OBJECTIVES: Chronic traumatic encephalopathy (CTE) is linked to repeated head trauma, and although not diagnosed until post-mortem, symptoms include irritability, impulsivity, and mood changes. Repeated head trauma is also linked to the development of hearing complications, either by direct injury to the ear or the auditory cortex. Auditory processing disorder (APD) is a deficit in the brain’s ability to understand and interpret auditory stimuli and can result from head trauma. This study aims to ascertain whether the diagnosis of APD, following a specified number of head injuries, influences any subsequent diagnosis of mood or behavior disorders.

METHODS: This retrospective cohort study identified mood and behavior disorder diagnoses of two pediatric populations using the TriNetX federated network of deidentified health data and patient populations were identified through the platform’s USA network. Only diagnoses with three or more instances of head trauma (ICD-10 S06) within the last five years were assessed. Population one was comprised of patients that lacked the APD diagnosis, while population two included patients diagnosed with APD. Populations were propensity score matched for sex, race, and ethnicity to prevent confounding from any demographic variables.

RESULTS: The prevalence of mood or behavior disorders among pediatric patients with APD was 38.1%, compared to the 23.9% without an APD diagnosis. Compared to pediatric patients without APD and similar head trauma history, those with APD had a higher risk of being diagnosed with a mood or behavior disorder (RR=1.588, 95% CI=1.352, 1.866; p<0.0001).

CONCLUSIONS: In this analysis using real-world data, pediatric patients with APD and a defined number of documented head injuries are more likely to be diagnosed with mood or behavioral disorders compared to pediatric patients with similar head injury history without APD. This may indicate progressive brain damage, making this cohort ideal for a longitudinal study of CTE development throughout the life course.