Structure of Attention in Children with Traumatic Brain Injury

Abstract

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.

Clinical utility of the Conners’ Continuous Performance Test-II to detect poor effort in U.S. Military personnel following traumatic brain injury.

“…However, in the data presented by Ord and colleagues. there were some small to medium effect sizes noted between groups on Omissions T scores (d = .43) and raw scores {d = .45), Commissions raw score (d = .39), and Perseveration raw score (d = .47). Nonetheless, there was a lack of difference between TBI severity groups that was consistent with our own findings and with other recent studies comparing CPT-II performance between MTBI and moderate to severe TBI groups in adults (Kraus et al, 2007), and mild to moderate TBI and severe TBI groups in children (Park, Allen, Barney, Ringdahl, & Mayfield, 2009). Taken as a whole, these findings suggest that the sensitivity of the CPT-n to severity of TBI is questionable in both civilian and military populations.…”

Bimanual Coordination and Corpus Callosum Microstructure in Young Adults with Traumatic Brain Injury: A Diffusion Tensor Imaging Study

“…These results are consistent with previous studies using different cognitive task-switching paradigms in TBI (Larson et al, 2006;Schroeter et al, 2007). These switching deficits in TBI patients may be related to attentional problems when transferring between different motor tasks (Park et al, 2009). In other words, patients with TBI have difficulty shifting attention in order to perform on-line modification of motor patterns during the execution of complex movements.…”

Attention processing abnormalities in children with traumatic brain injury and attention-deficit/hyperactivity disorder: Differential impairment of component processes

“…Finally, the encode component allows for the brief retention of information that then is linked to various cognitive processes, including mental manipulation and recall, and may be associated with the hippocampal and amygdala function (Mirsky, 1987). Mirsky's model of attention has undergone considerable validation in children and adults, as well as in various clinical populations including schizophrenia (Allen et al, 1997;Combs & Gouvier, 2004), autism (Goldstein, Johnson, & Minshew, 2001), HIV encephalopathy (Levine et al, 2008), traumatic brain injury (TBI; Ewing-Cobbs, Prasad, & Fletcher, 1998;Park, Allen, Barney, Ringdahl, & Mayfield, 2009), and attention-deficit/hyperactivity disorder (ADHD; Mirsky et al, 1999). Factor analysis has confirmed the presence of the four attention components in many of these populations and demonstrated that the four components may be differentially affected in these disorders.…”

“…However, Power and colleagues (Power, Catroppa, Coleman, Ditchfield, & Anderson, 2007) found that the amount of brain damage, rather than the location, predicted attentional deficits following pediatric TBI. Research on TBI populations using Mirsky's model has demonstrated that children with severe TBI performed poorer on the focus and shift components of attention than did children with mild and moderate TBI (Ewing-Cobbs et al, 1998) and that these two components further predicted TBI severity (Park et al, 2009). Additional research on the focus component suggests that this component is relatively spared in individuals with ADHD (Egeland, 2007;Marchetta, Hurks, De Sonneville, Krabbendam, & Jolles, 2008;Rodrigues, 2009).…”