Research Reports - Problem solving following traumatic brain injury in adolescence: Associations with functional outcomes

Arch Phys Med Rehabil. 2017 Apr 4. pii: S0003-9993(17)30219-8. doi:
10.1016/j.apmr.2017.03.006. [Epub ahead of print]

Wade SL(1), Cassedy AE(2), Fulks LE(3), Taylor HG(4), Stancin T(5), Kirkwood
MW(6), Yeates KO(7), Kurowski BG(8).

OBJECTIVE: To examine the association of problem solving with functioning in
youth with traumatic brain injury (TBI).
DESIGN: Cross-sectional evaluation of pre-treatment data from a randomized
clinical trial.
SETTING: Four children's hospitals and one general hospital, with level 1 trauma
units.
PARTICIPANTS: Youth, ages 11 to 18, who sustained moderate or severe TBI in the
past 18 months (n = 133).
MAIN OUTCOME AND MEASURES: Problem-solving skills were assessed using the Social
Problem Solving Inventory (SPSI) and the Dodge Social Information Processing
Short Stories (SIP-SR). Everyday functioning was assessed based on 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.
RESULTS: 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 a higher total problem
solving scores for the TBI group compared to a normative sample (p < .001).
SIP-SR dimensions were correlated (r=.23 to .37) with SPSI subscales in the
anticipated direction. While 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).
CONCLUSION: and Relevance: Problem solving following TBI differs from normative
samples and is associated with functional impairments. The relationship 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. 

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