Attentional functioning in children with and without post-traumatic stress symptoms post traumatic brain injury

© 2010 Dr. Senem ErenAttentional deficits are common following childhood traumatic brain injury (TBI). There is also evidence of attentional impairments in individuals with post-traumatic stress disorder (PTSD), however it remains unclear as to how attention might be impacted when a child has sustained a TBI and is also experiencing PTSD. To address this issue, the current study was comprised of three key components. Study 1 examined the presence and nature of attentional deficits in children with and without subsyndromal PTSD post TBI using hierarchical clinical and questionnaire measures; Study 2 involved developing experimental measures which have been shown to be useful in characterizing PTSD symptoms in adults and explored the potential application in children. The behavioural versions of the emotional counting stroop and faces paradigms were piloted in healthy children as part of this process; and Study 3 reported case study analyses of the newly developed experimental measures in children with and without PTSD post TBI. Participants involved in study 1 were between the ages of 6-14 years at the time of injury and were assessed six months post-injury. Results indicated that children with TBI do not exhibit a generalized pattern of attentional impairment. Instead, attentional deficits were limited to specific components and were related to factors such as injury severity and brain maturity at the time of injury. Although the incidence was low, findings confirmed that children with TBI can also develop subsyndromal PTSD, with comparable rates observed across TBI severity levels. Findings also suggested that the presence of subsyndromal PTSD post TBI does not compound the higher-order attentional difficulties experienced as a result of TBI. Poorer attentional functioning was best predicted by injury severity and age at injury, whereas SES, pre-injury emotional functioning and the presence of subsyndromal PTSD post TBI did not contribute significantly to attentional functioning outcomes post pediatric TBI. A total of 10 neurologically healthy children, 3 male and 7 female, participated in study 2. While the results need to be considered preliminary in light of the small sample size, healthy children responded significantly faster to the baseline condition when compared to other stimuli. Additionally, there were no significant differences in error rates in both paradigms. Two male children with moderate TBI and no PTSD and two male children with dual PTSD/mild TBI were included in the case study analyses. Findings on the emotional counting stroop case studies suggested that the processing of trauma-related information may be recruiting greater attentional resources in children with PTSD, but only in those who are displaying severe hyperarousal symptoms on clinical presentation. The stroop interference effect was not observed in the healthy controls or children with TBI only, highlighting the disorder-specific nature of the observed interference effect. The expected attentional bias to fearful expression was not observed in the faces paradigm. A number of possible explanations were considered to account for the findings, with strong suggestions that attentional bias in children with PTSD post TBI is specific to trauma-related information and does not extend to generally negative stimuli. Overall, the piloting and development of the emotional counting stroop and faces paradigms, together with the case studies, allowed for the establishment of optimal timing parameters for a pediatric population and marked the first time developmentally appropriate versions of these two paradigms were implemented in children. This was an important step towards validating these experimental paradigms for future use in larger clinical samples