TBI disability risk elevated in kids with ADHD

Updated recommendations for sports concussions released
Updated recommendations for sports concussions released

HealthDay News -- Children with attention-deficit/hyperactivity disorder (ADHD) who experience mild traumatic brain injury (TBI) are more likely to be moderately disabled from the injury compared with those without the disorder, study results suggest.

"This finding may be important in managing treatment in children with ADHD who experience a closed head injury (CHI), in informing families about expectations as a child recovers from the injury, and in emphasizing the importance of TBI prevention in children with ADHD," Christoper M. Bonfield, MD, from the University of Pittsburgh, and colleagues reported in the Journal of Neurosurgery: Pediatrics.

Traumatic brain injuries account for approximately 600,000 U.S. ED visits annually and are the leading cause of childhood death and long-term disability. Previous research has suggested that existing ADHD may increase the likelihood of a TBI event.

To determine whether children with ADHD who experience head injuries become more disable than those without ADHD, Bonfield and colleagues retrospectively reviewed the charts of 48 patients with a diagnosis of mild CHI and ADHD and 45 age-matched controls with similar injuries, but without ADHD.

All children were admitted to Children's Hospital of Pittsburgh between January 2003 and December 2010. An initial Glasgow Coma Scale (GCS) score of 13 to 15 was used to define mild TBI due to closed head injury. Children in the ADHD group had a mean age of 12.2 years vs. 11.14 years in the control group.

At follow-up, 25% of patients with mild TBI who had ADHD were moderately disabled (King's Outcome Scale for Childhood Head Injury [KOSCHI] score, 4b) and 56% had completely recovered (KOSCHI score, 5b).

In comparison, 2% of patients with mild TBI without ADHD were moderately disabled and 84% had completely recovered at follow-up (P<0.01).

Following mild TBI, significantly more patients with ADHD than without were disabled, even when controlling for age, sex, initial GCS score, hospital length of stay, length of follow-up, mechanism of injury and the presence of other extracranial injuries.

"Further studies are needed to evaluate the impact of ADHD and other conditions on outcome after TBI of increasing severity, and to explore the mechanisms underlying the relationship between these two conditions," the researchers concluded.


References

  1. Bonfield CM et al. J Neurosurg Pediatr. 2013; doi: 10.3171/2013.5.PEDS12424.
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