Effect on Behavior Problems of Teen Online Problem-Solving for Adolescent Traumatic Brain Injury

Wade, Shari L.; Walz, Nicolay Chertkoff; Carey, Joanne; McMullen, Kendra M.; Cass, Jennifer; Mark, Erin; Yeates, Keith Owen

doi:10.1542/peds.2010-3721

Cited by 81 publications

(99 citation statements)

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“…problem-solving and emotional dysregulation) noted minimal behavioural changes immediately post-intervention [58, 93,98,100,104,105,107]. However there was high participant satisfaction with using tele-practice [93] and greater changes observed in outcome at follow-up [58, 98,100,104,105,107].…”

Section: Telerehabilitationmentioning

confidence: 99%

“…Indeed, telerehabilitation for MANUSCRIPT ACCEPTED -BRAIN INJURY: 02 FEBRUARY 2017 17 people with TBI featured in 38 of the included papers (see Table 2), comprising 2 systematic reviews [39,79], 22 group comparison trials [23][24][25]30,35,52,58,74,77,82,84,[98][99][100][104][105][106][108][109][110][111]113], 9 case series [28,50,80,83,93,97,101,102,107] Importantly, no statistically significant differences were found between the tele-practice and face-to-face intervention delivery methods [39,79].…”

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confidence: 99%

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Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

et al. 2017

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distinct from motor speech impairments or primary language impairments (e.g. aphasia), in that the impairments arise from the diffuse axonal injuries which occur in frontal and prefrontal areas of the brain [6]. These impairments can be defined as any aspect of communication that result from underlying deficits in cognition [4,5,7].Communication difficulties after a TBI can affect how a person hears, listens, understands, speaks, reads, writes, and how they engage in conversation and social communication [5]. The underlying deficits of cognition that affect these communicative functions can include slowed information processing; impaired working memory and attention; disorientation and disorganisation; executive function problems including rigidity, poor conceptualization, planning, and problem solving; and poor self-control or selfregulation of cognition or behaviour [4,5]. As a result of these changes in cognitivecommunicative processes, people with TBI have been described as 'overtalkative, inefficient, tangential or drifting from topic to topic, or lacking in language output. ' [4] (p.354). These cognitive-communication impairments can restrict a person's ability to communicate, live independently, return to work or education, participate in society, and build or maintain relationships after their TBI [8].The International Cognitive (INCOG) guidelines for the management of a person's cognitive rehabilitation following TBI highlight that assessment of cognitive-communication skills should incorporate performance in everyday social activities [4]. Adolescents and young adults, the group most at risk of TBI, use digital and online communication MANUSCRIPT ACCEPTED -BRAIN INJURY: 02 FEBRUARY 2017 4 technologies from a young age [9] and, following TBI, involvement in social, academic, and societal situations may be reduced with difficulties using technology and social media [5]. As a result, people with cognitive-communication impairments resulting from a TBI face challenges in accessing information independently and engaging effectively in social networks [8]. However, little is known about how people with cognitive-communication impairments after TBI use and experience digital communication and the internet.Furthermore, clinical guidelines for the assessment of cognitive-communication skills following a TBI do not provide guidance on the use of social media, or of assistive technologies (AT) to support cognitive-communication rehabilitation [4,5].In order to review the existing literature on technology it is essential to consider which types of technology appear in relation to TBI and cognitive-communication. In this study, we considered three major categories of technology: (i) Assistive Technology (AT), being 'any item, piece of equipment, or product, whether it is acquired commercially, includes technology such as email, the internet, and mobile phones [13] which enable users to access, store, transmit, and manipulate information [14]. The multiple purposes of the different types of technology selected ...

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Section: Telerehabilitationmentioning

confidence: 99%

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confidence: 99%

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

et al. 2017

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“…[32][33][34][35]50 In a large randomized controlled trial, we documented improvements on ratings of global executive functioning in older but not younger adolescents. On further analysis, it appears that older teens improved in both behavioral regulation and metacognitive aspects of executive functioning.…”

Section: Discussionmentioning

confidence: 92%

“…21 Problem-solving training has demonstrated promise in various clinical populations [22][23][24][25][26] ; however, it has only been preliminarily explored in pediatric TBI. [27][28][29][30][31][32][33][34] In a small randomized trial of children aged 5 to 17 years (N = 32), findings showed that family-centered online problem-solving therapy improved internalizing behavioral problems after severe TBI. 32 Initial evidence suggests that problem-solving interventions can also be delivered effectively through a web-based portal directly to children with TBI.…”

Section: Discussionmentioning

confidence: 99%

“…32 Initial evidence suggests that problem-solving interventions can also be delivered effectively through a web-based portal directly to children with TBI. 35 In a small randomized-controlled trial of adolescents aged 11 to 18 years (n = 35), teendirected online problem-solving improved both parent-and self-reported behavioral problems 33 but only improved self-ratings, not parent-ratings, of executive dysfunction. 34 These studies have been limited by small sample sizes and heterogeneous populations.…”

Section: Discussionmentioning

confidence: 99%

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Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

2013

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WHAT'S KNOWN ON THIS SUBJECT:Cognitive and behavioral problems after pediatric traumatic brain injury lead to poor functioning across multiple settings and can persist long-term after injury. Executive dysfunction is particularly common; however, there is a paucity of evidence-based interventions to guide treatment. WHAT THIS STUDY ADDS:This study is among the largest randomized controlled trials performed in pediatric traumatic brain injury. It demonstrates the ability to use an online problemsolving-based intervention to improve caregiver ratings of executive dysfunction within 12 months after injury. abstract OBJECTIVE: Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant problems in functioning across multiple settings. The objective of this study was to evaluate the efficacy of a web-based counselor-assisted problem solving (CAPS) intervention compared with an Internet resource comparison (IRC) for treatment of executive dysfunction within 12 months after complicated mild to severe TBI in adolescents. We hypothesized that CAPS would significantly improve parent ratings of executive dysfunction compared with an IRC. METHODS:Participants included 132 adolescents aged 12 to 17 years who sustained a complicated mild to severe TBI within 1 to 6 months before study enrollment. Study design was a multisite, assessorblinded, randomized controlled trial. Study sites included 3 tertiary pediatric hospitals and 2 tertiary general medical centers. The main outcome measure was primary caregiver Behavioral Rating Inventory of Executive Function Global Executive Composite at baseline and 6-month follow-up. Generalized linear models that controlled for baseline scores were used to compare the CAPS and IRC scores. RESULTS:In older teens, the CAPS group showed significant improvement in executive function behaviors at 6-month follow-up compared with the IRC group (F = 6.74, P = .01, Cohen' s d = 0.63). CONCLUSIONS:Findings indicate that web-based CAPS improves primary caregiver-rated executive functioning within the first 12 months after TBI in older adolescents. Future research needs to define the optimal timing after injury for delivery of CAPS and characteristics of individuals and families who are most likely to benefit from CAPS. Pediatrics 2013;132:e158-e166 AUTHORS:

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Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children

et al. 2014

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IMPORTANCE Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant short- and long-term problems in functioning across multiple settings. We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving (CAPS) intervention. OBJECTIVE To evaluate the efficacy of a CAPS intervention administered within 7 months of complicated mild to severe TBI compared with an Internet resource condition in improving long-term executive dysfunction. DESIGN, SETTING, AND PARTICIPANTS Multisite, assessor-blinded, randomized clinical trial at 3 tertiary pediatric hospitals and 2 tertiary general medical centers. Participants included 132 adolescents aged 12 to 17 years who sustained a moderate to severe TBI 1 to 7 months before study enrollment. INTERVENTION Web-based CAPS intervention. MAIN OUTCOMES AND MEASURES The primary outcome was the parent-reported Global Executive Composite (GEC) of the Behavior Rating Inventory of Executive Function. Secondary outcomes included the Behavioral Regulation Index (BRI) and Metacognition Index (MI) of the GEC. RESULTS In older (>14 to 17 years) adolescents, the CAPS intervention was associated with lower GEC ratings at 12 (β = −0.46; P = .03) and 18 (β = −0.52; P = .02) months after enrollment. Trends were also observed for older adolescents toward lower GEC ratings at 6 months (β = −0.40; P = .05), lower BRI ratings at 12 (β = −0.40; P = .06) and 18 (β = −0.47; P = .04) months, and lower MI ratings at 6 (β = −0.41; P = .05), 12 (β = −0.46; P = .03), and 18 (β = −0.50; P = .03) months. In younger (12–14 years) adolescents, no group differences were found on the GEC, BRI, or MI ratings. CONCLUSIONS AND RELEVANCE Delivery of the CAPS intervention early after TBI in older adolescents improves long-term executive function. This trial is, to our knowledge, one of the few large, randomized clinical treatment trials performed in pediatric TBI to demonstrate the efficacy of an intervention for management of executive dysfunction and long-term benefits of an intervention delivered soon after injury. Use of the CAPS intervention clinically should be considered; however, further research should explore ways to optimize delivery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00409448

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Effect on Behavior Problems of Teen Online Problem-Solving for Adolescent Traumatic Brain Injury

Abstract: Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants.

Cited by 81 publications

References 13 publications

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children

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