title: The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury.
abstract: OBJECTIVE
  Attention deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) are significant independent public health concerns in the pediatric population. This study explores the impact of a premorbid diagnosis of ADHD on outcome following mild TBI.
  
  
  METHODS
  The charts of all patients with a diagnosis of mild closed head injury (CHI) and ADHD who were admitted to Children's Hospital of Pittsburgh between January 2003 and December 2010 were retrospectively reviewed after institutional review board approval was granted. Patient demographics, initial Glasgow Coma Scale (GCS) score, hospital course, and King's Outcome Scale for Childhood Head Injury (KOSCHI) score were recorded. The results were compared with a sample of age-matched controls admitted with a diagnosis of CHI without ADHD.
  
  
  RESULTS
  Forty-eight patients with mild CHI and ADHD, and 45 patients with mild CHI without ADHD were included in the statistical analysis. Mild TBI due to CHI was defined as an initial GCS score of 13-15. The ADHD group had a mean age of 12.2 years (range 6-17 years), and the control group had a mean age of 11.14 years (range 5-16 years). For patients with mild TBI who had ADHD, 25% were moderately disabled (KOSCHI Score 4b), and 56% had completely recovered (KOSCHI Score 5b) at follow-up. For patients with mild TBI without ADHD, 2% were moderately disabled and 84% had completely recovered at follow-up (p < 0.01). Patients with ADHD were statistically significantly more disabled after mild TBI than were control patients without ADHD, even when controlling for age, sex, initial GCS score, hospital length of stay, length of follow-up, mechanism of injury, and presence of other (extracranial) injury.
  
  
  CONCLUSIONS
  Patients who sustain mild TBIs in the setting of a premorbid diagnosis of ADHD are more likely to be moderately disabled by the injury than are patients without ADHD.
authors.affiliation: Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania 15224, USA. bonfieldcm@upmc.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bonfield
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
authors.forename: Yimo
authors.initials: Y
authors.lastname: Lin
authors.forename: Stephanie
authors.initials: S
authors.lastname: Greene
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008499:Medical Records; D010414:Pennsylvania / Q000453:epidemiology; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome