Levin Harvey, Hanten Gerri, Max Jeffrey, Li Xiaoqi, Swank Paul, Ewing-Cobbs Linda, Dennis Maureen, Menefee Deleene S, Schachar Russell
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
J Dev Behav Pediatr. 2007 Apr;28(2):108-18. doi: 10.1097/01.DBP.0000267559.26576.cd.
We investigated changes in inattentive and hyperactive symptoms over 2 years following traumatic brain injury (TBI) in relation to preinjury attention-deficit/hyperactivity disorder (ADHD), injury, and socioeconomic status (SES) variables. Postinjury stimulant medication treatment was also documented. Of 175 consecutive patients of ages 5 to 15 years with acute TBI, 148 consented, including 114 without preinjury ADHD (mean age, 10.0 years, SD = 2.76) and 34 with preinjury ADHD (mean age 10.36 years, SD = 2.75). The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version, was administered at baseline and at 6, 12, and 24 months post-injury to assess the presence of nine core inattentive and nine hyperactive symptoms and associated impairment. The baseline assessment was performed within 1 month post-injury to establish preinjury diagnosis.
Nonlinear change in inattentive symptoms in patients without preinjury ADHD contrasted with higher and more stable symptom levels in children with preinjury diagnosis, including the cubic trend (chi2(1) = 6.23, p = .0126). There was also a significant interaction of group x gender effect (chi2(1) = 4.08, p = .0435) as males had higher numbers of inattentive symptoms than females in the preinjury ADHD group. Change in hyperactive symptoms over time also differed by group, including both linear (chi2(1) = 5.42, p = .0199) and cubic trends (chi2(1) = 8.91, p = .0029), reflecting greater and more frequent fluctuations in children without preinjury ADHD. Socioeconomic level also contributed to change in hyperactive symptoms as reflected by the interaction of SES and linear time (chi2(1) = 6.91, p = .009), as well as quadratic time (chi2(1) = 4.90, p = .027). Occurrence of ADHD diagnosed post-injury ranged from 14.5% (12 months) to 18.3% (24 months) in the group without preinjury ADHD compared with a range from 86.4% (12 months) to 96.2% (6 months) in children with preinjury ADHD. In children without preinjury ADHD, SES was the only patient variable that predicted onset of ADHD, t(110) = -2.85, p = .0052. Treatment with stimulant medication post-injury was more frequently associated with preinjury ADHD (39% vs 7% of children without preinjury ADHD), p< .0001 (Fisher exact test). Children with preinjury ADHD who were treated pre-injury with stimulant medication had fewer total symptoms at 24 months post-injury relative to untreated patients with preinjury ADHD (F[1,14] = 3.93, p = 0.069, Cohen's d = 1.28).
Change in ADHD symptoms after TBI varies with preinjury diagnosis, reflects injury severity in children without preinjury ADHD, and is treated with stimulant medication mainly in those patients with preinjury ADHD.
我们调查了创伤性脑损伤（TBI）后2年内注意力不集中和多动症状的变化，这些变化与伤前注意力缺陷多动障碍（ADHD）、损伤及社会经济地位（SES）变量相关。还记录了伤后使用兴奋剂药物治疗的情况。在175例年龄5至15岁的急性TBI连续患者中，148例同意参与研究，其中114例伤前无ADHD（平均年龄10.0岁，标准差=2.76），34例伤前有ADHD（平均年龄10.36岁，标准差=2.75）。采用学龄儿童情感障碍和精神分裂症量表（现患及终生版）在基线以及伤后6、12和24个月进行评估，以评估9种核心注意力不集中症状、9种多动症状及相关损害的存在情况。伤后1个月内进行基线评估以确立伤前诊断。
伤前无ADHD患者的注意力不集中症状呈非线性变化，这与伤前已确诊的儿童中更高且更稳定的症状水平形成对比，包括三次趋势（χ2(1)=6.23，p = 0.0126）。组x性别效应也存在显著交互作用（χ2(1)=4.08，p = 0.0435），因为在伤前ADHD组中，男性的注意力不集中症状数量多于女性。随着时间推移，多动症状的变化也因组而异，包括线性趋势（χ2(1)=5.42，p = 0.0199）和三次趋势（χ2(1)=8.91，p = 0.0029），这反映出伤前无ADHD的儿童症状波动更大且更频繁。社会经济水平也导致多动症状的变化，这体现在SES与线性时间的交互作用（χ2(1)=6.91，p = 0.009）以及二次时间的交互作用（χ2(1)=4.90，p = 0.0
