Traumatic brain injuries (TBI) send over one million children, adolescents and young adults to the ER each year in the United States. A recent study suggested that TBI might be linked to an increased risk of attention deficit/hyperactivity disorder (ADHD) that does not appear for several years.
In the research reported in JAMA Pediatrics by Megan Narad, PhD of Cincinnati Children’s Hospital Medical Center and colleagues, very young children who experienced severe TBI were 3.6 times more likely to develop secondary ADHD as long as 6.8 years following the injury.
“Children with a history of traumatic brain injuries – even those with less severe injuries – have an increased risk for the development of new-onset attention problems, potentially many years after injury,” Narad said.
“While previous studies suggest kids with a history of traumatic brain injuries are at risk of developing attention problems, they only followed children 2 to 3 years after injury,” she said in an interview with Med Page Today. “Our study is unique in that we followed children 7 to 10 years after their injury and demonstrated that some kids develop attention problems many years after injury.”
After traumatic brain injury children often experience impairment when challenged by tasks of increasing complexity and awareness. Although the risk factors are not well understood, children with a history of TBI have a 20% chance of developing secondary ADHD.
For this research, 187 children ages 3 to 7, that were kept overnight in four hospitals in Ohio from January 2003 to June 2008, were studied; one group with TBI and the other, a control group with orthopedic injuries. Children in the control group had sustained a bone fracture other than a skull fracture and had no signs or symptoms of TBI.
The children had no history of ADHD prior to the injury. Their average age was 5.1 and the group was 58 percent male and 27 percent non-white. Parents performed assessments at 0-3 months, 6 months, 12 months, 18 months; 3.4 years and 6.8 years, following the injury. Secondary ADHD was defined by researchers as an elevated T-score on the DSM-Oriented Attention-Deficit/Hyperactivity Scale, or the Child Behavior Checklist as reported by parents; a report of an ADHD diagnosis, or current treatment with stimulant medication that was absent at the baseline assessment. Using the Glasgow Coma Scale (GCS) severe TBI was defined as a score of 8 or lower, moderate at 9-12, and complicated mild at 13 to 15 with abnormal brain imaging.
Secondary ADHD was present in 25.7% of the 187 children. The risk of secondary ADHD increased with the level of TBI severity compared with the control group. The children with severe TBI demonstrated a hazard ratio or 3.62. All TBI groups, including complicated mild and moderate TBI, showed nearly double the risk for ADHD compared with controls, although they did not meet the threshold for statistical significance.
The majority of the children developed secondary ADHD within 18 months after severe TBI, however a segment of those with complicated mild or moderate TBI demonstrate later onset of secondary ADHD several years later. Researchers also observed that a higher level of maternal education was associated with a lower risk of secondary ADHD.
Was Your Child Injured?
Children who develop secondary ADHD have a learning disability and are more likely to be under-achievers in school and require special education. They may also under perform as adults compared to their full potential had the injury not occurred.
Vititoe Law Group is a personal injury law firm committed to the health and safety of our youths. If you have a child who suffered a traumatic brain injury, regardless of severity, speak to a brain injury attorney today to explore your legal options to ensure your child’s future. Call 818-851-1886 for a free, confidential consultation.