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

Abstract

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:

Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial

“…3,4 Adolescents are at elevated risk of sustaining TBI 1 and may be responsive to interventions designed to improve self-regulation and executive function skills 5,6 that underlie deficits in everyday functioning. 7 Recent reviews highlight the paucity of high-quality trials addressing behavior and attention problems after TBI, 8,9 although some notable exceptions exist. 10,11 Family problemsolving therapy (FPST) has emerged as a potentially efficacious treatment of reducing behavioral and executive dysfunction after TBI in adolescents.…”

“…10,11 Family problemsolving therapy (FPST) has emerged as a potentially efficacious treatment of reducing behavioral and executive dysfunction after TBI in adolescents. [5][6][7][12][13][14][15] Family functioning contributes to recovery after TBI [16][17][18][19] ; thus, interventions promoting family problem-solving may improve the child's behavior and functioning.…”

“…[5][6][7]12,13 Both family socioeconomic status (SES) and the child's age moderated treatment efficacy. Older children and those from lower-income families showed the greatest improvements in parentreported behavior problems and executive dysfunction.…”

“…Older children and those from lower-income families showed the greatest improvements in parentreported behavior problems and executive dysfunction. 5,7 Tele-health treatments may benefit adolescents after TBI. [5][6][7][12][13][14][15]20 However, meta-analyses comparing online to traditional face-to-face approaches for various psychiatric and medical conditions have yielded mixed conclusions.…”

“…5,7 Tele-health treatments may benefit adolescents after TBI. [5][6][7][12][13][14][15]20 However, meta-analyses comparing online to traditional face-to-face approaches for various psychiatric and medical conditions have yielded mixed conclusions. 14,21,22 Although some reviews indicated comparable efficacy of traditional and tele-health interventions, 22 others noted smaller effects for online treatments.…”