Understanding and supporting peer relationships in adolescents with acquired brain injury: A stakeholder engagement study.

Peer relationship difficulties in adolescents with acquired brain injury (ABI) are under-recognized and targets for intervention are unclear. From a social constructionist position, this study aimed to engage with stakeholders to develop a collaborative understanding of peer relationship difficulties in adolescents with ABI and seek consultation on what might be required to improve them. Focus groups and semi-structured interviews were conducted with four stakeholder groups: adolescents with ABI (n = 4); parents of adolescents with ABI (n = 7); adults who sustained an ABI in adolescence (n = 2); and specialist practitioners (n = 3). Qualitative data were analysed using thematic analysis. The analysis yielded 11 themes, grouped into two domains. The first, understanding peer relationship difficulties, included themes from "exclusion and a need to belong", to "loss of past self". The second, supporting peer relationships, comprised themes of "building understanding" and "meaningful social connection", amongst others. A logic model of stakeholder experiences of peer relationship difficulties was constructed. Difficulties with peers can increase vulnerability to feelings of loneliness, shame, and hopelessness for adolescents post-ABI. Stakeholders described that a meaningful intervention would be multi-layered, targeting change within the adolescent's environment and within the adolescent themselves. The presented logic model provides a framework for future intervention development.

Preliminary evidence that caffeine improves attention in multiple sclerosis.

There are no licensed drugs to boost cognitive performance in multiple sclerosis (MS). Here, we provide preliminary evidence that caffeine can improve attention in people with MS. Participants were tested on three different metrics of attentional functioning [choice reaction times, Stroop performance and a Rapid Serial Visual Presentation (RSVP) task] repeated across four sessions (baseline, one week after caffeine abstention and two sessions on days 8 and 9 where participants were pseudorandomized to receive counterbalanced caffeine or decaffeinated products). The administration of caffeine, compared to decaffeinated substances, was found to selectively reduce the 'attentional blink' in MS patients. There was no evidence that caffeine administration significantly affected performance on the Stroop or choice reaction time tasks. However, in contrast to other metrics of attention used in this study, there was evidence that Stroop performance declined on day 7 compared to day 1, an effect perhaps due to caffeine withdrawal. Cumulatively, these results suggest that caffeine can act as a cognitive enhancer in MS but may only benefit patients under situations of high attentional demand (RSVP dual task). Interestingly, there may be long-term positive effects of caffeine on cognition in MS that are only exposed following sustained abstinence periods.

Caffeine and attentional control: improved and impaired performance in healthy older adults and Parkinson's disease according to task demands.

INTRODUCTION: Caffeine is frequently consumed to boost goal-directed attention. These procognitive effects may occur due to the adenosine-mediated enhancement of monoamines, such as dopamine, after caffeine administration. As such, caffeine's beneficial effects may be altered in conditions such as Parkinson's disease (PD). However, whether caffeine improves cognition, and at what cost, has not been experimentally established in patients with neurodegenerative disease. METHODS: Single-dose trials to probe cognitive effects of caffeine are often confounded by short-term caffeine abstinence which conflates caffeine's effects with treatment of withdrawal. Using a placebo controlled, blinded, randomised trial design, we assessed the effect of 100 mg of caffeine across well-established tasks (Choice reaction time, Stroop Task and Rapid Serial Visual Presentation Task; RSVP) that probe different aspects of attention in PD patients (n = 24) and controls (n = 44). Critically, participants withdrew from caffeine for a week prior to testing to eliminate the possibility that withdrawal reversal explained any cognitive benefit. RESULTS: Caffeine administration was found to reduce the overall number of errors in patients and controls on the Stroop (p = .018, η2p = .086) and Choice reaction time (p < . 0001, η2p = .588) tasks, but there was no specific effect of caffeine on ignoring irrelevant information in the Stroop task. On the RSVP task, caffeine improved dual item accuracy (p = .037) but impaired single item accuracy (p = .044). Across all tasks, there was little evidence that caffeine has different effects in PD participants and controls. CONCLUSION: When removing withdrawal effects as a factor, we demonstrate caffeine has beneficial effects on selective attention but is a double-edge sword for visual temporal attention and would need careful targeting to be clinically useful.