Inattention and impulsivity in attention-deficit/hyperactivity disorder (ADHD) and pediatric extremity fractures: an association between neurobehavioral traits and trauma presentation

BACKGROUND: This study aimed to investigate whether the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, particularly inattention and impulsivity, is associated with extremity fractures in children. Additionally, ADHD symptom scores were compared between surgically and conservatively treated fracture cases, and the relationship between trauma energy level and ADHD symptoms was evaluated. METHODS: In this cross-sectional study, 160 children aged 7-17 years were evaluated. Participants were divided into three groups: children with surgically treated fractures (n=40), children with conservatively treated fractures (n=40), and fracture-free controls (n=80). ADHD symptoms were assessed using a parent-completed Screening and Assessment Scale based on the Diagnostic and Sta-tistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Sociodemographic data, trauma mechanisms, and fracture characteristics were also documented. RESULTS: Children with fractures had significantly higher inattention scores (6.13±3.44 vs. 4.26±2.34; p<0.001), impulsivity scores (6.50±4.70 vs. 4.45±2.10; p=0.001), and total ADHD scores (12.60±6.41 vs. 8.74±3.62; p<0.001) compared with controls. No significant differences were observed between the surgical and conservative treatment groups or between low- and high-energy trauma subgroups. Sociodemographic variables and fracture history among siblings did not differ significantly between the groups. CONCLUSION: Higher ADHD symptom scores were significantly associated with the occurrence of extremity fractures in children. These findings suggest that assessing ADHD-related symptoms may provide useful insights during pediatric trauma evaluations. However, due to the cross-sectional design, temporality and causality cannot be established. Longitudinal studies are needed to confirm these associations.