Utilization of behavioral therapy services long-term after traumatic brain injury in young children.

OBJECTIVE: To examine associations of clinical need, defined by elevated parent ratings of child behavior problems and utilization of behavioral health services in young children with traumatic brain injury (TBI) and an orthopedic injury (OI) comparison group. DESIGN: Parents completed outcome measures 18 months after injury and at an extended follow-up conducted an average of 38 months postinjury. SETTING: Children's hospitals and a general hospital. PARTICIPANTS: Participants included parents of 3 groups of children injured between 3 and 7 years of age (N=139): 47 children with complicated mild to moderate TBI, 18 with severe TBI, and 74 with OI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Parents completed ratings of child behavior, mental health symptomology, and family functioning at both visits; at the extended follow-up, they reported utilization of behavior therapy or counseling services since the 18-month follow-up visit. RESULTS: Children with TBI had more behavior problems than those with OI. Although clinical need at both follow-ups was associated with greater service utilization at the extended follow-up, all groups had unmet needs as defined by a clinical need in the absence of services. Lower socioeconomic status was associated with higher rates of unmet need across groups. CONCLUSIONS: The results document unmet long-term behavioral health needs after both TBI and OI in children and underscore the importance of monitoring and treatment of postinjury behavior problems.

Counselor-assisted problem solving improves caregiver efficacy following adolescent brain injury.

PURPOSE: The purpose of the current study is to examine the efficacy of Counselor-Assisted Problem Solving (CAPS) in improving caregiver adaptation following traumatic brain injury (TBI). RESEARCH METHOD/DESIGN: In a randomized clinical trial comparing CAPS (n = 65), an online problem-solving intervention with accompanying Web-based counseling sessions, with an information-based Internet Resource Comparison (IRC; n = 67) program, participants included families of 12- to 17-year-olds who had sustained a TBI in the past 6 months. Linear regression analyses were used to identify main effects and to examine whether caregiver education, race, or prior computer use moderated treatment efficacy. RESULTS: Computer experience moderated postintervention improvements in caregiving self-efficacy following CAPS, Specifically, parents in CAPS with low levels of prior use reporting the greatest improvements. CAPS participants who completed 5 or more sessions reported greater reductions in depression than did the IRC; however, the groups did not differ on global distress. CONCLUSIONS/IMPLICATIONS: Findings support the potential utility of counselor-supported Web-based interventions particularly for individuals with limited computer expertise following adolescent TBI.

Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild-to-severe traumatic brain injury.

Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n = 65) or to an Internet resource comparison (IRC; n = 67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy.

Age at injury and long-term behavior problems after traumatic brain injury in young children.

OBJECTIVE: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). METHOD: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. RESULTS: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. CONCLUSIONS: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age.