title: Online problem-solving therapy for executive dysfunction after child traumatic brain 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, assessor-blinded, 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.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA. brad.kurowski@cchmc.org
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kirkwood
authors.forename: Tanya M
authors.initials: TM
authors.lastname: Brown
authors.forename: Terry
authors.initials: T
authors.lastname: Stancin
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D001930:Brain Injuries / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003376:Counseling / Q000379:methods; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D020407:Internet; D008279:Magnetic Resonance Imaging; D008297:Male; D010552:Personality Assessment; D011340:Problem Solving; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed
keywords: adolescent; brain injury; child; executive function; online; therapy