Citation

Narad ME, Riemersma J, Wade SL, Smith-Paine J, Morrison P, Taylor HG, Yeates KO, Kurowski BG. J. Head Trauma Rehabil. 2019; ePub(ePub): ePub.

Affiliation

Divisions of Behavioral Medicine and Clinical Psychology (Dr Narad) and Physical Medicine & Rehabilitation (Drs Wade and Kurowski and Ms Smith-Paine), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of Pediatrics (Drs Narad, Wade, and Kurowski) and Neurology and Rehabilitation Medicine (Dr Kurowski), University of Cincinnati College of Medicine (Mss Riemersma and Morrison), Cincinnati, Ohio; Department of Psychology, University of Cincinnati, Cincinnati, Ohio (Ms Smith-Paine); Biobehavioral Health Center, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio (Dr Taylor); Department of Pediatrics, The Ohio State University, Columbus, Ohio (Dr Taylor); and Department of Psychology (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), University of Calgary, Calgary, Alberta, Canada.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000550

PMID

31834065

Abstract

OBJECTIVE: To examine the impact of secondary attention-deficit/hyperactivity disorder (SADHD) on long-term global and executive functioning in adolescents after traumatic brain injury (TBI). SETTING: Three tertiary cared children's hospitals and 1 general hospital. PARTICIPANTS: One hundred twenty children (TBI: n = 54; orthopedic injury: n = 66) without preinjury ADHD evaluated approximately 6.8 years postinjury.

DESIGN: Cross-sectional data analysis from a prospective, longitudinal study. MAIN MEASURES: Outcomes included functional impairment (Child and Adolescent Functional Assessment Scale) and executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]).

RESULTS: SADHD moderated the association of injury type with the BRIEF-Behavioral Regulation Index (F1,113 = 4.42, P =.04) and the Child and Adolescent Functional Assessment Scale (F1,112 = 8.95, P =.003). TBI was only associated with poorer outcomes in the context of SADHD. SADHD was also associated with poorer outcomes on the BRIEF-Global Executive Composite (F1,113 = 52.92, P <.0001) and BRIEF-Metacognitive Index scores (F1,113 = 48.64, P <.0001) across groups. Adolescents with TBI had greater BRIEF-Global Executive Composite scores than those with orthopedic injury (F1,113 = 5.00, P =.03).

CONCLUSIONS: Although SADHD was associated with poorer functioning across groups, its adverse effects on behavioral regulation and overall functioning were amplified following TBI. TBI + SADHD may confer an elevated risk for significant impairments in early adolescence.

Language: en