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Psychiatry and psychology/community

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H. E. Miller, R. J. McCarter, A. L. Curran, L. Hunt, A. Brownsdon, P. M. Sharples, the Kids Head Injury Study Group. Frenchay Hospital, Bristol

Introduction: TBI is a major cause of hospital admission in childhood. TBI is recognised to result in attentional problems, yet surprisingly few data exist concerning their nature and determinants, especially early after TBI.

Aims: (1) To define attentional status in TBI children admitted to hospital at 1 month after injury compared with normal uninjured controls; (2) to explore the factors related to attentional status.

Methods: Prospective cohort study. TBI was classed by Glasgow Coma Score (GCS) as severe (GCS 3–8), moderate (GCS 9–12), or mild (GCS 13–15). Attentional status was assessed using the Test of Everyday Attention for Children (TEA-Ch). Psychological response was assessed by the Birleson Depression Scale (BDS), Impact of Events Scale (IES), Revised Children’s Manifest Anxiety Scale (RCMAS), and Child Behaviour Checklist (CBCL). Maternal depressive symptomatology was assessed by the Beck Depression Inventory-II (BDI-II).

Results: 88 TBI subjects (51 severe/moderate; 37 mild) and 47 controls were recruited. There was no significant difference in age between TBI (mean 13.1 years) and controls (mean 13.2 years) (p 0.877). There was a significant difference between severe/moderate TBI children and controls but not mild TBI and controls on selective attention (Map Mission, p<0.001), attentional switching (Opposite Opposite Worlds, p<0.001), and divided attention (Sky Search DT, p<0.05). There was a significant relationship between attentional status and problematic behaviour in the child (CBCL externalising score, p 0.005; CBCL total problem score, p 0.004) but not between attentional status and symptoms of depression or anxiety (BDS, p 0.36, IES, p 0.74; RCMAS, p 0.55). There was a significant correlation between the child’s attentional status and maternal depressive symptomatology (p 0.008).

Conclusion: TBI produces significant problems across a range of …

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