Structure of attention in children with traumatic brain injury.

Traumatic brain injury (TBI) is a common cause of disability among children in the United States, and attention deficits are frequently observed in both the acute and chronic phases of injury. The current study investigated models of attention in children with TBI and examined differential sensitivity of various components of these attention models to the severity of the brain injury. Participants included 151 children and adolescents (mean age 12.9 years, SD=2.6) who had suffered TBI, and 50 normal controls (mean age 12.5 years old, SD=2.2). All children were administered neuropsychological tests of attention as part of a comprehensive neuropsychological battery for brain injury (TBI group) or for the purposes of the current investigation (normal controls). Confirmatory factor analysis (CFA) of the attention tests indicated that a four-factor model of attention composed of Shift, Focus, Encode, and Sustain factors provided the best fit of the TBI group data. Factor scores were subsequently created and used to predict the severity of brain injury. All four factors were sensitive to TBI in that those with TBI performed significantly worse than the controls, but regression analysis indicated that only the Shift and Focus factors were significant predictors of TBI severity. These findings support the utility of a multicomponent model of attention to understand attention deficits resulting from TBI, and may be useful in determining those aspects of attention that are differentially impacted by TBI, in order to assist in assessment and rehabilitation planning.