A Systematic Scoping Review of New Attention Problems Following Traumatic Brain Injury in Children

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.

Sex Differences in Adult Incarceration After Pediatric Traumatic Brain Injury

“…A well-known complication of pTBI is secondary, or post-injury, attention-deficit hyperactivity disorder (SADHD), which represents significant impairment that can be suffered for several years after the inciting injury, resulting in long-term functional impairment. 1 , 22 , 25 , 26 Studies on SADHD have variously found that male sex is associated with an increased likelihood of developing attentional impairments and that there are no sex-related differences in the risk of developing such neurocognitive issues. 25 In contrast, studies on pediatric populations with primary, or pre-injury, attention-deficit hyperactivity disorder (ADHD) demonstrated that male sex is a major risk factor for worsening of primary ADHD severity in the post-pTBI setting.…”

“… 25 In contrast, studies on pediatric populations with primary, or pre-injury, attention-deficit hyperactivity disorder (ADHD) demonstrated that male sex is a major risk factor for worsening of primary ADHD severity in the post-pTBI setting. 22 , 25 In essence, the paucity of concrete trends regarding the sex-related differences in post-pTBI events may be attributable to limitations related to sex bias with a male predominance and insufficient protocols in studies to draw powerful conclusions. 21 , 25 , 27 …”

Predictors of Speech Language Pathology Referral Following Pediatric Concussion Using a Speech Language Checklist: A Brief Report

“…The overwhelming majority of referrals to SLP in this cohort presented with postconcussion symptoms related to attention and memory/organization skills. Brain injury in children is associated with multiple impairments, as injury to the developing brain affects developmental processes, and attention problems are particularly common 17–19 . Attention deficits after concussion may negatively impact a child’s ability to successfully perform in both home and school settings, so it is critical to identify these deficits early in the postconcussion timeline.…”

“…Brain injury in children is associated with multiple impairments, as injury to the developing brain affects developmental processes, and attention problems are particularly common. [17][18][19] Attention deficits after concussion may negatively impact a child's ability to successfully perform in both home and school settings, so it is critical to identify these deficits early in the postconcussion timeline. Furthermore, compared with adults, adolescents have more severe cognitive impairments that take longer to resolve.…”

Multimodal Analysis of Secondary Cerebellar Alterations after Pediatric Traumatic Brain Injury

“…We found significant differences only with the HC comparison, while differences between msTBI and OI were no longer significant. However, ADHD is a common pre-/comorbidity of TBI 42 and is associated with cerebellar changes, 35 so we also examined only HC and OI sites that excluded children with ADHD. When excluding HC and OI cohorts that did not exclude children with ADHD, the HC and OI results were very similar (Supplementary Table 8).…”