Interventions for Attention Problems After Pediatric Traumatic Brain Injury: What Is the Evidence?

Objective: To gain an understanding of the current state of the evidence for management of attention problems after traumatic brain injury (TBI) in children, determine gaps in the literature, and make recommendations for future research. Type: Focused systematic review. Literature Survey: PubMed/Medline and PsychINFO databases were searched for relevant articles published in English during the last 20 years. Keywords included attention attention deficit and disruptive behavior disorders, and brain injuries. Studies were limited to children. Methodology: Titles were examined first and eliminated based on lack of relevancy to attention problems after brain injury in children. This was followed by an abstract and full text review. Article quality was determined based on the US Preventative Services Task Force recommendations for evidence grading. Synthesis: Four pharmacologic and 10 cognitive therapy intervention studies were identified. These studies varied in level of evidence quality but were primarily non-randomized or cohort studies. Conclusions: There are studies that demonstrate benefits of varying pharmacologic and cognitive therapies for the management of attention problems after TBI. However, there is a paucity of evidence available to definitively guide management of attention problems after pediatric TBI. Larger randomized, controlled trials and multicenter studies are needed to elucidate optimal treatment strategies in this population.