Methylphenidate treatment of attention-deficit/hyperactivity disorder secondary to traumatic brain injury: a critical appraisal of treatment studies.
OBJECTIVE
Are stimulants effective in treating attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI)? The authors reviewed and examined the current knowledge on efficacy of stimulant treatment ADHD/TBI.


METHODS
A systematic review of the literature using a quality assessment scale to assess the quality of randomized clinical trials was undertaken. We identified all studies in which stimulants had been administered to individuals with ADHD/TBI. Information was extracted on study characteristics, interventions, and outcomes. A meta-analysis was not performed because of the limited number of studies with strict research design and the heterogeneity of outcome measures. Seven studies involving 118 subjects, 41 of whom were children and adolescents, were identified.


RESULTS
Of the seven identified studies, one was a chart review, one used a single-blind, placebo-controlled crossover design, and five were double-blind, placebo-controlled crossovers. These studies used >50 subjective and objective tests to measure behavioral and cognitive outcomes. Methylphenidate (MPH) effects on behavior (hyperactivity, impulsivity) were evident but were not as robust as those typically observed with MPH in primary ADHD. The effect of MPH on cognition was less apparent. More favorable outcome was associated with initiation of treatment soon after head injury, although this factor was not systematically studied, and trials with relatively long durations. Studies with negative MPH response reported neither improvement in behavioral nor cognitive symptoms.


CONCLUSIONS
There is only modest evidence to support the efficacy of MPH in the treatment of ADHD/TBI. While MPH might still be a promising treatment for ADHD/TBI, there is need for rigorous treatment outcome research among representative samples of ADHD/TBI individuals.
Department of Psychiatry, North Shore University Hospital, Manhasset, New York, USA.
Charles
C
Jin
Russell
R
Schachar
D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D000697:Central Nervous System Stimulants; D008774:Methylphenidate