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Biopsychosocial Factors Associated With Attention Problems in Children After Traumatic Brain Injury: A Systematic
Priya D Bolikal1, Megan Narad, Stacey Raj
1From the Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (PDB, BGK); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (PDB, BGK); Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (PDB, BGK); Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (MN); Xavier University, School of Psychology, Cincinnati, Ohio (SR); University of Cincinnati College of Medicine, Cincinnati, Ohio (MK); and Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina (MK).
Insights
Biopsychosocial factors increase attention problems risk in children after traumatic brain injury (TBI). Younger age, pre-existing ADHD, and lower socioeconomic status are key risk factors requiring attention.
Area of Science:
- Pediatric Neuropsychology
- Developmental Psychology
- Rehabilitation Medicine
Background:
- Traumatic brain injury (TBI) in children can lead to persistent attention problems.
- Understanding biopsychosocial risk factors is crucial for early intervention and improved outcomes.
Purpose of the Study:
- To systematically review biopsychosocial factors associated with attention problems post-pediatric TBI.
- To identify specific risk factors that predict the development of attention deficits.
Main Methods:
- Systematic literature review of MEDLINE, PsycINFO, and CINAHL up to August 2020.
- Included studies focused on pediatric TBI and attention problems.
- Risk factors were categorized as biological, psychological, and social.
Main Results:
- Younger age at injury, pre-injury ADHD, poorer pre-injury functioning, lower socioeconomic status, and poor family functioning were associated with increased attention problems.
- Findings were mixed, indicating a complex interplay of factors.
Conclusions:
- Attention problems after pediatric TBI are multifactorial, involving biological, environmental, injury-related, and host factors.
- Further research is needed to clarify these relationships.
- Screening children with risk factors can facilitate early identification and intervention.
Objective:
The aim of this review was to examine biopsychosocial factors associated with an increased risk of attention problems after a traumatic brain injury in children.
Design:
A systematic review of the literature was conducted using data sources of MEDLINE, PsycINFO, and CINAHL up to August 30, 2020. Literature primarily examined pediatric patients with traumatic brain injury and attention problems. Risk factors for attention problems posttraumatic brain injury examined in all articles were identified and grouped into broad categories of biological, psychological, and social factors. Methodological quality of each study was assessed using the modified Downs and Black checklist. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines from 2009 were used in completing this review.
Results:
Forty articles met inclusion criteria for this study. Overall findings were mixed but suggested that younger age at injury, presence of preinjury attention-deficit/hyperactivity disorder, poorer preinjury adaptive functioning, lower socioeconomic status, and poorer family functioning were associated with increased risk of developing attention problems posttraumatic brain injury.
Conclusions:
Development of attention problems after pediatric traumatic brain injury is complex and influenced by an array of biologic, environmental/social, injury-related, and host factors. Evidence is mixed, and further study is needed to better understand the relationships between these factors and how they influence attention after traumatic brain injury. Nonetheless, screening for attention problems in children with risk factors may allow for earlier identification and intervention, minimizing negative impacts of attention problems after traumatic brain injury in children. Limitations of this study included heterogeneity of studies and overall low to moderate methodological quality of studies included as measured by the modified Downs and Black checklist.
To Claim Cme Credits:
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Cme Objectives:
Upon completion of this article, the reader should be able to: (1) Describe the importance of recognizing and identifying attention problems after traumatic brain injury in children; (2) Identify risk factors for development of attention problems after pediatric traumatic brain injury; and (3) Recognize gaps in existing literature regarding predictors of attention problems after pediatric traumatic brain injury.
Level:
Advanced.
Accreditation:
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
