Treatment of Traumatic Brain Injury (TBI)-Related Attention Deficits

Inclusion Criteria:

• Males and females, ages 16 to 45

• Closed head injury rated as moderate/severe (based on Glasgow Coma Scale rating,estimated posttraumatic amnesia, etc.)

• Sustained 6 to 36 months earlier, and considered to be neurologically stable

• Persistent (> 6 months) problems with focused or sustained attention (+1 SD or worseon Inattention component of ADHD self ratings) corroborated by professional staff (nurses, therapists, etc.) or caregivers. Problems with attention/concentration ratedas among most prominent cognitive changes.

• Accompanying features may include diminished arousal/speed/stamina and/or disinhibitedsymptoms

Exclusion Criteria:

• Penetrating head injury

• Pre-injury history of diagnosed ADHD

• Other psychiatric conditions such as mania or psychosis. Current posttraumatic stressdisorder (PTSD) symptoms may be present but not so severe as to require pharmacologictreatment.

• Lifetime history of psychostimulant abuse or dependence. Other (non-psychostimulant)substance abuse within the past 6 months. Total lifetime drug use will not exceed 5times each for substances such as amphetamine, meth-amphetamine, or cocaine.

• Prior treatment with psychostimulant(s)

• Tics or other contraindications for psychostimulant use including arteriosclerosis,cardiovascular disease, uncontrolled hypertension or hyperthyroidism, glaucoma,agitation, use of MAO inhibitor within 6 weeks

• Current treatment with other psychotropic medication(s) within the past 6 weeks

• Estimated IQ < 80

• Sensory and/or motor impairment(s) seriously limiting testing options

• Other neurological conditions including epilepsy, degenerative disorders, brain tumor,or stroke.

• Physical conditions affecting arousal, activity level or stamina, includinguncontrolled thyroid dysfunction, anemia, autoimmune or metabolic disorders, untreatedmoderate/severe sleep apnea, etc.

• Persons for whom MRI scanning is contraindicated, including weight greater than 275pounds (due to scanner table limitations), severe claustrophobia, implanted electronicmedical devices (e.g. pacemaker, cochlear or other inner ear implant, deep brainstimulator), metallic foreign object in eye or rest of the body, history of sheetmetal work, aneurysm clips, non-removable metallic piercings, and dental prosthetics.