Attention Functioning in Children Following Mild Closed Head Injury: The Importance of Prospective Sampling

Attention is commonly disrupted in children after traumatic brain injury (TBI), yet there is continued debate regarding the presence of attention difficulties in mild TBI. The present study sought to investigate acute mild TBI via virtual reality (VR)-based testing. We hypothesized that mTBI would lead to increased commission and omission error relative to controls. 11 children ages 8–14 admitted to the Emergency Room for a mild closed head injury were assessed within 9 months of injury on a Virtual Reality-Continuous Performance Task (Virtual Classroom). Performance was compared with 8 age-matched, non-injured children in separate conditions based on the presence or absence of typical classroom distractions. Results revealed that the mild TBI and control groups committed similar rates of omission (F = .12, p = ns) and commission (F = .42, p = ns) error on the VR-CPT overall and by distraction condition. This was not likely a function of sample size, as younger controls committed significantly more commission errors than younger TBI participants. The fact that Virtual Classroom performance was comparable in mTBI and control groups suggests that children are not likely to experience sustained attention problems after mTBI. This was somewhat surprising yet consistent with other prospective (vs. clinic-referred) studies of mTBI. This study underscores the importance of sampling prospectively when seeking to generalize findings to all mild injury cases. It is crucial to recognize, however, that a subset of children experience more complicated recovery after mTBI, a fact that should guide ongoing understanding of risk following mTBI.