Attention problems are common in children who sustain a traumatic brain injury (TBI). The differential features of TBI-related Attention Deficit Hyperactivity Disorder (ADHD) and primary ADHD are largely unknown. This study aimed to compare sleep problems and quality of life between children with TBI and ADHD and children with primary ADHD.
Methods
Twenty children with TBI (mean age = 12.7 ± 3.1 years) who had clinically significant ADHD symptoms according to the structured diagnostic interview and rating scales and a control group with primary ADHD (n = 20) were included. Parents completed Children’s Sleep Habits Questionnaire (CSHQ) and Kinder Lebensqualitätsfragebogen: Children’s Quality of Life Questionnaire-revised (KINDL-R). Neurology clinic charts were reviewed for TBI-related variables.
Results
When compared to children with primary ADHD, the Total Score and Sleep Onset Delay, Daytime Sleepiness, Parasomnias, and Sleep Disordered Breathing subscores of CSHQ were found to be higher in children with TBI and ADHD. The Total Score and Emotional Well-Being and Self-Esteem subscores of the KINDL-R were found to be low (poorer) in children with TBI and ADHD. The Total Score and certain subscores of KINDL-R were found to be lower in TBI patients with a CSHQ > 56 (corresponds to significant sleep problems) when compared to those with a CSHQ < 56. CSHQ Total Score was negatively correlated with age.
Conclusion
Children with TBI and ADHD symptoms were found to have a poorer sleep quality and quality of life than children with primary ADHD. ADHD in TBI may be considered as a highly impairing condition which must be early diagnosed and treated.
MenonDSchwabKWrightD. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil2010; 91: 1637–1640.
2.
LangloisJRutland-BrownWWaldM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil2006; 21: 375–378.
3.
BeauchampMCatroppaCGodfreyC. Selective changes in executive functioning ten years after severe childhood traumatic brain injury. Dev Neuropsychol2011; 36: 578–595.
4.
TaylorHGSwartwoutMDYeatesKO. Traumatic brain injury in young children: postacute effects on cognitive and school readiness skills. J Int Neuropsychol Soc2008; 14: 734–745.
5.
EmeR. ADHD: an integration with pediatric traumatic brain injury. Expert Rev Neurother2012; 12: 475–483.
6.
LevinHHantenGMaxJ. Symptoms of attention-deficit/hyperactivity disorder following traumatic brain injury in children. J Dev Behav Pediatrics2007; 28: 108–118.
7.
MaxJLansingAKoeleS. Attention deficit hyperactivity disorder in children and adolescents following traumatic brain injury. Dev Neuropsychol2004; 25: 159–177.
8.
BrennerLDise-LewisJBartlesS. The long-term impact and rehabilitation of pediatric traumatic brain injury: a 50-year follow-up case study. J Head Trauma Rehabil2007; 22: 56–64.
9.
StoresGStoresR. Sleep disorders in children with traumatic brain injury: a case of serious neglect. Dev Med Child Neurol2013; 55: 797–805.
10.
MilroyGDorrisLMcMillanTM. Sleep disturbances following mild traumatic brain injury in childhood. J Pediatr Psychol2008; 33: 242–247.
11.
ThamSWPalermoTMVavilalaMS. The longitudinal course, risk factors, and impact of sleep disturbances in children with traumatic brain injury. J Neurotrauma2012; 29: 154–161.
12.
BeebeDWKrivitzkyLWellsCT. Brief report: parental report of sleep behaviors following moderate or severe pediatric traumatic brain injury. J Pediatr Psychol2007; 32: 845–850.
13.
ClarkeEBakerBGardnerM. Effectiveness of stimulant drug treatment for attention problems: a look at head injured children. School Psychol Int1990; 11: 227–234.
14.
GerringJPBradyKDChenA. Premorbid prevalence of ADHD and development of secondary ADHD after closed head injury. J Am Acad Child Adolesc Psychiatry1998; 37: 647–654.
15.
CatroppaCAndersonV. Traumatic brain injury in childhood: rehabilitation considerations. Dev Neurorehab2009; 12: 53–61.
16.
FletcherJMEwing-CobbsLMinerME. Behavioral changes after closed head injury in children. J Consult Clin Psychol1990; 58: 93–98.
17.
WassenbergR1MaxJEKoeleSL. Classifying psychiatric disorders after traumatic brain injury and orthopaedic injury in children: adequacy of K-SADS versus CBCL. Brain Inj2004; 18: 377–390.
18.
OwensJASpiritoAMcGuinnM. The children’s sleep habits questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep2000; 23: 1043–1051.
19.
FişNPArmanAAyP. The validity and the reliability of Turkish Version of Children's Sleep Habits Questionnaire. Anadolu Psikiyatri Derg2010; 11: 151–160. [in Turkish].
20.
SikoraDMJohnsonKClemonsT. The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders. Pediatrics2012; 130(Suppl 2): 83–90.
21.
Ravens-SiebererUBullingerM. Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Qual Life Res1998; 7: 399–407.
22.
EserEYükselHBaydurH. The psychometric properties of the new Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Turk Psikiyatri Derg2008; 19: 409–417. [in Turkish].
23.
GoyetteCHConnersCKUlrichRF. Normative data on Revised Conners Parent and Teacher Rating Scales. J Abnorm Child Psychol1978; 6: 221–236.
24.
DereboyCSenolSSenerS. Conners kısa form öğretmen ve anababa derecelendirme ölçeklerinin geçerliliği. Turk Psikiyatri Dergisi2007; 18: 48–58. [in Turkish].
25.
ŞenerSDereboyÇDereboyIF. Turkish adaptation of Conners Teacher Rating-I. Turk J Chıld Adolesc Ment Health1995; 2: 131–141. [in Turkish].
26.
SumpterREDorrisLKellyT. Pediatric sleep difficulties after moderate-severe traumatic brain injury. J Int Neuropsychol Soc2013; 19: 829–834.
27.
WeedED. ADHD in school-aged youth: management and special treatment considerations in the primary care setting. Int J Psychiatr Med2016; 51: 120–136.
28.
CorkumPMoldofskyHHogg-JohnsonS. Sleep problems in children with attention-deficit/hyperactivity disorder: İmpact of subtype, comorbidity, and stimulant medication. J Am Acad Child Adolesc Psychiatry1999; 38: 1285–1293.
29.
KaufmanYTzischinskyOEpsteinR. Long-term sleep disturbances in adolescents after minor head injury. Pediatr Neurol2001; 24: 129–134.
30.
DanckaertsMSonuga-BarkeEJBanaschewskiT. The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry2010; 19: 83–105.
31.
MorleyCP. Disparities in ADHD assessment, diagnosis, and treatment. Int J Psychiatr Med2010; 40: 383–389.
32.
GormezVForbesFCM. Self-image profile in children and adolescents with attention deficit/ hyperactivity disorder and the quality of life in their parents. Int J Psychiatr Med2015; 49: 19–33.
33.
CastriottaRJWildeMCLaiJM. Prevalence and consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med2007; 3: 349–356.
34.
WildeMCCastriottaRJLaiJM. Cognitive impairment in patients with traumatic brain injury and obstructive sleep apnea. Arch Phys Med Rehabil2007; 88: 1284–1288.
35.
OsorioMBKurowskiBGBeebeD. Association of daytime somnolence with executive functioning in the first 6 months after adolescent traumatic brain injury. PM R2013; 5: 554–562.
HawleyCAWardABMagnayAR. Outcomes following childhood head injury: a population study. J Neurol Neurosurg Psychiatry2004; 75: 737–742.
38.
FichtenbergNLZafonteRDPutnamS. Insomnia in a post-acute brain injury sample. Brain Inj2002; 16: 197–206.
39.
BrehautJCMillerARainaP. Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics2003; 111: 262–269.
40.
GinstfeldtTEmanuelsonI. An overview of attention deficits after paediatric traumatic brain injury. Brain Inj2010; 24: 1123–1134.
41.
BloomfieldILEspieCAEvansJJ. Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?J Int Neuropsychol Soc2010; 16: 17–25.
42.
HargraveTMArthurME. Teaching child psychiatric assessment skills: Using pediatric mental health screening tools. Int J Psychiatr Med2015; 50: 60–72.
