Research Reports - Long-term behavioral outcomes after counselor-assisted problem solving for adolescents with traumatic brain injury

J Neurotrauma. 2015 May 7

Wade SL(1), Taylor HG, Cassedy A, Zhang N, Kirkwood MW, Brown TM, Stancin T.

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.

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