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A Comparison of 2 Online Parent Skills Training Interventions for Early Childhood Brain Injury

Improvements in Internalizing and Executive Function Behaviors

Aguilar, Jessica M., PhD; Cassedy, Amy E., PhD; Shultz, Emily L., BS; Kirkwood, Michael W., PhD; Stancin, Terry, PhD; Yeates, Keith Owen, PhD; Taylor, H. Gerry, PhD; Wade, Shari L., PhD

The Journal of Head Trauma Rehabilitation: March/April 2019 - Volume 34 - Issue 2 - p 65–76
doi: 10.1097/HTR.0000000000000443
Pediatric TBI 2019

Objective: To examine the effectiveness of a web-based parenting intervention (Internet-Based Interacting Together Everyday: Recovery After Childhood TBI [I-InTERACT]) and an abbreviated version (Express) in reducing executive dysfunction and internalizing problems among young children following traumatic brain injury (TBI).

Method: Parents of 113 children (ages 3-9 years) who had sustained a TBI were randomized to 1 of 3 treatment groups: I-InTERACT, Express, or an Internet Resource Comparison (IRC) group. Parents who participated in either I-InTERACT or Express completed self-guided web sessions and received live coaching of their parenting skills via videoconferencing with a therapist. I-InTERACT included additional psychoeducation, stress management, and family communication skills (eg, marriage, grief, pain, and sleep). Analyses of covariance were utilized to compare the groups on parent-reported executive function behaviors (ie, Behavior Rating Inventory of Executive Function) and internalizing symptoms (ie, Child Behavior Checklist) at baseline and 6 months.

Results: Parents who participated in Express reported significantly lower levels of executive dysfunction than those in I-InTERACT, β = −0.49; t(2, 73) = −2.47, P = .048, and significantly lower levels of withdrawal than those in the IRC group, β = −0.44; t(2, 74) = −2.22, P = .03. The Express group did not significantly differ from the IRC group on executive function behaviors or the I-InTERACT group on internalizing problems, all P > .05. Children with more problems at baseline, families with lower education levels, and parents with more symptoms of depression benefited most.

Conclusion: A brief, online parent training intervention may be efficacious in improving executive dysfunction and internalizing problems following early TBI, particularly among children of lower socioeconomic status or with existing behavioral concerns.

Division of Physical Medicine and Rehabilitation (Drs Aguilar and Wade and Ms Shultz) and Division of Biostatistics and Epidemiology (Dr Cassedy), Cincinnati Children's Hospital Medical Center, Ohio; University of Cincinnati, Ohio (Ms Shultz and Dr Wade); Children's Hospital Colorado, Denver (Dr Kirkwood); Metrohealth Medical Center, Cleveland, Ohio (Dr Stancin); Case Western Reserve University, Cleveland, Ohio (Drs Stancin and Taylor); Department of Pediatrics and Clinical Neurosciences, University of Calgary, Ontario (Dr Yeates); and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio (Dr Taylor).

Corresponding Author: Jessica M. Aguilar, PhD, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 (

This study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, formerly known as the National Institute on Disability and Rehabilitation Research (grant number: H133B090010).

We acknowledge the contributions of Kendra McMullen, MA (Cincinnati Children's Hospital Medical Center), Karen Oberjohn, MA (Cincinnati Children's Hospital Medical Center), Holly McPherson, BSc (Cincinnati Children's Hospital Medical Center), Jessica King, BA (Cincinnati Children's Hospital Medical Center), Jennifer Taylor, BA (Cincinnati Children's Hospital Medical Center), April Hunt, MA (Nationwide Children's Hospital), Anne Birnbaum, BA (Case Western Reserve University), Melissa Ginn, BS (Nationwide Children's Hospital), and Robert Blaha, MA (Children's Hospital Colorado) in data collection and entry; and Nori Minich, BA (Case Western Reserve University) in data management. We also acknowledge the contribution of study therapists: Britt Nielsen, PhD (MetroHealth), Nikki Ebberle, PhD (Children's Hospital Colorado), Christine Karver-Petranovich, PhD (Cincinnati Children's Hopsital Medical Center), Tanya Antonini, PhD (Cincinnati Children's Hospital Medical Center), Brad Jackson, PhD (Children's Hospital Colorado), Stacey Raj, PhD (Cincinnati Children's Hospital Medical Center), and Jennifer Cass, PhD (Nationwide Children's Hospital). Finally, we acknowledge the statistical experts for the study, which include Amy E. Cassedy, PhD, Huaiyu Zang, BS, and Nanhua Zhang, PhD, each from Cincinnati Children's Hospital Medical Center.

Trial registration: (NCT01214694).

The authors declare no conflicts of interest.

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