Psychopharmacologic Treatment of Acquired Attention Disorders in Children with Brain Injury

Abstract

This investigation examined the efficacy of psychostimulant therapy in alleviating neurobehavioral dysfunction attendant to pediatric brain injury. The most commonly reported neurobehavioral sequelae associated with head injury in the pediatric population involve deficits along the attentional matrix. This is also the most common objectively documented neurobehavioral finding among children as well as adults. There are several investigations in the adult literature which have employed the use of psychostimulants in treating both psychiatric and neuropsychological residua associated with head injury. Overall, the results of these studies are equivocal, but suggest a beneficial impact on general functioning. The present prospective investigation utilized a double-blind, placebo-controlled, cross-over experimental design to examine the efficacy of methylphenidate in treating children with acquired attentional disorders secondary to brain injury. A cohort of 14 children with varying degrees of head injury were recruited for participation. As expected, differences between drug and placebo conditions uniformly achieved statistical significance. Additionally, there were no differences in performance between baseline and placebo conditions on neurobehavioral tasks of attention and concentration. Current findings suggest that methylphenidate (and probably other psychostimulants such as Cylert, Adderal, Wellbutrin and dextroamphetamine sulfate) is an extremely effective agent in treating attentional disorders secondary to brain injury in children.

Symptoms of Attention-Deficit/Hyperactivity Disorder Following Traumatic Brain Injury in Children

“…It is plausible that clinicians and parents perceived that ADHD symptoms would resolve in children who had no preinjury history of ADHD. In the absence of placebo-controlled, randomized clinical trials of pharmacologic treatment of the behavioral sequelae of TBI in children, the extant preliminary studies [22][23][24][25] provide only a suggestion that stimulants may be effective. With residual ADHD symptoms in our SADHD group and persistent high levels of symptoms in those children with preinjury ADHD, our results indicate the need for controlled treatment studies that stratify the randomization according to preinjury ADHD.…”

“…8 The literature consists of a retrospective chart review of 10 children treated with methylphenidate after sustaining TBI and a crossover, placebo-controlled clinical trial. [22][23][24][25] In view of the findings of Mahalick et al 24 that methylphenidate produced cognitive gains over 1 week relative to placebo and performance with placebo did not differ from pretreatment baseline, there is justification for further clinical trials. Although the 2003 National Survey of Children's Health conducted by the Centers for Disease Control and Prevention 26 recorded that 56% of 4.4 million children age 4 to 17 years who had been diagnosed with developmental ADHD had been treated at some time with stimulants, and a recent population-based, birth cohort study 27 reported that 77% of children diagnosed with ADHD by DSM-IV criteria had been treated with stimulants by age 17 years, there are sparse data concerning the current practice of pharmacologic management of ADHD symptoms following TBI in children.…”

Question 3 Should stimulants be administered to manage diffi culties with attention, hyperactivity and impulsivity following paediatric acquired brain injury?: Table 3

“…Eight retrieved papers4 7 16–21 evaluated MPH use after TBI. Five of these4 16–19 met level 2b evidence criteria 22. No studies solely examined use of MPH with brain tumours as participants with ALL were always included.…”

Diagnosis and Treatment of Postconcussive Neurobehavioral Symptoms

“…Several prospective randomized controlled studies showed improvement of processing speed and inattention after brain injury with the use of methylphenidate (Mahalick et al, 1998;Plenger et al, 1996;Whyte et al, 2004;Whyte et al, 1997).…”