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Pediatrics. 2015 Sep;136(3):534-41. doi: 10.1542/peds.2015-0437. Epub 2015 Aug 3.

Pediatric Traumatic Brain Injury and Attention Deficit.

Author information

1
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; m.konigs@vu.nl.
2
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital Academic Medical Centre and VU University Medical Center, Amsterdam, Netherlands;
3
Departments of Pediatric Orthopedics, and.
4
Pediatric Neurology, VU University Medical Center, Amsterdam, Netherlands;
5
Trauma Unit, and.
6
Departments of Emergency Medicine, and.
7
Pediatric Neurology, Academic Medical Center, Amsterdam, Netherlands;
8
Merem Rehabilitation Center 'De Trappenberg,' Huizen, Netherlands; Department of Rehabilitation, Academic Medical Centre, Amsterdam Netherlands;
9
Libra Rehabilitation Medicine and Audiology 'Blixembosch', Eindhoven, Netherlands;
10
Libra Rehabilitation Medicine and Audiology 'Leijpark', Tilburg, Netherlands;
11
Department of Pediatric Neurology, Erasmus Medical Centre, Rotterdam, Netherlands; and.
12
Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; Emma Children's Hospital Academic Medical Centre, Amsterdam. Netherlands.

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.

PMID:
26240208
DOI:
10.1542/peds.2015-0437
[Indexed for MEDLINE]
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