This study examined whether an online problem-solving intervention could improve parental adjustment following pediatric traumatic brain injury (TBI). Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children's hospital and randomly assigned to receive online family problem solving therapy (FPS; n = 20) or Internet resources (IRC; n = 20) in addition to usual care. The FPS group reported significantly less global distress, depressive symptoms, and anxiety at follow-up than did the IRC group after controlling for baseline symptoms. The FPS group also reported significant improvements in problem-solving skills, although the groups did not differ significantly at follow-up. Findings suggest that an online, skill-building approach can be effective in facilitating parental adaptation after TBI.

Objective To determine whether parents of children with traumatic brain injuries (TBI) report increased injury-related burden, distress, and family dysfunction and to examine the effects of attrition on the results. Methods Children with severe TBI, moderate TBI, and orthopedic injuries were followed at six time points from baseline to 6 years after injury. Parents completed measures of injury-related burden, psychological distress, and family functioning at each assessment. Mixed model analysis was used to examine long-term changes. Results Attrition was higher among families in the severe TBI group with lower burden thereby amplifying group differences. The severe TBI group reported higher injury-related burden over time after injury than the other groups. Family functioning was moderated by social resources. Families of children with severe TBI and low resources reporting deteriorating functioning over the follow-up interval. Conclusions Although environmental advantages moderate long-term effects on family functioning, families of children with severe TBI experience long-standing injury-related burden.

To describe a family-centered problem-solving intervention (FPS) for pediatric traumatic brain injury (TBI), and to assess the efficacy of the intervention in a randomized clinical trial. Families of 32 school-aged children with moderate to severe TBI randomly assigned to FPS or usual care (UC) group. Child Behavior Checklist, Brief Symptom Inventory, Conflict Behavior Questionnaire. Seven-session problem-solving/skill-building intervention delivered over a 6-month period for the participating families. Parents in the FPS group reported significantly greater improvements in their children in internalizing symptoms, anxiety/depression, and withdrawal than did parents in the UC comparison group. FPS holds promise for reducing child behavior problems, the most common and persistent sequelae of TBI.

Parenting behaviors play a critical role in the child's behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3-7 years, hospitalized for TBI (n = 80) or OI (n = 113), were seen acutely and again 6 months later. Parent-child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist; T. M. Achenbach & L. A. Rescorla, 2001) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems.

Mounting evidence suggests that early brain injury has more profound and persistent effects than brain injury sustained in later childhood or adolescence.¹ Impairments cut across domains of neurocognitive abilities, executive function skills, behavior, and social competence.² However, to our knowledge, few studies have examined the consequences of early brain injury on everyday functioning, particularly among cohorts that were followed up prospectively since the time of injury. Characterization of everyday functioning following traumatic brain injury (TBI) may help us to understand and predict long-term deficits in educational attainment, employment, relationships, and quality of life.³

Objective To report preliminary efficacy data from a Web-based family problem-solving intervention to improve parent and child adaptation. Method Eight parents and six children with moderate to severe traumatic brain injury (TBI) who were injured more than 15 months earlier (M = 16 months) participated in the intervention. Families were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after they completed self-guided Web exercises on problem-solving, communication, and antecedent behavior management strategies. Results Paired t tests comparing pre- and post-intervention scores revealed significant improvements in injury-related burden, parental psychiatric symptoms, depression, and parenting stress. There were also significant reductions in antisocial behaviors in the injured child, but not in self-reported depressive symptoms. Conclusions These findings suggest that a computer-based intervention may successfully be used to improve both parent and child outcomes following TBI in children.