Association of Pediatric Head Trauma with Attention Deficit Hyperactivity Disorder (ADHD) among School-aged Children in the United States

Background

Pediatric concussion is an important issue in healthcare that has gained recognition in recent years. Concussion may lead to negative emotional and cognitive consequences. ADHD may be a potential neurobehavioral consequence of head trauma, with evidence suggesting an increased likelihood of ADHD in individuals who have experienced concussions or have a history of head trauma.

Objective

This study examined disparities in pediatric head trauma and the association of a history of pediatric head trauma with ADHD using nationally representative data from the United States.

Methods

We performed a cross-sectional study using the 2021 National Health Interview Survey (NHIS). The study was restricted to school-aged children (5-17 years) with no missing information on ADHD or head trauma. There were 5,960 participants representing ~52.11 million US children. Our key independent variable was concussion (Yes/No) with yes indicating a positive response to any question in the 2021 NHIS survey fitting the following descriptions: “ever lost consciousness”, “ever told had a concussion”, “ever dazed or memory gap”, and “ever headache, vomit, blurred vision, or mood change after blow to the head.” ADHD was derived from a question that asked about the diagnosis of ADHD by a health professional or doctor. We performed Rao-Scott Chi-square tests and logistic regression analyses to identify the association of concussion with ADHD while controlling for other explanatory variables (sex, race & ethnicity, age, poverty status, food security, housing security, problem paying medical bills, health insurance, region, metro, family structure, adult education level). All analyses were conducted with SAS 9.4 survey procedures.

Results

Among the sample, 8.1% had experienced head trauma, and 10.6% had been diagnosed with ADHD. A lower percentage of Non-Hispanic Blacks (NHB) experienced head trauma (5.5% vs. 9.6%) compared to Non-Hispanic Whites (NHW). A higher percentage of males (9.1% vs. 7.0%) had head trauma compared to females. The prevalence of head trauma was higher in minors 14-17 years (13.3% vs. 4.9%) compared to 5–10-year-old children. A higher percentage of those with head trauma (20.7% vs 9.8%) had ADHD compared to those without head trauma. After adjustment for other covariates, children with concussion were more likely to report ADHD (aOR = 1.81, 95% CI = 1.34, 2.45) compared to those without concussion.

Conclusion

NHWs, males, and minors aged between 14-17 years were more likely to report a history of head trauma. Head trauma was associated with ADHD even when adjusted for confounding variables. It has been speculated in the past that NHW predominance in head trauma may represent greater prevalence of reporting rather than an actual increase in head trauma in this group raising the question of whether lack of injury recognition in minority demographics represents a possible area of improvement for improved health outcomes. In addition, the positive correlation between ADHD and pediatric head trauma warrants further investigation to establish possible causal relationships.