The Injured Brain + Stimulants: Part 1

In 2012, my daughter was meeting with a pediatric neuropsychologist at a Children’s Hospital, to complete full testing following 3 years of brain-based cancer treatment.  As a result of long-term chemo & radiation treatment, tumor resection, remitting-relapsing hydrocephalus, and tissue damage from heavy necrosis, her doctors needed a baseline of cognitive functioning.  If any of you have ever had a full neuro-psychological evaluation, you know….it is grueling, exhausting, headache-provoking, self-esteem questioning, and overall, almost intolerable.  And it most definitely is for those with an injured brain.   

After 8 hours of testing, we were told we would come back for results, feedback, and follow-up in two weeks. At the follow-up appointment, the things we were seeing and learning to manage were validated: short-term memory loss, significant deficits in processing speed, visual memory impairment, and moderate executive dysfunction. In our own words: paralyzing fatigue, lack of initiation and follow-through, short term memory loss, sensory overwhelm, blunted mood, and slow information processing, despite an above-average IQ.  

Some things were validated, and some things were new information.  Hope and expectation were narrowed to: “the best chance of her baseline recovery is approximately 24-months post-injury.”  We would watch and wait, while doing extensive and intensive outpatient rehabilitation in the meantime.  Lucky for us, I worked in neurosciences for years, and understood the power of neuroplasticity in the brain, and the absolute necessity of therapies to improve neural connections.  

But the thing that stuck out most that day was a bold statement by her incredible pediatric neuropsychologist.  He said confidently, “Why everyone with a brain injury of this type isn’t put on a stimulant medication; I will never know.”  That sentence stuck.  And it still sticks.  

Ask my colleagues. They hear me preaching about this, as if I’m a neuropsychiatrist or neuropsychologist or something. (Disclaimer: I’m not. But I did work for years in a neuropsychology clinic and got my post-grad supervision 20 years ago from two neuropsychologists. I say that counts for something!?) I have talked passionately about this with other therapists. I have talked to psychiatric providers, neurologists, and internal med providers about this.  I have asked many their opinions about stimulants and brain injury.   

Normally I am a therapist that stays in my lane.  However, when I see something that has a profound impact on a patient’s quality of life; including their ability to better learn and participate; while increasing stamina and energy, I will defy the rules of my lane to protect them.   

Bottom line, I believe this topic warrants additional consideration, at the very least, from both patients and providers.  This is not about a mental health diagnosis.  This is about treating the symptoms that prevent a person from engagement and accomplishment of their goals, while protecting worth, value, and quality of life.  Of all the things a brain injured patient deserves, these are it.

Disclaimer: I am not a doctor. I don’t prescribe, and I am grateful I don’t. There are many behaviors and characteristics to consider that might make stimulants contraindicated for you. Furthermore, medications are not being promoted as the only method of improvement.  Brain injuries and post-concussive syndromes require a collaborative approach involving multiple therapies as well.  Talk to your medical team; seek your own information; and be informed. You are your own best advocate.    

Note:   I use “injured brain” as inclusive of all levels of brain injury and post-concussive syndromes.

Written by:

Ashley Olsen, MSW, LCSW

Founder/Owner of The Praxis Group