Aims There is substantial evidence that attention is significantly affected in children with a history of stroke. However, which domains of attention are affected and how lesion characteristics (volume, location and age at stroke) affect attention difficulties is unclear.

Methods We conducted a systematic review of the current literature to address these gaps. Searches were carried out using PUBMED, Psychinfo and Web of Science which retrieved studies that investigated attention in paediatric stroke population. Quality assessment was carried out using modified versions of the STROBE Checklist and the Quality Assessment Instrument.

Results The 8 studies fulfilling our criteria were individually of good to excellent quality but were limited by small sample sizes and heterogeneous stroke aetiologies. Sustained attention was affected by paediatric strooke in 6/8 studies with medium to large effect sizes (d=0.5 to 1.5). Attentional control was impaired in individuals with paediatric stroke in two studies with small to medium effect sizes (d=0.2 to 0.57). Four studies found divided attention to be significantly affected after paediatric stroke with large effect sizes (d=0.9 to 1.4). Selective attention was moderately affected by paediatric stroke (d=0.6 to 0.75) in 2 studies. Lesions located bilaterally within frontal, subcortical and cortical regions appeared to impact attentional abilities with a small to medium effect of lesions in extra-frontal brain regions with poorer performance on divided attention (d=0.31; 1 study), sustained attention (d=0.12 and 0.16; 2 studies) and attentional control (d=0.42; 1 study). However lesion volume and laterality had no effect on attention. Of the 5 studies which looked at lesion size on MRI, 3 found no relationship while the other two found significant effects, with poorer attention in those with larger lesion size, one with moderate effect sizes for selective attention (d=0.38) and attentional control (d=0.46) for those with parenchymal lesions >25% of the total. Stroke occurrence before the age of 5 years appeared to affect sustained and divided attention, while those with onset aged less than 12 months appeared to have reduced sustained and selective attention.

Discussion Longitudinal research investigating specific aetiologies of stroke is warranted to investigate the impact of lesion characteristics on attention difficulties further.