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

Search terms Search terms (designed for Medline and tailored accordingly for other sources) were: (exp Brain Injuries/OR Brain Neoplasms/ OR brain adj2 injur* OR head adj2 injur* OR brain adj2 tumo?r* OR neurooncolog* OR neuro-oncolog* OR brain adj2 cancer* OR brain adj2 neoplasm* OR brain adj2 carcinoma* OR head adj2 trauma* OR brain adj2 trauma* OR cerebrovascular adj2 trauma*) AND (exp "Attention Deficit and Disruptive Behavior Disorders"/ OR exp Attention Deficit Disorder with Hyperactivity/ OR exp Attention/ OR exp Hyperkinesis/ OR exp Impulse Control Disorders/ OR exp Impulsive Behavior/ OR attenti* OR hyperactiv* OR impulsiv* OR ADHD* OR AD* OR HD* OR hyperkine* OR ADD* OR learn* OR cogniti* OR neuropsychol* OR neuro-psychol* OR educat* OR attain* OR achiev* OR intell*) AND (exp Central Nervous System Stimulants/ OR stimulant* OR methylphenidate OR MPH OR atomoxetine OR dexamfetamine OR modafinil OR concerta OR ritalin OR biphentin OR attenta OR methylin OR metadate OR equasym OR rubifen OR motiron OR stimdate OR daytrana OR strattera OR dexedrine OR medikinet OR provigil OR amphetamine OR pemoline). To enhance clinical assessment and to obtain improved outcomes for this group, it is recommended that high quality, well-designed level 1b randomised controlled trial (RCTs) with condition or injury mechanism specific paediatric samples are conducted to address study limitations and develop a diagnosis and treatment delineated evidence base. Modified-release MPH formulations are available as well as the alternative stimulant of dexamphetamine which is licensed for use as an adjunct in the management of refractory presentations. 24 In addition, atomoxetine, a non-stimulant selective norepinephrine reuptake inhibitor is available to address ADHD presentations. 24 Placebo controlled trials comparing the effectiveness of different preparations and medications for ADHD have been conducted with evidence for effectiveness demonstrated. 25 There is a very considerable research opportunity to conduct similar trials for children with ABI who demonstrate an ADHD pattern of behaviour.