Moderate-Severe Brain Trauma in Children Linked to Increased Risk for ADHD

Traumatic Brain Injury Sends Over 1 Million Kids, Young Adults to Hospital Annually

Tuesday, March 20, 2018

Severe traumatic brain injury in children was associated with increased risk for later onset of attention-deficit/hyperactivity (ADHD) up to about seven years after injury, according to a study in JAMA Pediatrics.

Researchers at Cincinnati Children’s Hospital Medical Center said the observational study used an analysis of information for 187 children ages 3 to 7 hospitalized overnight for traumatic brain injury or orthopaedic injury at four Ohio hospitals from 2003 to 2008. Forty-eight (25.7 percent) of the children met the definition of secondary ADHD with moderate to severe traumatic brain injury being associated with increased risk.

The information is based on assessments completed by parents up to about seven years following initial injury.

“The findings from this study have important clinical implications and support the need for post-injury monitoring for attention problems and planning clinical follow-up children with traumatic brain injury,” said Brad Kurowski, MD, study co-investigator in the Division of Rehabilitation Medicine at Cincinnati Children’s.

Traumatic brain injury (TBI) sends more than 1 million children, adolescents and young adults to emergency departments every year in the United States. ADHD is the most common psychiatric disorder among children with a history of TBI. Risk factors for secondary ADHD, which has its onset after an injury such as a TBI, are not well understood, according to study co-author Megan Narad, PhD, also in the Division of Rehabilitation Medicine.

Study authors report injury and environmental factors were associated with the risk of secondary ADHD. They point to lower levels of maternal education as being significantly associated with this risk. Family dysfunction also was significantly associated with increased risk in patients with TBI, but not in children admitted overnight for orthopaedic injuries.

The four Ohio hospitals used for the informational analysis were Cincinnati Children’s, Nationwide Children’s Hospital (Columbus), Rainbow Babies and Children’s Hospital (Cleveland) and MetroHealth Medical Center (Cleveland).

Researchers said the study’s limitations include all reports (including ADHD symptoms, history of diagnosis and prescribed medication) being based on parent reports.

Funding support for the study came in part from the Eunice Kennedy Shriver National Institute of Child and Human Development (R01HD42729, 1F32HD088011, K23HDO7468303), a Trauma Research Grant from the State of Ohio Emergency Medical Services, the National Center for Advancing Translational Sciences of the National Institutes of Health (8UL1TR000077), and the Rehabilitation Research Experience for Medical Students.