ADHD May Be Tied to Longer-Lasting Head Injury, Study Says06/25/13
TUESDAY, June 25 (HealthDay News) -- Children with
attention-deficit hyperactivity disorder should be steered away
from contact sports such as football or basketball because these
kids may be at greater risk of long-lasting head injury than their
peers, a new study recommends.
Scientists found that children with ADHD -- who are already
prone to risk-taking behaviors -- were much more likely than kids
without the disorder to suffer a moderate disability after
sustaining a mild traumatic brain injury from events such as car
accidents, falls and injuries from high-impact sports.
"This was a phenomenon that I had noticed in my own practice -- some children with ADHD didn't recover as well following a traumatic brain injury," said senior study author Dr. Stephanie Greene, an assistant professor of neurological surgery at Children's Hospital of Pittsburgh. Some of the symptoms of traumatic brain injury are also symptoms of ADHD -- disinhibited behavior and impaired memory, she noted. "The effects of the [traumatic brain injury] may be additive to those of ADHD," she explained.
Encouraging activities in which the chances of brain injury are
lower -- for example, swimming or track instead of football or
basketball -- is a way in which parents can provide an outlet for
energy while protecting their child's brain, she added.
The study is published online June 25 in the
Journal of Neurosurgery: Pediatrics.
About 8 percent of American children have ADHD, a neurological
disorder characterized by problems focusing, being overactive and
exhibiting poor impulse control, according to the U.S. Centers for
Disease Control and Prevention. Traumatic brain injury results in
more than 7,000 deaths, 60,000 hospitalizations and 600,000
emergency room visits annually in the United States, according to
the study. Prior research has linked several aspects of ADHD and
traumatic brain injury.
In the new study, Greene and her colleagues reviewed medical
charts of all patients at Children's Hospital of Pittsburgh who had
ADHD and were diagnosed with a mild traumatic brain injury between
2003 and 2010. Forty-eight of these children were compared with a
control group of 45 children without ADHD who had also sustained a
mild traumatic brain injury.
The researchers found that 25 percent of the ADHD group suffered
a moderate disability, and 56 percent had completely recovered
after a nearly six-month follow-up period. In contrast, among the
patients without ADHD, only 2 percent suffered a moderate
disability and 84 percent had completely recovered after a much
shorter follow-up of seven weeks. Moderate disability was defined
as needing supervision or help for physical or behavioral problems,
or having residual problems with learning or functioning.
Dr. Andrew Adesman, chief of developmental and behavioral
pediatrics at Steven and Alexandra Cohen Children's Medical Center
of New York in New Hyde Park, praised the study's design and said
the authors excelled at explaining the possible implications of the
"As someone who specializes in the evaluation and care of children with ADHD, I know they are at increased risk of injury," he said. "I think this study is suggesting that if they do experience a significant head injury, they may have greater long-term problems from that. Why that's true is hard to know."
The study made several recommendations stemming from the
results, including that doctors should counsel families of children
with ADHD about expected outcomes after a head injury; that more
intensive treatment and rehabilitation for these patients be
initiated; and that parents perhaps discourage children with ADHD
from sports or hobbies that carry higher risks of sustaining a
traumatic brain injury.
"Part of the problem with children with ADHD is that they often have poor impulse control, which means that they are at higher risk of sustaining a [traumatic brain injury] by engaging in risk-taking behaviors in daily life, separate from sports," Greene said. "When risky sports are added to the already elevated risk of [traumatic brain injury], the chances of a child sustaining a [traumatic brain injury] with potentially lingering effects become unacceptably high."
But Adesman said the findings need to be replicated before he
would agree with curtailing contact sports for children with
"I would not steer all kids with ADHD away from contact sports based on single study," he said. "Certainly we know that kids can experience accidents thru a variety of means . . . sports accidents made up a very small percent of accidents" in this study.
The U.S. Centers for Disease Control and Prevention has more
traumatic brain injury.
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