Long-term attention problems in children with traumatic brain injury.
OBJECTIVE
To examine long-term attention problems and their cognitive correlates after childhood traumatic brain injury (TBI).


METHODS
Data were drawn from a prospective, longitudinal study conducted between 1992 and 2002. Participants included 41 children with severe TBI, 41 with moderate TBI, and 50 with orthopedic injury (OI), who were all between 6 and 12 years of age at the time of injury. Parent ratings of attention problems were obtained at a long-term follow-up on average 4 years post-injury and compared with ratings of premorbid attention problems obtained shortly after injury. At the long-term follow-up, children also completed several cognitive tests of attention and executive functions.


RESULTS
Hierarchical linear and logistic regression analyses indicated that the severe TBI group displayed significantly more attention problems than the OI group at 4 years post-injury, both behaviorally and cognitively, after controlling for race, socioeconomic status, and premorbid attention problems. At long-term follow-up, 46% of the severe TBI group displayed significant attention problems on the Child Behavior Checklist, as opposed to 26% of the OI group (odds ratio=3.38; 95% confidence interval, 1.15-9.94). On the Attention-Deficit/Hyperactivity Disorder Rating Scale, 20% of the severe TBI group displayed clinically significant attention problems compared with 4% in the OI group (odds ratio=9.59; 95% confidence interval, 1.24-73.99). However, group differences in behavioral symptoms were significantly larger for children with more premorbid symptoms than for children with fewer premorbid problems. Measures of executive functions were significantly related to behavioral attention problems, after controlling for group membership, race, and socioeconomic status.


CONCLUSIONS
Childhood TBI exacerbates premorbid attention problems. Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI.
Yeates
Keith Owen
KO
Department of Pediatrics, The Ohio State University and Columbus Children's Research Institute, Columbus, OH, USA. yeatesk@chi.osu.edu
Armstrong
Kira
K
Janusz
Jennifer
J
Taylor
H Gerry
HG
Wade
Shari
S
Stancin
Terry
T
Drotar
Dennis
D
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology; D020208:Brain Injury, Chronic / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010552:Personality Assessment / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values