title: Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes.
abstract: To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI).
  
  
  
  Cross-sectional evaluation of pretreatment data from a randomized controlled trial.
  
  
  
  Four children's hospitals and 1 general hospital, with level 1 trauma units.
  
  
  
  Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153).
  
  
  
  Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures.
  
  
  
  The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23-.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001).
  
  
  
  Problem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: shari.wade@cchmc.org.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Wade
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Cassedy
authors.affiliation: College of Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Fulks
authors.affiliation: 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, OH.
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.affiliation: Division of Pediatric Psychology, Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.
authors.forename: Terry
authors.initials: T
authors.lastname: Stancin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kirkwood
authors.affiliation: Departments of Psychology and Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Keith O
authors.initials: KO
authors.lastname: Yeates
authors.affiliation: Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Brad G
authors.initials: BG
authors.lastname: Kurowski
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D011340:Problem Solving / Q000502:physiology*
keywords: Brain injuries; Problem solving; Rehabilitation