August 3, 2015 / 2:28 PM / 5 years ago

Pediatric brain injury may lead to attention problems

(Reuters Health) - Kids with traumatic brain injury (TBI) have more lapses in attention and longer reaction times than children who suffer trauma to other parts of the body, researchers report.

Attention problems have been seen in adults after TBI. This study, however, is the first to show not just lapses of attention in children with TBI but also that these lapses are related to intelligence and attention problems, said lead author Marsh Konigs of VU University Amsterdam in The Netherlands.

His team compared 113 kids, ages six to 13, who had suffered a traumatic brain injury, and 53 kids who suffered a non-head injury.

An average of one and a half years after the injury, parents and teachers rated attention problems and internalizing problems like anxiety higher for kids with TBI. Parents also rated externalizing problems, like aggression, higher for the kids with TBI.

Average reaction time was slower for kids in the TBI group than for those in the other trauma group, the researchers found.

Ninety-one kids had moderate to severe TBI, meaning they lost consciousness for more than 30 minutes and had posttraumatic amnesia for at least an hour. This group scored lower on IQ tests and had more lapses of attention than the 24 kids with mild TBI, according to a report in Pediatrics.

Kids with mild TBI and extra risk factors like headache, vomiting or seizures after their injury also had lower IQ scores and more lapses of attention.

Because the attention problems persisted more than a year after the injury, it is unlikely that they will resolve themselves over time, Konigs said.

For more than 15 years now, researchers have known that “secondary attention deficit hyperactivity disorder” can develop after brain injury in children, according to Dr. Bradley L. Schlaggar, head of the Division of Pediatric and Developmental Neurology at Washington University School of Medicine in St. Louis, Missouri.

Schlaggar was not part of the new study.

“The kinds of daily life problems caused by attention deficits, internalizing behaviors, and externalizing behaviors are numerous and fairly self-evident,” he told Reuters Health by email. “An impulsive child who is aggressive will have difficulty with relationships, with school performance, with participation in extracurricular activities, and so forth.”

The consequences of TBI vary between children, depending on injury severity and other factors, Konigs said.

Teachers and doctors should know that children with TBI can have very short lapses in focus, and appear to process information slower, he told Reuters Health by email.

Wearing helmets while bicycling and having separate bicycle lanes on busy streets may reduce the risk of TBI, he said.

“There is only so much parents can do to minimize risk of an injury but monitoring their child’s risk-taking behavior, modeling and teaching skills that reduce risk of an injury, using protective gear or devices, supervision, and monitoring of organized activities or sports for aggressive or risky coaching or competition are all helpful,” said Talin Babikian of the UCLA BrainSPORT Program in Los Angeles, California, who was not part of the new study.

“Our research did not investigate treatment options for lapses of attention, but other studies showed that stimulant treatment (methylphenidate) successfully reduce lapses of attention in children with ADHD and childhood cancer survivors, suggesting that this treatment could potentially reduce lapses of attention in children with TBI as well,” Konigs said.

SOURCE: Pediatrics, online August 3, 2015.

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