Research Reports - Problem-solving after traumatic brain injury in adolescence

Arch Phys Med Rehabil. 2017 Aug;98(8):1614-1621. doi: 10.1016/j.apmr.2017.03.006.
Epub 2017 Apr 4.

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 pretreatment data from a randomized
controlled trial.
SETTING: Four children's hospitals and 1 general hospital, with level 1 trauma
PARTICIPANTS: Youth, ages 11 to 18 years, who sustained moderate or severe TBI in
the last 18 months (N=153).
MAIN OUTCOME MEASURES: 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.
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 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).
CONCLUSIONS: 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. 

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