title: Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury.
abstract: OBJECTIVE
  To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI).
  
  
  METHODS
  A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47-17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy.
  
  
  RESULTS
  Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied.
  
  
  CONCLUSIONS
  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.
authors: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA. shari.wade@cchmc.org
authors: Shari L
authors: SL
authors: Wade
authors: Nicolay C
authors: NC
authors: Walz
authors: Joanne
authors: J
authors: Carey
authors: Kendra M
authors: KM
authors: McMullen
authors: Jennifer
authors: J
authors: Cass
authors: Erin
authors: E
authors: Mark
authors: Keith Owen
authors: KO
authors: Yeates
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001521:Behavior Therapy / Q000379:methods*; D001930:Brain Injuries / Q000523:psychology*; D002648:Child; D003142:Communication; D054541:Family Conflict; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000628:therapy*; D010287:Parent-Child Relations; D011340:Problem Solving; D057566:Self Report; D012923:Social Class; D012927:Social Control, Informal; D016896:Treatment Outcome