Attention deficit hyperactivity disorder (ADHD) is a risk factor for pediatric TBI and often persists post-injury. TBI may also produce attention deficis de novo (secondary ADHD [SADHD]). When combining pre-TBI ADHD and SADHD rates, the prevalence of post-injury ADHD is near 40-45%. First line medication treatment for primary ADHD is methylphenidate, but the use of methylphenidate for attention problems after pediatric TBI is highly variable. Only two clinical trials evaluating the efficacy of methylphenidate on attention problems after pediatric TBI have been performed and the results have been inconclusive. The inconclusive results may be due to limitations of small sample sizes, inadequate dose titration, and inadequate evaluation of potential mediating and moderating factors. This proposal will begin to address these knowledge gaps. The objectives of the study are to (1) determine the efficacy and dose-response of methylphenidate treatment of attention problems after pediatric TBI and (2) provide a better understanding of the relationship of a prior history of ADHD, ADHD subtypes after TBI, executive function, and attentional control to treatment efficacy. The proposed clinical trial will enroll 50 children, age 6-17 years, with attention problems 12-48 months after moderate to severe TBI into a randomized, double-blind, placebo-controlled, cross-over design trial with 3 dose conditions (low, medium, and high). The study will characterize the response of attention problems after pediatric TBI to methylphenidate (primary analysis) and evaluate potential mediating and moderating factors of treatment response (secondary analyses). The study will add new and innovative information to the pediatric TBI literature. It will provide a better understanding of the efficacy of methylphenidate for treatment of attention problems after pediatric TBI and it will elucidate clinical profiles tha may influence response to treatment. The findings have the potential to directly impact clinical management. Findings will also inform the development of larger studies that will facilitate the development of individualized protocols for management of attention problems after pediatric TBI. The study also builds on the candidate's prior research that has evaluated predictors and moderators of cognitive and behavioral outcomes after pediatric TBI. It will provide him with new skills and knowledge that will allow him to move beyond evaluating moderators of outcomes. This proposal will provide the candidate with new expertise in the development, conduct and analysis of clinical trials, improve his knowledge of neuropharmacology, and further develop his knowledge of the assessment of cognitive and behavioral outcomes after pediatric TBI. The candidate's expertise in these areas will be facilitated through a training plan that incorporates didactic course work, directed mentoring, and guidance from his mentoring team on manuscript and future grant preparation. At completion of the project, the candidate will be poised to develop clinical trials to individualize the management of neurobehavioral and cognitive sequelae of pediatric TBI.

Public Health Relevance

Attention problems after traumatic brain injury (TBI) in children often lead to difficulties in multiple settings. This project will determine the effectiveess of methylphenidate for treatment of long-term attention problems after pediatric TBI. The influence of clinical characteristics of attention problems on treatment effectiveness will also be evaluated. Findings from the study have the potential to directly impact clinical care.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Pediatrics Subcommittee (CHHD)
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Michel, Mary E
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Cincinnati Children's Hospital Medical Center
United States
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Evanson, Nathan K; Paulson, Andrea L; Kurowski, Brad G (2016) A Narrative Review of Pharmacologic and Non-pharmacologic Interventions for Disorders of Consciousness Following Brain Injury in the Pediatric Population. Curr Phys Med Rehabil Rep 4:56-70
Kurowski, Brad G; Wade, Shari L; Dexheimer, Judith W et al. (2016) Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study. J Head Trauma Rehabil 31:369-378
Kurowski, Brad G; Backeljauw, Barynia; Zang, Huaiyu et al. (2016) Influence of Catechol-O-methyltransferase on Executive Functioning Longitudinally After Early Childhood Traumatic Brain Injury: Preliminary Findings. J Head Trauma Rehabil 31:E1-9
Kurowski, Brad G; Hugentobler, Jason; Quatman-Yates, Catherine et al. (2016) Aerobic Exercise for Adolescents With Prolonged Symptoms After Mild Traumatic Brain Injury: An Exploratory Randomized Clinical Trial. J Head Trauma Rehabil :
Chan, Steven; Kurowski, Brad; Byczkowski, Terri et al. (2015) Intravenous migraine therapy in children with posttraumatic headache in the ED. Am J Emerg Med 33:635-9
Quatman-Yates, Catherine C; Bonnette, Scott; Hugentobler, Jason A et al. (2015) Postconcussion Postural Sway Variability Changes in Youth: The Benefit of Structural Variability Analyses. Pediatr Phys Ther 27:316-27
Wade, Shari L; Kurowski, Brad G; Kirkwood, Michael W et al. (2015) Online problem-solving therapy after traumatic brain injury: a randomized controlled trial. Pediatrics 135:e487-95
Kurowski, Brad G; Pomerantz, Wendy J; Schaiper, Courtney et al. (2015) Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes. J Trauma Acute Care Surg 79:S21-8
Kurowski, Brad; Pomerantz, Wendy J; Schaiper, Courtney et al. (2014) Factors that influence concussion knowledge and self-reported attitudes in high school athletes. J Trauma Acute Care Surg 77:S12-7
Ding, Lili; Kurowski, Brad G; He, Hua et al. (2014) Modeling of multivariate longitudinal phenotypes in family genetic studies with Bayesian multiplicity adjustment. BMC Proc 8:S69

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