Attention-Deficit/Hyperactivity Disorder Following Mild Traumatic Brain Injury in Children: A Retrospective Exploratory Study

Introduction This study examines whether attention-deficit/hyperactivity disorder (ADHD) can develop after traumatic brain injury in children. Overlapping acute symptoms can hinder early identification and diagnosis. We investigated whether demographic or acute clinical features are associated with the development of secondary ADHD (S-ADHD) following mild pediatric traumatic brain injury. Materials and methods We conducted a retrospective cohort study of patients at the Boston Medical Center Pediatric Concussion Clinic from 2010 to 2023. Of 284 screened pediatric patients with traumatic brain injury, 198 were excluded due to missing initial or last SCAT scores, pre-existing ADHD, or incomplete assessments. The final analytic sample included 86 patients, categorized into an S-ADHD group (n = 10) and a non-ADHD group (n = 76), based on a new diagnosis made by a pediatric neurologist. We compared demographics and symptom variables using descriptive statistics, the Wilcoxon rank-sum test, and Fisher's exact test. Results No statistically significant differences were observed between groups in age, sex, or acute clinical symptoms (e.g., loss of consciousness, confusion, amnesia). However, children diagnosed with S-ADHD demonstrated a significantly longer follow-up duration (median 536 vs. 132 days, p < 0.001), highlighting the need for prolonged clinical monitoring in this population. Conclusion This exploratory study found no significant acute clinical features associated with S-ADHD development after mild traumatic brain injury. The findings underscore the importance of prolonged clinical monitoring, as S-ADHD may manifest later in life. Future research with larger cohorts is needed to identify reliable early indicators.