accuracy. A second DFA retained the focus factor in differentiating the two clinical groups with 70.0% accuracy. These findings provide evidence of differential attention deficits resulting from TBI and ADHD.

Neuropsychological and behavioral measures are used to assess attention, but little convergence has been found between these two assessment methods. However, many prior studies have not considered attention as a multicomponent system, which may contribute to this lack of agreement between neuropsychological and behavioral measures. To address this the current study examined the relationship between the neuropsychological measures that comprise a four-component model of attention and parent-report behavioral ratings of attention problems and hyperactivity. A total of 65 children and adolescents who had sustained a traumatic brain injury (TBI) were included in the study. Principal components analysis identified the four attention components in this sample, which accounted for 80.9% of the variance. However, correlations between the neuropsychological measures of attention and behavioral ratings of attention and hyperactivity were low and non-significant. This minimal correspondence suggests that neuropsychological and behavioral measures assess different aspects of attentional disturbances in children with TBI.