Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury.
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.
1 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
Shari L
SL
Wade
2 Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University and Rainbow Babies and Children's Hospital , University Hospitals Case Medical Center, Cleveland, Ohio.
H Gerry
HG
Taylor
1 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
Amy
A
Cassedy
1 Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio.
Nanhua
N
Zhang
3 Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine , Aurora, Colorado.
Michael W
MW
Kirkwood
4 Department of Psychiatry and Psychology, Mayo Clinic College of Medicine , Mayo Clinic, Rochester, Minnesota.
Tanya M
TM
Brown
5 Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University , Cleveland, Ohio.
Terry
T
Stancin
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008297:Male; D017063:Outcome Assessment, Health Care; D000066553:Problem Behavior / Q000523:psychology*; D011340:Problem Solving; D016896:Treatment Outcome
adolescent; behavior; brain injury; child; online; therapy