Improving the identification and treatment of attention problems following paediatric brain injury

Sharma, Surina 2025. Improving the identification and treatment of attention problems following paediatric brain injury. ClinPsy Thesis, Cardiff University. Item availability restricted.

	PDF (DClinPsy Thesis) - Accepted Post-Print Version Restricted to Repository staff only until 14 November 2026 due to copyright restrictions. Download (10MB) | Request a copy
	PDF (Cardiff University Electronic Publication Form) - Supplemental Material Restricted to Repository staff only Download (196kB) | Request a copy

Abstract

Children and teenagers who experience a traumatic brain injury often struggle with attention in ways that affect learning and daily life. The systematic review describes the current evidence base for what psychological interventions are being used to manage attention after paediatric traumatic brain injury and appraises how reliable those findings are. The empirical paper pilots modifications made to an attention task within a screening instrument to make it more challenging for adolescents. The review set out to (a) identify the psychological approaches being used, (b) map each approach to a well-known attention-network framework (alerting, orienting, and executive control) to clarify what network is being targeted, and (c) judge the quality and reliability of reported effects. Several databases were searched in a structured way using predefined eligibility criteria, and the quality of each study was checked with methods suited to its design. Due to variation in interventions, comparators, and outcome measures, findings were brought together as a clear narrative rather than combined statistically. Eight studies met criteria. Across studies, repetitive, practice based attention training improved performance on laboratory attention tests, but these gains rarely generalised to everyday functioning at home or school. Strategy focused programmes did not show clear advantages over robust psychoeducation controls at 6- or 24-month follow-up. The most promising evidence came from family centred problem-solving therapy, with benefits demonstrated in older adolescents (14+ years old) but not younger participants, suggesting that developmental stage matters. A small neuroimaging study reported that behavioural improvements may coincide with changes in brain connectivity, but findings were preliminary. Overall, confidence in the effects of psychological interventions on attention following paediatric traumatic brain injury remains limited by small samples, heterogeneous measures, unblinded ratings, and an emphasis on test scores rather than real-world outcomes, which limits confidence in generalisation. Taken together, the evidence tentatively suggests that targeted training may help to improve test scores, and pairing this with supports in the child’s everyday context, including family-centred work, may help benefits transfer into daily life, but this has not yet been shown consistently. Future research should focus on adequately powered, assessor-blinded, age-stratified trials that also include longer follow-ups, so that services can offer children and families interventions that make a measurable difference where it counts. The empirical study addresses a practical problem in adolescent attention testing. A brief attention task within the Children’s Cognitive Screening Instrument was proving too easy for many teenagers, which meant genuine difficulties could be missed. The study aimed to create a more demanding version that was developmentally appropriate but would still be quick to use in schools and clinics, and to check whether pupils found it acceptable and whether it produced a wider spread of scores and reduced ceiling effects. The modification drew on the same attention-network framework and incorporated three elements: irregular timing to sustain alertness and reduce guessing; rule reversals similar to ‘no-go’ trials to tax inhibitory control and flexibility; and realistic background sounds to challenge selective attention. Typically developing (i.e. non-clinical) teenagers aged 12-15 years old, completed both the original and modified versions. Comparisons focused on ceiling rates, links with a standard vigilance task, and brief user feedback aligned to an established framework for assessing acceptability. Findings were encouraging but preliminary. Far fewer pupils reached the maximum on the modified version than on the original, which suggests the refinement reduced the ceiling effect and increased the spread of scores. Scores still clustered near the top, so a further modest increase in difficulty may be helpful. The association between the modified measure and the vigilance task was small and uncertain in this pilot, which may reflect different task demands and the limited sample size. Most pupils reported that the task made sense, felt doable, and seemed worthwhile, although effort ratings were higher and views on fairness were mixed, which fits the intention to make the task more challenging without becoming off-putting. Theoretically, it offers a brief way to assess attention processes that continue to mature as a teenager, particularly executive control under distraction and unpredictability. Clinically, it points towards a practical tool that, after full validation and clinical testing, could help earlier identification in schools and acute settings. Together, these papers point to a potential path forward. This thesis suggests that better outcomes from childhood brain injury may come from combining developmentally tuned assessments with targeted skill practice and supporting the young person in their everyday context so that the gains translate into daily functioning.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	14 November 2025
Last Modified:	18 Nov 2025 16:45
URI:	https://orca.cardiff.ac.uk/id/eprint/182422

Actions (repository staff only)

Edit Item