Objectives: The growing population of survivors of childhood brain tumors present the challenge of long-term quality of survival. The domains most affected by tumor and treatment are those implicated in development of typical intellectual functions: attention, working memory, and processing speed, with consequent effects upon function and quality of life. In this paper we present service evaluation data on the 12-month effect upon processing speed, visual and auditory attentional domains in 29 patients receiving methylphenidate aged 5-16 years (Mean=10.6). Methods: Patients received immediate-release methylphenidate and were converted to modified-release as appropriate. Mean optimal dose of immediate-release methylphenidate was 0.34 mg/kg per dose (range 0.2-0.67). Results: Patients showed a significant positive impact of methylphenidate on attention in all tests of selective visual attention from the Test of Everyday Attention for Children 2. A significant improvement was also shown on response time. Significant change was not found on psychometric measures of sustained auditory or visual attention, or selective auditory attention. Ratings of Health-Related Quality of Life showed a positive benefit of methylphenidate at 12 months. Side effects were minimal and not statistically significant. Conclusions: Survivors of childhood brain tumor with attentional and processing speed deficit show clinical benefit from methylphenidate.

Background: The deleterious impact upon the cognitive development of survivors of pediatric brain tumors (PBT) is well documented. Impairment in cognitive function is associated with reduced health-related quality of life (HRQoL), such that survivors of PBT report difficulties in multiple distinct domains and an overall reduced quality of life. Studies of the use of methylphenidate in survivors of PBT to alleviate impairment in cognitive functions have shown some success. The current study aimed to explore the impact upon HRQoL in survivors of PBT of a trial of psychostimulant medication. Method: Data were collected from 12 pediatric neuro-oncology patients aged 7–17 years receiving methylphenidate treatment. HRQoL was measured using the PEDS QL quality of life self-report measure and a semi-structured questionnaire-based interview. Results: Analyses of data demonstrates benefit to five domains associated with HRQoL: social, emotional, academic, physical, and cognition. Conclusion: Survivors of PBT reported favorable views as to the subjective benefit of methylphenidate on post-treatment impairment of HRQoL. This medication may offer the potential for restoration of a sense of ‘normality’ of function following cancer treatment in this clinical population.

Whilst an increasing number of children survive previously incurable cancers of the central nervous system (CNS), associated treatments often result in significant neurocognitive late effects. Methylphenidate provides some signs of alleviating cognitive difficulties in different pediatric groups; however, a minimal amount of systematic work has explored its effectiveness isolated to vulnerable attentional domains. The current review aimed to explore the effectiveness of methylphenidate isolated to two attentional domains (sustained and selective attention)—with an aim to substantiate its utility in childhood cancer survivors. Five databases were comprehensively searched for relevant articles. A purpose-developed tool was used to assess each study’s robustness and research quality. Eleven out of 1,865 identified articles were included within the review. Studies drew upon five clinical populations. Individual attentional domains demonstrate variation in their response to methylphenidate. Sustained attention demonstrated the most consistent benefit of methylphenidate, reported largely in attention-deficit/hyperactivity disorder (ADHD) groups. Gains in selective attention and higher-order cognitive functions appeared to follow initial gains in sustained attention. Childhood cancer survivors report greater gains in selective attention compared to sustained attention. Higher doses may yield greater benefit for children with more diffuse attentional deficits. There is a need to improve the validity of current attentional measures before further methylphenidate trials are conducted.

‘Forced care’ describes the provision of personal care to an individual who does not have the capacity to make a decision about that care and resists receiving that care. This study explored the views of clinical psychologists on supporting staff involved with forced care and considered the following question: Do clinical psychologists feel that they have a role in guiding decisions around forced care, and if so, what? Interview data were gathered from five clinical psychologists experienced in the field of Older Adult psychology in the UK. This study concludes that the environment in which psychologists work influences the psychologist’s beliefs about whether psychologists should be involved with making recommendations about forced care, and how they should be involved.

Background As the number of survivors of childhood brain tumor increase, fatigue is increasingly recognised as a long-term correlate of survivorship. Objective This study systematically evaluates the evidence for fatigue in pediatric brain tumor survivors. Method A systematic search using EMBASE, Medline and PsycINFO identified 20 papers meeting the inclusion criteria. Result 19 of the 20 studies reviewed showed conclusive evidence of fatigue in survivors of pediatric brain tumor. This review found that the construct of fatigue was poorly defined throughout, with early-onset fatigue associated with the physical effects of treatment and later emergent fatigue associated with long-term cognitive impairment not distinguished. Conclusion Poor construct validity reduces the generalizability of the data and its utility in developing effective interventions. Current research does not provide a sound basis for developing effective management and rehabilitation plans and fails to support children who have survived brain tumor. Implications for Practice The nebulous definition and imprecise measurement of post-tumor fatigue leaves survivors without a clear diagnosis of impairment, and, in the case of some regions, access to treatment. Further research built on a well-defined construct offers potential to improve the quality of life of pediatric brain tumor survivors. What is Foundational Despite the significant impact of ‘fatigue’ on cancer survivorship, much of the research available is based upon a poorly-defined construct. This paper is the first to question the utility of this all-encompassing construct and to call for further research that identifies the fatigue experience in different sub-groups of brain tumor survivors. Keywords: fatigue, brain tumor, pediatric, psychological impact

Impairment in sustained attention is a common consequence of childhood Acquired Brain Injury (ABI). Whilst methylphenidate provides promise in enhancing “attention” as a unitary construct, little work has explored its effectiveness upon individual attentional domains. The current systematic review and meta-analysis evaluates the utility of methylphenidate on sustained attentional performance across childhood ABI groups. Five databases (PsycINFO, MEDLINE, Embase, Scopus & Cochrane Library) were searched for relevant articles from their inception to March 2022. A purpose-developed evaluation tool was used to assess each study’s research quality (QuEST:MAP). Nine of the 1600 identified articles were included within this review (n = 259). Meta-analytical findings reported an overall significant benefit of methylphenidate on sustained attention in childhood ABI (g = −0.33, 95% CI: −0.62 to −0.04). Associated summary effect sizes were relatively small, particularly when adjusting for outlier cases. Subgroup analyses identified a significantly greater benefit of methylphenidate in clinical subgroups with comorbid ADHD diagnoses (p < .01). The current evidence base is characterized by small-scale clinical trials with variable research quality and low generalizability. Further robust research is needed to quantify methylphenidate utility upon individual attentional domains in larger and more representative ABI samples.