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Online Problem Solving for Adolescent Brain Injury: A Randomized Trial of 2 Approaches

Wade, Shari, L., PhD*; Taylor, Hudson, Gerry, PhD; Yeates, Keith, Owen, PhD‡,§; Kirkwood, Michael, PhD; Zang, Huaiyu, MS; McNally, Kelly, PhD**; Stacin, Terry, PhD††; Zhang, Nanhua, PhD

Journal of Developmental & Behavioral Pediatrics: February/March 2018 - Volume 39 - Issue 2 - p 154–162
doi: 10.1097/DBP.0000000000000519
Original Articles

Objective: Adolescent traumatic brain injury (TBI) contributes to deficits in executive functioning and behavior, but few evidence-based treatments exist. We conducted a randomized clinical trial comparing Teen Online Problem Solving with Family (TOPS-Family) with Teen Online Problem Solving with Teen Only (TOPS-TO) or the access to Internet Resources Comparison (IRC) group.

Methods: Children, aged 11 to 18 years, who sustained a complicated mild-to-severe TBI in the previous 18 months were randomly assigned to the TOPS-Family (49), TOPS-TO (51), or IRC group (52). Parent and self-report measures of externalizing behaviors and executive functioning were completed before treatment and 6 months later. Treatment effects were examined using linear regression models, adjusting for baseline symptom levels. Age, maternal education, and family stresses were examined as moderators.

Results: The TOPS-Family group had lower levels of parent-reported executive dysfunction at follow-up than the TOPS-TO group, and differences between the TOPS-Family and IRC groups approached significance. Maternal education moderated improvements in parent-reported externalizing behaviors, with less educated parents in the TOPS-Family group reporting fewer symptoms. On the self-report Behavior Rating Inventory of Executive Functions, treatment efficacy varied with the level of parental stresses. The TOPS-Family group reported greater improvements at low stress levels, whereas the TOPS-TO group reported greater improvement at high-stress levels. The TOPS-TO group did not have significantly lower symptoms than the IRC group on any comparison.

Conclusion: Findings support the efficacy of online family problem solving to address executive dysfunction and improve externalizing behaviors among youth with TBI from less advantaged households. Treatment with the teen alone may be indicated in high-stress families.

*Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

Department of Pediatrics, Case Western University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH;

Departments of Psychology, and

§Pediatrics & Clinical Neurosciences, University of Calgary, Calgary, AB, Canada;

Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO;

Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH;

**Section of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH;

††Department of Pediatrics, MetroHealth Medical Center and Case Western Reserve University, Cleveland, OH.

Address for reprints: Shari L. Wade, PhD, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3039; e-mail:

This study was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research, formerly known as the National Institute on Disability and Rehabilitation Research (Grant No. H133B090010).

Disclosure: The authors declare no conflict of interest.

Received April , 2017

Accepted September , 2017

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