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July 12, 2021

Advances in Understanding the Association Between Pediatric Traumatic Brain Injury and Attention-Deficit/Hyperactivity Disorder

Author Affiliations
  • 1Department of Psychology, Alberta Children’s Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  • 2Department of Psychiatry, University of California, San Diego,
  • 3Department of Psychiatry, Rady Children’s Hospital , San Diego, California
  • 4Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 5Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Pediatr. 2021;175(10):1001-1003. doi:10.1001/jamapediatrics.2021.2038

Traumatic brain injury (TBI) is the leading cause of acquired disability in children, and attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental sources of disability.1,2 The association between TBI and ADHD has been a topic of controversy, which Asarnow et al3 address in their systematic review and meta-analysis in this issue of JAMA Pediatrics. They focus on whether the risk of ADHD increases after TBI, but also present data bearing on the question of whether ADHD is itself a risk factor for TBI. Importantly, their analysis shows a “dose-related” association between TBI severity and postinjury ADHD, with a significantly elevated risk of ADHD among children with severe TBI compared with an other injured control (OIC) group of children and children with mild TBI within 1 year postinjury, and with a noninjured control (NIC) group, OIC, and children with mild TBI more than 1 year postinjury. In addition, their analyses show no increase in postinjury ADHD in children with concussion, mild TBI, or moderate TBI compared with the rate in the NICs or OICs. They also note that the rate of preinjury ADHD was higher in children with TBI than in the general population, although not higher than among samples of the NIC or OIC groups. These findings have important clinical implications, highlighting the need to assess for ADHD in children with TBI, especially those with severe injuries, but also to take a careful history to determine whether symptoms of ADHD predate the injury.

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