Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury

Abstract

Family problem-solving therapy (FPST) has been shown to reduce behavior problems after pediatric traumatic brain injury (TBI). It is unclear whether treatment gains are maintained. We sought to evaluate the maintenance of improvements in behavior problems after a Web-based counselor-assisted FPST (CAPS) intervention compared to an Internet resource comparison (IRC) intervention provided to adolescents within the initial year post-TBI. We hypothesized that family socioeconomic status, child educational status, and baseline levels of symptoms would moderate the efficacy of the treatment over time. Participants included 132 adolescents ages 12-17 years who sustained a complicated mild-to-severe TBI 1-6 months before study enrollment. Primary outcomes were the Child Behavior Checklist Internalizing and Externalizing Totals. Mixed-models analyses, using random intercepts and slopes, were conducted to examine group differences over time. There was a significant group · time · grade interaction (F (1,304) = 4.42; p = 0.03) for internalizing problems, with high school-age participants in CAPS reporting significantly lower symptoms at 18 months postbaseline than those in the IRC. Post-hoc analyses to elucidate the nature of effects on internalizing problems revealed significant group · time · grade interactions for the anxious/depressed ( p = 0.03) and somatic complaints subscales ( p = 0.04). Results also indicated significant improvement over time for CAPS participants who reported elevated externalizing behavior problems at baseline (F (1, 310) = 7.17; p = 0.008). Findings suggest that CAPS may lead to long-term improvements in behavior problems among older adolescents and those with pretreatment symptoms.

Community-based interventions for adolescents following traumatic brain injury: A systematic review

“…One of the CAPS studies reported a significant decrease in problematic behavioural functioning post-intervention, including decreases in internalizing (p < .05), aggressive (p < .05), attention problems (p < .05), ADHD (p < .05), and conduct disorder symptoms (p < .05) (Wade et al, 2014). A decrease in externalizing behaviours was reported consistently at multiple follow up points compared to an internet resource comparison (p < .01; p = .01; p < .01) (Wade, Taylor, et al, 2015). One of the TOPS studies also found a decrease in internalizing behaviours for the intervention group (p = .03, d = .580) (Wade et al, 2008).…”

“…Nine studies reported statistically significant results regarding treatment effect (Cook, Chapman, Elliott, Evenson, & Vinton, 2014;Kurowski et al, 2013;Wade et al, 2008;Wade et al, 2010;Wade et al, 2011;Wade et al, 2014;Wade, Kurowski et al, 2015;and Wade, Taylor et al, 2015;Babcock et al, 2017). Of these, Cohen's d effect sizes were reported in three (Cook, Chapman, Elliott, Evenson, & Vinton, 2014;Kurowski et al, 2013;and Wade et al, 2008).…”

Using telehealth technologies to engage and support parents of children with disabilities: An evaluation of a novel telehealth parenting programme

“…While not a 'novel' study as such, it is also worth noting an additional study by Wade et al, (2015) detected during this update. Extending on the findings of an earlier study included in the original systematic review (CAPS: this research examines the maintenance of treatment effects during the initial 12-months post treatment completion (as well as the moderating effects of family socioeconomic status on treatment response) providing a valuable contribution to the literature.…”

“…The programmes deliver parenting support in a manner that overcomes many of the traditional barriers to support, while maintaining high levels of client satisfaction Wade et al, 2012). While research in relation to telehealth parenting interventions that specifically target, and/or include, adaptations to meet the specialised needs of parents and caregivers of children with a disability is even more limited, the evidence that 29 is available provides similar support to the efficacy of such interventions for improving parent skill and adjustment, as well as child behaviour outcomes, Kable et al, 2012;Pickard, Wainer, Bailey, & Ingersoll, 2016;Wade et al, 2015).…”

“…The programmes deliver parenting support in a manner that overcomes many of the traditional barriers to support, while maintaining high levels of client satisfaction Wade et al, 2012). While research in relation to telehealth parenting interventions that specifically target, and/or include, adaptations to meet the specialised needs of parents and caregivers of children with a disability is even more limited, the evidence that 29 is available provides similar support to the efficacy of such interventions for improving parent skill and adjustment, as well as child behaviour outcomes, Kable et al, 2012;Pickard, Wainer, Bailey, & Ingersoll, 2016;Wade et al, 2015).While acknowledging the promise of telehealth parenting interventions, increasing accessibility to effective parenting programmes using telehealth modalities remains of little utility if increased consumer uptake does not also occur. With the success of any parenting programme depending on both the willingness of parents to engage, as well as the feasibility of such engagement, it is vital that consumer preference be used to inform online parenting intervention design Macdonell & Prinz, 2016).…”