Long-term maintenance of treatment effects following intervention for families with children who have acquired brain injury

Intl J of Devlp Neuroscience

et al. 2015

Self Cite

107

Pediatric traumatic brain injury (TBI) can result in a range of social impairments, however longitudinal recovery is not well characterized, and clinicians are poorly equipped to identify children at risk for persisting difficulties. Using a longitudinal prospective design, this study aimed to evaluate the contribution of injury and non-injury related risk and resilience factors to longitudinal outcome and recovery of social problems from 12- to 24-months post-TBI. 78 children with TBI (injury age: 5.0-15.0 years) and 40 age and gender-matched typically developing (TD) children underwent magnetic resonance imaging including a susceptibility-weighted imaging (SWI) sequence 2-8 weeks post-injury (M=39.25, SD=27.64 days). At 12 and 24-months post- injury, parents completed questionnaires rating their child's social functioning, and environmental factors including socioeconomic status, caregiver mental health and family functioning. Results revealed that longitudinal recovery profiles differed as a function of injury severity, such that among children with severe TBI, social problems significantly increased from 12- to 24-months post-injury, and were found to be significantly worse than TD controls and children with mild and moderate TBI. In contrast, children with mild and moderate injuries showed few problems at 12-months post-injury and little change over time. Pre-injury environment and SWI did not significantly contribute to outcome at 24-months, however concurrent caregiver mental health and family functioning explained a large and significant proportion of variance in these outcomes. Overall, this study shows that longitudinal recovery profiles differ as a function of injury severity, with evidence for late-emerging social problems among children with severe TBI. Poorer long-term social outcomes were associated with family dysfunction and poorer caregiver mental health at 24-months post injury, suggesting that efforts to optimize the child's environment and bolster family coping resources may enhance recovery of social problems following pediatric TBI.

Section: Discussionmentioning

confidence: 99%

Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment

Ryan

Bijnen

Intl J of Devlp Neuroscience

et al. 2015

Self Cite

107

“…In young patients, supportive friendships (Heverly-Fitt et al, 2014) and positive parenting (Wade et al, 2011; Woods et al, 2014a; Yeates et al, 2010) have been identified as factors which may facilitate behavioral recovery after TBI. The influence of a supportive environment can be further explored with experimental models, for example, by introducing multisensory housing conditions including social and cognitive challenges, collectively termed environmental enrichment (Brenes et al, 2015; Doulames et al, 2014).…”

Section: Social Functioning Influences Health and Post-injury Recomentioning

confidence: 99%

“…A randomized, controlled trial study demonstrated the effectiveness of this context-sensitive methodology, with evidence for statistically significant improvements in cognitive and motor outcomes compared to children receiving direct clinician-delivered interventions (Braga et al, 2005). Similarly, the efficacy of the family-centered model is shown to generalize to social and behavioral domains, with evidence that parent training programs for management of challenging behaviours may markedly improve child outcomes and contribute to maintenance of gains over time (Woods et al, 2014a; Woods et al, 2014b). …”

Section: : Translating Current Knowledge Into Evidence-based Practicmentioning

confidence: 99%

Social dysfunction after pediatric traumatic brain injury: A translational perspective

Ryan

Neuroscience & Biobehavioral Reviews

Godfrey

et al. 2016

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Social dysfunction is common after traumatic brain injury (TBI), contributing to reduced quality of life for survivors. Factors which influence the emergence, development or persistence of social deficits after injury remain poorly understood, particularly in the context of ongoing brain maturation during childhood. Aberrant social interactions have recently been modeled in adult and juvenile rodents after experimental TBI, providing an opportunity to gain new insights into the underlying neurobiology of these behaviors. Here, we review our current understanding of social dysfunction in both humans and rodent models of TBI, with a focus on brain injuries acquired during early development. Modulators of social outcomes are discussed, including injury-related and environmental risk and resilience factors. Disruption of social brain network connectivity and aberrant neuroendocrine function are identified as potential mechanisms of social impairments after pediatric TBI. Throughout, we highlight the overlap and disparities between outcome measures and findings from clinical and experimental approaches, and explore the translational potential of future research to prevent or ameliorate social dysfunction after childhood TBI.

“…The current results are contrary to previous studies that reported the maintenance of reduced parental stress after completion of Signposts. 23,24 However, these previous studies did not include a control group, which might have affected results. In addition, parents in the current sample did not present with clinical levels of parental stress, which can hinder the detection of treatment effects.…”

Section: Parental Stress and Parent Self-efficacymentioning

confidence: 99%

“…20 Results were maintained 18 months after treatment completion. 23 To date, evidence of the effectiveness of Signposts in children with ABI is based on case series and pre-post group designs rather than the use of "gold standard" randomized controlled trials (RCTs). Further, these studies have been conducted in English-speaking countries (Australia), have not specifically addressed self-regulation, and did not study whether changes generalized to a school setting.…”

Section: Introductionmentioning

confidence: 99%

A Parenting Program to Reduce Disruptive Behavior in Hispanic Children with Acquired Brain Injury: A Randomized Controlled Trial Conducted in Mexico

Arana

Developmental Neurorehabilitation

Yáñez-Téllez

et al. 2019

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Children with acquired brain injury (ABI) are at risk of impairments in self-regulation and disruptive behavior. We aimed to investigate the effectiveness of the Signposts program to reduce disruptive behavior and improve self-regulation in Hispanic children with ABI, and reduce parental stress and improve parenting practices. Using a randomized controlled trial design, we assigned children (n = 71) and their parents to Signposts or generic telephone support. Blinded assessors conducted assessments at pre-intervention, immediately post-intervention, and at 3 months post-intervention. Signposts was effective in reducing dysfunctional parenting practices. Further, when analyzing participants at risk of behavioral disturbance (n = 46), Signposts was effective in reducing child disruptive behavior in the home environment and emotional self-regulation. No differences were found for parental stress, parent sense of competence, child disruptive behaviors at school, and child cognitive and behavioral selfregulation. The reduction in disruptive behavior was associated with the implementation of authoritative parenting practices (external regulation), and not associated with child self-regulation. ARTICLE HISTORY