Research Reports - Online problem-solving therapy for executive dysfunction after child traumatic brain injury

Pediatrics. 2013 Jul;132(1):e158-66

Kurowski BG, Wade SL, Kirkwood MW, Brown TM, Stancin T, Taylor HG

OBJECTIVE: Executive dysfunction after traumatic brain injury (TBI) in children
is common and leads to significant problems in functioning across multiple
settings. The objective of this study was to evaluate the efficacy of a web-based
counselor-assisted problem solving (CAPS) intervention compared with an Internet
resource comparison (IRC) for treatment of executive dysfunction within 12 months
after complicated mild to severe TBI in adolescents. We hypothesized that CAPS
would significantly improve parent ratings of executive dysfunction compared with
an IRC.
METHODS: Participants included 132 adolescents aged 12 to 17 years who sustained
a complicated mild to severe TBI within 1 to 6 months before study enrollment.
Study design was a multisite, assessor-blinded, randomized controlled trial.
Study sites included 3 tertiary pediatric hospitals and 2 tertiary general
medical centers. The main outcome measure was primary caregiver Behavioral Rating
Inventory of Executive Function Global Executive Composite at baseline and
6-month follow-up. Generalized linear models that controlled for baseline scores
were used to compare the CAPS and IRC scores.
RESULTS: In older teens, the CAPS group showed significant improvement in
executive function behaviors at 6-month follow-up compared with the IRC group (F
= 6.74, P = .01, Cohen's d = 0.63).
CONCLUSIONS: Findings indicate that web-based CAPS improves primary
caregiver-rated executive functioning within the first 12 months after TBI in
older adolescents. Future research needs to define the optimal timing after
injury for delivery of CAPS and characteristics of individuals and families who
are most likely to benefit from CAPS.

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