Impact of Secondary ADHD on Long-Term Outcomes After Early Childhood Traumatic Brain Injury

Objective: To examine the impact of secondary attention-deficit/hyperactivity disorder (SADHD) on long-term global and executive functioning in adolescents after traumatic brain injury (TBI). Setting: Three tertiary cared children's hospitals and 1 general hospital. Participants: One hundred twenty children (TBI: n = 54; orthopedic injury: n = 66) without preinjury ADHD evaluated approximately 6.8 years postinjury. Design: Cross-sectional data analysis from a prospective, longitudinal study. Main Measures: Outcomes included functional impairment (Child and Adolescent Functional Assessment Scale) and executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]). Results: SADHD moderated the association of injury type with the BRIEF-Behavioral Regulation Index (F-1,F-113 = 4.42, P = .04) and the Child and Adolescent Functional Assessment Scale (F-1,F-112 = 8.95, P = .003). TBI was only associated with poorer outcomes in the context of SADHD. SADHD was also associated with poorer outcomes on the BRIEF-Global Executive Composite (F-1,F-113 = 52.92, P < .0001) and BRIEF-Metacognitive Index scores (F-1,F-113 = 48.64, P < .0001) across groups. Adolescents with TBI had greater BRIEF-Global Executive Composite scores than those with orthopedic injury (F-1,F-113 = 5.00, P = .03). Conclusions: Although SADHD was associated with poorer functioning across groups, its adverse effects on behavioral regulation and overall functioning were amplified following TBI. TBI + SADHD may confer an elevated risk for significant impairments in early adolescence.