Mild head injury and attention deficit hyperactivity disorder in children
Veronique Chasle1, Laurent Riffaud2,3, Romain Longuet1
1Department of Pediatrics and Emergency Medicine, Rennes University Hospital, Rennes, France.
Insights
Mild head injuries in children are not linked to attention deficit hyperactivity disorder (ADHD). Pre-existing ADHD may increase injury risk in children experiencing head trauma or fractures.
Area of Science:
- Pediatric neurology
- Trauma research
- Child psychology
Background:
- Post-concussion syndrome is a known complication of moderate to severe head trauma.
- The occurrence of post-concussion syndrome after mild head injuries in children is not well-established.
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
Purpose of the Study:
- To investigate the association between mild head injury in children and the subsequent development of ADHD.
- To identify if specific risk factors (e.g., CT findings, trauma severity) exacerbate this association.
Main Methods:
- A case-control study was conducted in an emergency department from 2009-2013.
- Mild head injury patients (aged 6-16) were compared to children with isolated forearm fractures.
- ADHD was assessed using the Conners' Global Index-Parent short version 3-40 months post-trauma.
Main Results:
- 34 mild head injury patients were compared with 64 controls; groups were comparable.
- ADHD prevalence was 18% in the mild head injury group and 11% in the control group.
- No statistically significant difference in ADHD rates was found between the groups, though prevalence was higher than the general population.
Conclusions:
- The findings do not support a specific risk of ADHD development following mild head injury in children.
- Pre-existing ADHD may contribute to a higher susceptibility to injuries in general.
- Clinicians should consider evaluating for ADHD in children presenting with trauma.
Purpose:
Post-concussion syndrome is a well-described complication following moderate and severe head trauma but whether it occurs after mild head injury in children remains unclear. The aim of this study was to evaluate whether exposure to mild head injury with potential additional risk factors (non-surgical lesion on computed tomographic, high kinetic trauma, or Glasgow Coma Scale <15) is associated with attention deficit hyperactivity disorder (ADHD) after the head trauma.
Methods:
This study was performed in an emergency department on children admitted between 2009 and 2013. It compared victims of mild head injury aged 6-16 years with matched children presenting isolated non-surgical forearm fracture (ratio1/2). ADHD was assessed using Conners' Global Index-Parent short version 3-40 months after the trauma. The patients were compared using chi-square test or Fisher's exact test, t test or u-test as appropriate with a p value set at 0.05.
Results:
During the study period, 676 patients were admitted for mild head injury. Among them, 34 (5 %) fulfilled the inclusion criteria and were compared with 64 matched patients admitted for a forearm fracture. The groups were comparable. ADHD was observed in both groups (18 % in the mild head injury group, 11 % in the control group) with no significant differences between groups. The prevalence was high when compared to an expected frequency of 3.5-5.6 % in children aged 6-12 years in the general population.
Conclusions:
These results suggest that pre-existing ADHD may have contributed to injury proneness in both groups and does not argue for a specific risk of ADHD induced by mild head injury. The diagnosis of ADHD should be evoked at admission of children aged 6-16 years presenting with a trauma.
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