title: Pediatric Traumatic Brain Injury and Attention Deficit.
abstract: BACKGROUND
  We investigated the impact of pediatric traumatic brain injury (TBI) on attention, a prerequisite for behavioral and neurocognitive functioning.
  
  
  METHODS
  Children aged 6 to 13 years who were diagnosed with TBI (n = 113; mean 1.7 years postinjury) were compared with children with a trauma control injury (not involving the head) (n = 53). TBI severity was defined as mild TBI with or without risk factors for complicated TBI (mild(RF+) TBI, n = 52; mild(RF-) TBI, n = 24) or moderate/severe TBI (n = 37). Behavioral functioning was assessed by using parent and teacher questionnaires, and the Attention Network Test assessed alerting, orienting, and executive attention. Ex-Gaussian modeling determined the contribution of extremely slow responses (lapses of attention) to mean reaction time (MRT).
  
  
  RESULTS
  The TBI group showed higher parent and teacher ratings of attention and internalizing problems, higher parent ratings of externalizing problems, and lower intelligence than the control group (P < .05, d ≥ 0.34). No effect of TBI on alerting, orienting, and executive attention was observed (P ≥ .55). MRT was slower in the TBI group (P = .008, d = 0.45), traced back to increased lapses of attention (P = .002, d = 0.52). The mild(RF-) TBI group was unaffected, whereas the mild(RF+) TBI and moderate/severe TBI groups showed elevated parent ratings of behavior problems, lower intelligence, and increased lapses of attention (P ≤ .03, d ≥ 0.48). Lapses of attention fully explained the negative relation between intelligence and parent-rated attention problems in the TBI group (P = .02).
  
  
  CONCLUSIONS
  Lapses of attention represent a core attention deficit in children with mild(RF+) TBI (even in the absence of intracranial pathology) or moderate/severe TBI, and relate to daily life problems after pediatric TBI.
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; m.konigs@vu.nl.
authors.forename: Marsh
authors.initials: M
authors.lastname: Königs
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Centre and VU University Medical Center, Amsterdam, Netherlands;
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Departments of Pediatric Orthopedics, and.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: van der Sluijs
authors.affiliation: Pediatric Neurology, VU University Medical Center, Amsterdam, Netherlands;
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
authors.affiliation: Trauma Unit, and.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Departments of Emergency Medicine, and.
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.affiliation: Pediatric Neurology, Academic Medical Center, Amsterdam, Netherlands;
authors.forename: Bwee Tien
authors.initials: BT
authors.lastname: Poll-Thé
authors.affiliation: Merem Rehabilitation Center 'De Trappenberg,' Huizen, Netherlands; Department of Rehabilitation, Academic Medical Centre, Amsterdam Netherlands;
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
authors.affiliation: Libra Rehabilitation Medicine and Audiology 'Blixembosch', Eindhoven, Netherlands;
authors.forename: Marleen
authors.initials: M
authors.lastname: van der Wees
authors.affiliation: Libra Rehabilitation Medicine and Audiology 'Leijpark', Tilburg, Netherlands;
authors.forename: Rachèl J J K
authors.initials: RJ
authors.lastname: Kemps
authors.affiliation: Department of Pediatric Neurology, Erasmus Medical Centre, Rotterdam, Netherlands; and.
authors.forename: Coriene E
authors.initials: CE
authors.lastname: Catsman-Berrevoets
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; Emma Children's Hospital Academic Medical Centre, Amsterdam. Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Oosterlaan
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology; D056344:Executive Function; D015600:Glasgow Coma Scale; D006801:Humans; D007360:Intelligence; D012307:Risk Factors