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Published on: October 19, 2014
A Systematic Scoping Review of New Attention Problems Following Traumatic Brain Injury in Children
Sonja Stojanovski1,2, Shannon E Scratch3,4,5, Benjamin T Dunkley1,6,7
1SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.
Insights
Children with traumatic brain injuries (TBI) may develop new attention problems, including ADHD. Severe injuries, early childhood injury, and pre-existing issues increase risk, but mild TBI
Area of Science:
- Pediatric Neurology
- Neuroscience
- Developmental Psychology
Background:
- Attention problems and ADHD are common after traumatic brain injury (TBI).
- Understanding these secondary attention deficits is crucial for pediatric care.
- Existing research varies in scope and focus.
Purpose of the Study:
- To synthesize current knowledge on attention problems following TBI in children.
- To identify risk factors, characteristics, and comorbidities of these attention issues.
- To highlight gaps in research for future investigation.
Main Methods:
- Systematic review of literature from PubMed, PsychINFO, and gray literature.
- Inclusion criteria focused on pediatric TBI, attention/ADHD assessment, and pre-TBI attention status.
- Thirty-nine studies were included in the final analysis.
Main Results:
- Prevalence rates of new ADHD diagnosis or attention problems post-TBI vary widely.
- Increased risk is associated with TBI severity, early childhood injury, and pre-injury adaptive functioning.
- Attention problems often co-occur with other neuropsychiatric impairments.
Conclusions:
- This review summarizes research on pediatric TBI-related attention problems, identifying key risk factors and comorbidities.
- Further research is needed to understand the impact of mild TBI and the neural underpinnings.
- Identifying intervention points is essential to mitigate the effects of these attention deficits.
Abstract:
Objective: To summarize existing knowledge about the characteristics of attention problems secondary to traumatic brain injuries (TBI) of all severities in children. Methods: Computerized databases PubMed and PsychINFO and gray literature sources were used to identify relevant studies. Search terms were selected to identify original research examining new ADHD diagnosis or attention problems after TBI in children. Studies were included if they investigated any severity of TBI, assessed attention or ADHD after brain injury, investigated children as a primary or sub-analysis, and controlled for or excluded participants with preinjury ADHD or attention problems. Results: Thirty-nine studies were included in the review. Studies examined the prevalence of and risk factors for new attention problems and ADHD following TBI in children as well as behavioral and neuropsychological factors associated with these attention problems. Studies report a wide range of prevalence rates of new ADHD diagnosis or attention problems after TBI. Evidence indicates that more severe injury, injury in early childhood, or preinjury adaptive functioning problems, increases the risk for new ADHD and attention problems after TBI and both sexes appear to be equally vulnerable. Further, literature suggests that cases of new ADHD often co-occurs with neuropsychiatric impairment in other domains. Identified gaps in our understanding of new attention problems and ADHD include if mild TBI, the most common type of injury, increases risk and what brain abnormalities are associated with the emergence of these problems. Conclusion: This scoping review describes existing studies of new attention problems and ADHD following TBI in children and highlights important risk factors and comorbidities. Important future research directions are identified that will inform the extent of this outcome across TBI severities, its neural basis and points of intervention to minimize its impact.
