title: The effect of premorbid attention-deficit/hyperactivity disorder on neuropsychological functioning in individuals with acute mild traumatic brain injuries.
abstract: BACKGROUND
  Mild traumatic brain injury (mTBI) is a frequent, yet undertreated condition that typically manifests with transient neurological and cognitive symptoms that resolve over the course of several weeks. In contrast, attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that presents initially in childhood but often persists into adulthood. mTBI and ADHD include overlapping symptomatology, making it difficult for clinicians to disentangle the sequelae of each condition when they co-occur in the same individual. We hypothesized that neuropsychological tests would be sensitive to preexisting ADHD in inpatients with acute mTBIs.
  
  
  METHODS
  We retrospectively examined the medical charts of 100 inpatients, aged 18-40 years (96% Caucasian; 77% male) with mTBIs in an acute care setting, half of whom had self-reported the presence of premorbid ADHD, and half of whom were matched controls. We analyzed group differences across neuropsychological tests of attention, processing speed, and executive functions, examined the profile ratings of independent, blinded, board-certified neuropsychologists, and correlated cognitive performance with time from traumatic injury to testing.
  
  
  RESULTS
  Individuals with premorbid ADHD (a) performed significantly worse than their matched counterparts on several tests of attention, processing speed, and working memory, and (b) were significantly more likely to produce profiles later rated as impaired by independent, board-certified clinical neuropsychologists. In addition, time from traumatic injury to testing was found to be negatively correlated with neurocognitive performance.
  
  
  CONCLUSIONS
  These findings (a) argue for the utility of a brief assessment of premorbid ADHD in the acute care of individuals with mTBIs and (b) provide clinicians with a barometer for gauging the relative contributions of premorbid ADHD to neuropsychological impairments in the neurocognitive profiles of individuals with mTBIs. Reported effect sizes will assist clinicians in accurately weighing the impact of premorbid ADHD when interpreting such profiles.
authors.affiliation: a Department of Psychology , Saint Louis University , Saint Louis , MO , USA.|b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Van Patten
authors.affiliation: a Department of Psychology , Saint Louis University , Saint Louis , MO , USA.|b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA.
authors.forename: Cierra
authors.initials: C
authors.lastname: Keith
authors.affiliation: a Department of Psychology , Saint Louis University , Saint Louis , MO , USA.
authors.forename: Madison
authors.initials: M
authors.lastname: Bertolin
authors.affiliation: b Department of Neuroscience , Mercy Hospital in Saint Louis , Saint Louis , MO , USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Mild traumatic brain injury; acute patient care; attention-deficit/hyperactivity disorder; neurocognitive performance; neuropsychological functioning