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J Int Neuropsychol Soc. 2014 Nov;20(10):971-81. doi: 10.1017/S1355617714000903.

Neuropsychological performance of youth with secondary attention-deficit/hyperactivity disorder 6- and 12-months after traumatic brain injury.

Author information

1Department of Psychology,Ryerson University,Toronto,Canada.
2Department of Psychiatry,Neurosciences and Mental Health and Brain and Behaviour Program,Research Institute,The Hospital for Sick Children,Toronto,Canada.
3Department of Pediatrics,University of Texas Health Science Center,Houston,Texas.
4Center for Brain Health,The University of Texas at Dallas,Dallas,Texas.
5Department of Psychology,Brain and Behaviour Program,Research Institute,The Hospital for Sick Children,Toronto,Canada.
6Department of Psychiatry,University of Texas Health Science Center,Houston,Texas.
7Department of Psychiatry,University of California,San Francisco,California.
8Department of Physical Medicine and Rehabilitation,Department of Neurosurgery,and Department of Psychiatry and Behavioral Sciences,Baylor College of Medicine,Houston,Texas.
9Department of Psychiatry,University of California,San Diego,and Rady Children's Hospital,San Diego,California.


The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6-16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions.

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