title: Premorbid prevalence of ADHD and development of secondary ADHD after closed head injury.
abstract: OBJECTIVE
  To determine premorbid prevalence of attention-deficit hyperactivity disorder (ADHD) in children with moderate and severe closed head injury (CHI), to determine incidence of ADHD 1 year after injury, and to characterize children who develop ADHD by demographic, neuropsychiatric, and outcome variables.
  
  
  METHODS
  Ninety-nine children who had severe and moderate CHI were followed up for 1 year. Premorbid and 1-year postinjury psychiatric status were ascertained by parent and child structured interviews and questionnaires measuring affective lability, aggression, apathy, and social judgment.
  
  
  RESULTS
  Premorbid prevalence of ADHD was 0.20, significantly higher than in a reference population (0.045). Fifteen of the remaining 80 children (0.19) developed full ADHD criteria (except for age of onset) by the end of the first year. Children who developed secondary ADHD (S-ADHD) had significantly greater premorbid psychosocial adversity, posttraumatic affective lability and aggression, posttraumatic psychiatric comorbidity, and overall disability than children who did not develop S-ADHD.
  
  
  CONCLUSIONS
  There is an excess prevalence of premorbid ADHD among children who present with moderate and severe CHI. Children with high psychosocial adversity are more likely to develop S-ADHD after CHI. S-ADHD has criteria in common with personality change due to CHI, a deficit in behavioral inhibition being the major overlapping feature.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Gerring
authors.forename: K D
authors.initials: KD
authors.lastname: Brady
authors.forename: A
authors.initials: A
authors.lastname: Chen
authors.forename: R
authors.initials: R
authors.lastname: Vasa
authors.forename: M
authors.initials: M
authors.lastname: Grados
authors.forename: K J
authors.initials: KJ
authors.lastname: Bandeen-Roche
authors.forename: R N
authors.initials: RN
authors.lastname: Bryan
authors.forename: M B
authors.initials: MB
authors.lastname: Denckla
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D015142:Baltimore / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*