Children with attention deficit-hyperactivity disorder (ADHD) may experience more disability after mild brain injuries than those without the condition, according to the latest study.
With more studies documenting the potentially long-lasting effects that concussions and mild brain injuries can have on intellectual skills, researchers from the Children’s Hospital of Pittsburgh decided to investigate how youngsters with ADHD may be affected by falls or trauma to the brain that often occur during high-contact sports such as football and soccer. Previous work suggested that ADHD can make children more prone to traumatic brain injuries, and that severe enough injuries can also contribute to a form of ADHD. So they focused on all children who were admitted to their hospital for mild head injuries from 2003 to 2010.
Mild traumatic brain injuries include any blows to the head that do not require brain surgery — which is the case for the majority of concussions.
The researchers investigated 48 children with ADHD who had head injuries patients and 45 similar children who did not experience trauma to the head. A team of brain experts then gave all of the participants a detailed test to assess their cognitive abilities and track any new disabilities during follow-up visits up to seven weeks later. The measures recorded whether the children were able to function normally on their own, or whether they had behavioral problems or required supervision to get dressed or navigate stairs.
About 25% of the patients with ADHD suffered what the scientists defined as moderate disability in which the children were basically independent but still required some assistance with behavioral or physical problems, and 56% showed good recovery, or no residual headaches or abnormal findings on brain scans following the injury. By comparison, 98% of the children without ADHD reverted to their initial cognitive function scores after brief drops following the trauma and 84% had recovered completely.
The researchers say there may be several reasons why children with ADHD experienced more significant disabilities from their head injuries; for one, these kids may have already had some deficits in certain functions that progressed over time, and the testing may have simply picked up this deterioration, independent of the effects of the brain injury. It’s also possible that ADHD interfered with the healing process or made rehabilitation efforts less successful.
That doesn’t mean that falling off a bicycle and hitting his head will leave a child with ADHD disabled. But the findings do suggest that the relationship deserves more study, especially given recent data among adults that connects concussions with cognitive problems and neurological conditions such as Alzheimer’s. The results also highlight the need to be even more vigilant in protecting children with ADHD from head trauma, by ensuring that they wear helmets when riding bicycles or playing sports in which they’re likely to fall or get hit in the head. Doctors, too, may need to monitor ADHD children more closely after any head injury and consider more intensive treatment and rehabilitation strategies to help them recover.
The study is published in the Journal of Neurosurgery: Pediatrics.
June 25, 2013