Influence of Methylphenidate on Long-Term Neuropsychological and Everyday Executive Functioning After Traumatic Brain Injury in Children with Secondary Attention Problems

Abstract

Objective: To investigate the effects of methylphenidate on long-term executive and neuropsychological functioning in children with attention problems following TBI, as well as the relationship between methylphenidate associated changes in lab-based neuropsychological measures of attentional control, processing speed, and executive functioning and parent- or self-report measures of everyday executive functioning. Method: 26 children aged 6–17 years, who were hospitalized for moderate-to-severe blunt head trauma 6 or more months previously, were recruited from a large children’s hospital medical center. Participants were randomized into a double-masked, placebo-controlled cross-over clinical trial. Participants completed a comprehensive neuropsychological battery and parent- and self-report ratings of everyday executive functioning at baseline, and at 4 weeks and 8 weeks following upward titration of medication to an optimal dose or while administered a placebo. Results: Methylphenidate was associated with significant improvements in processing speed, sustained attention, and both lab-based and everyday executive functioning. Significant treatment-by-period interactions were found on a task of sustained attention. Participants who were randomized to the methylphenidate condition for the first treatment period demonstrated random or erratic responding, with slower and more variable response times when given placebo during the second period. Conclusion: Results indicate that methylphenidate treatment is associated with positive outcomes in processing speed, sustained attention, and both lab-based and everyday measures of executive functioning compared to placebo group. Additionally, results suggest sustained attention worsens when discontinuing medication. (JINS, 2019, 25, 740–749)

Topological Aberrance of Structural Brain Network Provides Quantitative Markers of post-TBI Attention Deficits in Children

“…Among the most common cognitive consequences, significant attention deficits were reported in about 35% of children within two years of their TBI (Max et al, 2005), and were observed to strongly contribute to elevated risk for severe psychopathology and impairments in overall functioning in late adolescence, with the pathophysiological underpinning yet to be fully elucidated (Le Fur et al, 2019;Narad et al, 2019). The post-TBI attention problems in children have been evaluated and treated based on endorsements of behavioral symptoms from subjective observations, and have resulted in largely divergent results regarding effectiveness (Backeljauw and Kurowski, 2014;Kurowski et al, 2019;LeBlond et al, 2019). Understanding the neurobiological substrates of post-TBI attention deficits in children is thus vitally critical, so that timely and tailored strategies can be developed for diagnoses and long-term treatments and interventions.…”

Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta‐Analysis and Meta‐Regression

“…Likewise, the meta-analytic effect was replicated when including only the higher-quality studies with low risk of bias. 44,45,47,48,54 (d = 0.185, 95% CI: 0.028-0.341, P = 0.021). Finally, we found no evidence for publication bias in the visual inspection of the Funnel plot and Egger's Regression intercept (P = 0.15).…”

Abnormal structural and functional network topological properties associated with left prefrontal, parietal, and occipital cortices significantly predict childhood TBI-related attention deficits: A semi-supervised deep learning study

“…The attention problems in children post-TBI can persist into late adolescence and have been linked to the development of severe psychopathology and impairments in overall functioning (Le Fur et al, 2019;Narad et al, 2019). Without having established neurobiological signatures, treatments and interventions of TBI-related attention deficits in children have been based on subjective observations from clinicians and have resulted in suboptimal efficacy (Backeljauw and Kurowski, 2014;Kurowski et al, 2019;LeBlond et al, 2019).…”