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

Aggregated n-of-1 trials of central nervous system stimulants versus placebo for paediatric traumatic brain injury – a pilot study

“…While central nervous system (CNS) stimulant medication is generally a well-accepted treatment for developmental ADHD, there is controversy as to whether stimulant medication can be an effective method of treating acquired attention deficits. While some studies have reported a positive effect of stimulant medication on attention, concentration and impulsivity post injury (Bakker and Waugh, unpublished data; [10,11]) and particularly in those with pre-injury ADHD [12], others have reported a null result [13]. However, there are a limited number of studies on the efficacy of CNS stimulants on children following TBI, with a range of methodological issues that may impact on outcomes, including designs varying from case studies to randomised controlled trials (RCTs), limited sample sizes, and variable times since injury, ages at injury, type and doses of stimulant medication, type of data collected (retrospective versus prospective), and qualitative versus quantitative outcome measurement.…”

“…They concluded that there is need for rigorous treatment outcome research among representative samples of ADHD/TBI individuals. A recent systematic review [10] assessed sixteen studies examining the effectiveness of stimulants following paediatric ABI, and concluded that teams treating paediatric ABI need to assess for the presence of inattention and consider the use of stimulants with individualised n-of-1 monitored trials, as stimulants have been used in children with impaired attention and hyperactivity following acquired brain injury (ABI) with positive results.…”