Abstract
Attention deficits are among the most common and persistent impairments resulting from traumatic brain injury (TBI). This study was the first to examine the effects of lisdexamfetamine dimesylate (LDX, Vyvanse) in treating TBI-related attention deficits in children. It was an extension of a previous controlled trial with adults. This was a 12-week, randomized, double-blind, placebo-controlled, dose-titration, crossover trial. In addition to weekly safety monitoring, there were assessments on a broad range of neuropsychological and behavioral measures at baseline, 6-weeks, and 12-weeks. A total of 20 carefully selected children were enrolled, ranging from 10 to 16 years of age. The sample consisted of cases with mainly mild TBI (based on the known details regarding their injuries), but they had persisting attention deficits and other post-concussion symptoms lasting from 2 to 29 months by the time of enrollment. A total of 16 children completed the trial. One of the children withdrew due to a mild anxiety reaction while on LDX. There were no other adverse effects. Positive treatment results were found on both formal testing of sustained attention and in terms of parent ratings of attention, emotional status, behavioral controls, and various aspects of executive functioning. The findings also served to highlight broader insights into the nature of attention deficits and their treatment in children with TBI.
Highlights
New-onset or acquired attention deficits have been observed in both children and adults following traumatic brain injury (TBI)
The sample was evenly divided with respect to gender, but the racial composition consisted mainly of Caucasian children
Parent reluctance to consider medication treatment for younger children was a factor in some cases
Summary
New-onset or acquired attention deficits have been observed in both children and adults following traumatic brain injury (TBI). In a study by Levin et al [1], increased rates of newly diagnosed attention-deficit/hyperactivity disorder (ADHD) were found in children post-TBI (ranging from 14.5% at 12 months to 18.3% at 24 months). Injury to specific areas may be involved, as consistent with models of attention components and their mediation by different regions of the brain. Mirsky et al [4] articulated a four-component model of attention (focus-execute, sustain, encode, shift) that has been applied widely in ADHD research. It has been validated as applicable to children with TBI, with the underlying components affected to varying degrees depending on factors like severity of injury [5]. The particular pattern of impairment based on this model has been found to differ between children with TBI versus idiopathic ADHD [6]
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