Pediatric Traumatic Brain Injury and Attention Deficit
Marsh Königs1, Hugo A Heij2, Johannes A van der Sluijs3
1Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, Netherlands; m.konigs@vu.nl.
Insights
Pediatric traumatic brain injury (TBI) in children leads to attention problems, particularly increased lapses of attention, impacting daily functioning. Even mild TBI with risk factors can cause these deficits.
Area of Science:
- Neuroscience
- Pediatric Psychology
- Rehabilitation Medicine
Background:
- Pediatric traumatic brain injury (TBI) significantly impacts neurocognitive development.
- Attention is a critical cognitive function for overall functioning in children.
Purpose of the Study:
- To investigate the effects of pediatric TBI on various aspects of attention.
- To differentiate attention deficits based on TBI severity and risk factors.
Main Methods:
- Compared children with TBI (n=113) to a trauma control group (n=53).
- Classified TBI severity: mild(RF+) TBI, mild(RF-) TBI, and moderate/severe TBI.
- Assessed behavioral functioning via parent/teacher reports and cognitive functioning using the Attention Network Test and Ex-Gaussian modeling for attention lapses.
Main Results:
- Children with TBI exhibited more attention problems, internalizing/externalizing behaviors, and lower intelligence than controls.
- No significant differences were found in alerting, orienting, or executive attention networks between groups.
- Slower mean reaction time in the TBI group was attributed to increased lapses of attention, particularly in mild(RF+) TBI and moderate/severe TBI groups.
Conclusions:
- Lapses of attention are a key attention deficit following pediatric TBI, especially in moderate/severe or mild TBI with risk factors.
- These attention lapses correlate with real-world behavioral problems and lower intelligence in children post-TBI.
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.
