1
|
Narad ME, Smith-Paine J, Cassedy A, LeBlond E, Taylor HG, Yeates KO, Wade SL. Recovery trajectories of IQ after pediatric TBI: A latent class growth modeling analysis. J Int Neuropsychol Soc 2024; 30:273-284. [PMID: 37607070 DOI: 10.1017/s1355617723000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To identify latent trajectories of IQ over time after pediatric traumatic brain injury (TBI) and examine the predictive value of risk factors within and across recovery trajectories. METHOD 206 children ages 3-7 years at injury were included: 87 TBI (23 severe, 21 moderate, 43 complicated mild) and 119 orthopedic injury (OI). We administered intelligence tests shortly after injury (1½ months), 12 months, and 6.8 years postinjury. Latent class growth modeling was used to identify latent subgroups. Separate models examined verbal and nonverbal IQ recovery trajectories following TBI versus OI. Variables included: age at injury, sex, race, socioeconomic status, injury severity, quality of the home environment, family functioning, and parenting style. RESULTS Both the TBI and OI analyses yielded different growth models for nonverbal (k = 3) and verbal IQ (k = 3). Although all models resulted in 3 latent classes (below average, average, and aboveaverage performance); trajectory shapes, contributors to class membership, and performance within each class varied by injury group and IQ domain. TBI severity was associated with class membership for nonverbal IQ, with less severe injuries associated with higher IQ scores; however, TBI severity did not influence verbal IQ class membership. Parenting style had a more prominent effect on verbal and nonverbal IQ within the TBI than OI trajectories. CONCLUSIONS Findings suggest TBI severity is related to recovery trajectories for nonverbal but not verbal IQ and parenting style has stronger effects on recovery in TBI than OI. Results highlight the importance of parental factors on long-term recovery after TBI.
Collapse
Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | | | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- University of Cincinnati, Cincinnati, USA
| | - Elizabeth LeBlond
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- University of Cincinnati, Cincinnati, USA
| | - H Gerry Taylor
- Nationwide Children's Hospital, Columbus, USA
- The Ohio State University, Columbus, USA
| | | | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
- University of Cincinnati, Cincinnati, USA
| |
Collapse
|
2
|
Chadwick L, Marbil MG, Madigan S, Callahan BL, Yeates KO. The Relationship Between Parental and Family Functioning and Post-Concussive Symptoms After Pediatric Mild Traumatic Brain Injury: A Scoping Review. J Neurotrauma 2024; 41:305-318. [PMID: 37565282 DOI: 10.1089/neu.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
This scoping review aimed to address the following questions: (1) Does mild traumatic brain injury (mTBI) result in more parental distress or poorer family functioning than other injuries? (2) Does pre-injury or acute parental distress and family functioning predict post-concussive symptoms (PCS) after mTBI? and (3) Do acute PCS predict later parental distress and family functioning? The subjects of this review were children/adolescents who had sustained an mTBI before age 18 and underwent assessment of PCS and parent or family functioning. MEDLINE®, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and CENTRAL databases were searched to identify original, empirical, peer-reviewed research published in English. PCS measures included parent- and child-reported symptom counts and continuous scales. Parent and family measures assessed parental stress, psychological adjustment, anxiety, psychiatric history, parent-child interactions, family burden, and general family functioning. A total of 11,163 articles were screened, leading to the inclusion of 15 studies, with 2569 participants (mTBI = 2222; control = 347). Collectively, the included articles suggest that mTBI may not result in greater parental distress or poorer family functioning than other types of injuries. Pre-injury or acute phase parental and family functioning appears to predict subsequent PCS after mTBI, depending on the specific family characteristic being studied. Early PCS may also predict subsequent parental and family functioning, although findings were mixed in terms of predicting more positive or negative family outcomes. The available evidence suggests that parent and family functioning may have an important, perhaps bidirectional, association with PCS after pediatric mTBI. However, further research is needed to provide a more thorough understanding of this association.
Collapse
Affiliation(s)
- Leah Chadwick
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mica Gabrielle Marbil
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, and University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Byard K, Gosling AS, Tucker P, Richmond J, Ashton R, Pickering A, Charles F, Fine H, Reed J. Reflections on the physical, executive developmental and systems applied framework in child neuropsychological rehabilitation. Clin Child Psychol Psychiatry 2022; 27:1221-1233. [PMID: 34920675 DOI: 10.1177/13591045211062384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper describes the influence of the Physical, Executive, Developmental and Systems (PEDS) framework on the delivery of community-based child neuropsychological rehabilitation and how it has been enhanced by the proliferation of neuroscientific, neuropsychological and psychosocial research and evidence-base in childhood brain injury and rehabilitation over the past decade. The paper signposts to some of the key models, theories and concepts currently shaping service delivery. Application of the PEDS framework in a clinical case is described.
Collapse
Affiliation(s)
- Katie Byard
- Department of Clinical Psychology, Recolo UK Ltd, UK
| | | | - Peter Tucker
- Department of Clinical Psychology, Recolo UK Ltd, UK
| | | | | | | | | | - Howard Fine
- Department of Clinical Psychology, Recolo UK Ltd, UK
| | - Jonathan Reed
- Department of Clinical Psychology, Recolo UK Ltd, UK
| |
Collapse
|
4
|
LaRovere KL, Tang Y, Li K, Wadhwani N, Zhang B, Tasker RC, Yang G. Effectiveness of Training Programs for Reducing Adverse Psychological Outcomes in Parents of Children with Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neurol Ther 2022; 11:1691-1704. [PMID: 36048333 DOI: 10.1007/s40120-022-00399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Parental stress following critical illness in their child has the potential to impact functional outcomes and quality of life for the child and whole family. Parent emotional functioning may also be an important clinical target to optimize child outcomes. This study assessed the effectiveness of training programs for parents aimed at reducing adverse psychological outcomes in parents of children with acute brain injury (ABI). METHODS We conducted searches of Embase, PubMed, Web of Science, and Cochrane Library to November 13, 2020. Randomized controlled trials (RCTs) that compared parent training programs with usual care, or an active comparator, and assessed psychological outcomes (depression, anxiety, stress) in parents of children with ABI were included. Two reviewers independently extracted data on study characteristics, participants, interventions, outcome measures, and results before and after intervention. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS Four RCTs involving 318 parents of children with ABI were eligible for review. Compared with usual care or active comparator, parent training was associated with significant reduction in parent stress (four RCTs; standardized mean difference [SMD], - 0.32 on a numerical rating scale [95% CI, - 0.60, - 0.05]; I-squared = 7.5%, p = 0.356); significant reduction in parent depression (three RCTs; SMD, - 0.43 [95% CI, - 0.72, - 0.14]; I-squared = 0.0%, p = 0.393); and significant reduction in parent anxiety (two RCTs; SMD, - 0.63 [95% CI, - 1.05, - 0.21]; I-squared = 0.0%, p = 0.629). Overall risk of bias was high for randomization process (one RCT), missing outcome data (three RCTs), measurement of the outcome (three RCTs), and selection of reported result (two RCTs). Heterogeneity between studies by country of study origin was not significant. CONCLUSIONS Compared with usual care or an active comparator, parent training was associated with short-term reduction in stress, depression, and anxiety in parents of children with ABI. Future clinical trials of parent interventions are needed as there may be some short-term beneficial effects.
Collapse
Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Yuzhe Tang
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | - Kun Li
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | | | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Tasker
- Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China. .,Senior Department of Pediatrics, Seventh Medical Center, Chinese PLA General Hospital, 5 Nanmen Cang, Ten East and West, Dongcheng District, Beijing, 100700, China.
| |
Collapse
|
5
|
Rohrer-Baumgartner N, Holthe IL, Svendsen EJ, Røe C, Egeland J, Borgen IMH, Hauger SL, Forslund MV, Brunborg C, Øra HP, Dahl HM, Bragstad LK, Killi EM, Sandhaug M, Kleffelgård I, Strand-Saugnes AP, Dahl-Hilstad I, Ponsford J, Winter L, Wade S, Løvstad M. Rehabilitation for children with chronic acquired brain injury in the Child in Context Intervention (CICI) study: study protocol for a randomized controlled trial. Trials 2022; 23:169. [PMID: 35193666 PMCID: PMC8861614 DOI: 10.1186/s13063-022-06048-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pediatric acquired brain injury (pABI) is associated with long-term cognitive, behavioral, social, and emotional problems, which may affect the quality of life, school, and family functioning. Yet, there is a lack of evidence-based community-centered rehabilitation programs for chronic pABI and these children do not systematically receive comprehensive rehabilitation. The Child In Context Intervention (CICI) study is a pragmatic randomized controlled trial (RCT) for children with chronic pABI, which aims to evaluate the effectiveness of an individualized and goal-oriented intervention targeting everyday functioning of the child and family. METHODS Children aged 6-16 years with MRI/CT-verified intracranial abnormalities will be included in the CICI study if they have persistent self- or parent-reported cognitive, emotional, and/or behavioral challenges 1 year or more after insult and attend school regularly. A total of 70 families will be randomized 1:1 to an intervention or a control group. The intervention consists of seven family sessions, one parent seminar, and four school sessions delivered over approximately 6 months. The parent seminar will be held in person, and the other sessions will mainly be video based. The children's and families' self-reported major challenges in everyday life will be targeted using SMART goals. Evidence-based strategies, when available, will be applied to achieve the goals, combined with psychoeducation. Goal attainment scaling (GAS) will be used to evaluate goal attainment. Data is collected at baseline and after approximately 6 and 9 months. External assessors are blinded to group allocation. Primary outcomes are parent-reported brain injury symptoms in children and parenting self-efficacy at 9 months of follow-up. Secondary outcomes include child-reported brain injury symptoms, quality of life, executive functioning in daily life, parent emotional symptoms, family functioning, and unmet family health care needs. A process evaluation will be conducted. DISCUSSION The current study provides an innovative approach to rehabilitation for children in the chronic phase of ABI and their families. This complex intervention may contribute to the development of evidence-based, high-quality rehabilitation for a large patient group, which is underrepresented in clinical research. It may also improve collaboration between specialized rehabilitation facilities, schools, and local health care services. Inclusion for the trial started in April 2021. TRIAL REGISTRATION ClinicalTrials.gov NCT04798859 . Registered on March 15, 2021.
Collapse
Affiliation(s)
| | - Ingvil Laberg Holthe
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Edel Jannecke Svendsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Egeland
- Institute of Psychology, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Tønsberg, Norway
| | - Ida M. H. Borgen
- Institute of Psychology, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Solveig L. Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hege Prag Øra
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Hilde Margrete Dahl
- Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Line Kildal Bragstad
- Research Center for Habilitation and Rehabilitation Services and Models (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics Oslo Metropolitan University, Oslo, Norway
| | - Eli Marie Killi
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Maria Sandhaug
- Statped: Norwegian Service for Special Needs Education, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | | | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Laraine Winter
- Philadelphia Research and Education Foundation, Philadelphia, PA USA
- Nursing Service, Department of Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Shari Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
6
|
Schmidt AT, Lindsey HM, Dennis E, Wilde EA, Biekman BD, Chu ZD, Hanten GR, Formon DL, Spruiell MS, Hunter JV, Levin HS. Diffusion Tensor Imaging Correlates of Resilience Following Adolescent Traumatic Brain Injury. Cogn Behav Neurol 2021; 34:259-274. [PMID: 34851864 PMCID: PMC8647770 DOI: 10.1097/wnn.0000000000000283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is associated with considerable mortality and morbidity in adolescents, but positive outcomes are possible. Resilience is the concept that some individuals flourish despite significant adversity. OBJECTIVE To determine if there is a relationship between resilience-promoting factors that are known to promote resilience and white matter (WM) microstructure 1 year after complicated mild TBI or moderate or severe TBI that is sustained by adolescents. METHOD We examined the relationship between performance on a self-report measure of resilience-promoting factors and WM integrity assessed by diffusion tensor imaging in a group of adolescents who had sustained either a TBI (n = 38) or an orthopedic injury (OI) (n = 23). RESULTS Immediately following injury, the individuals with TBI and the OI controls had comparable levels of resilience-promoting factors; however, at 1 year post injury, the TBI group endorsed fewer resilience-promoting factors and exhibited WM disruption compared with the OI controls. The individuals with TBI who had more resilience-promoting factors at 1 year post injury exhibited increased WM integrity, but the OI controls did not. Findings were particularly strong for the following structures: anterior corona radiata, anterior limb of the internal capsule, and genu of the corpus callosum-structures that are implicated in social cognition and are frequently disrupted after TBI. Relationships were notable for caregiver and community-level resilience-promoting factors. CONCLUSION The current findings are some of the first to indicate neurobiological evidence of previously noted buffering effects of resilience-promoting factors in individuals with TBI.
Collapse
Affiliation(s)
- Adam T. Schmidt
- Department of Psychological Sciences, Texas Tech University Campus, Lubbock, Texas
| | | | - Emily Dennis
- Department of Neurology, University of Utah, Salt Lake City, Utah
| | | | - Brian D. Biekman
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili D. Chu
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Gerri R. Hanten
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Dana L. Formon
- Colorado Department of Human Services, Office of Behavioral Health, Court Services Division, Denver, Colorado
| | - Matthew S. Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas
- Department of Pediatric Radiology, Texas Children’s Hospital, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
7
|
Watson KH, Ciriegio AE, Pfalzer AC, Hale L, Jones MT, Brown B, Grice V, Moroz S, McDonell KE, Claassen DO, Compas BE. Neurobiological and Psychosocial Correlates of Communication Between Huntington's Disease Patients and Their Offspring. J Neuropsychiatry Clin Neurosci 2021; 33:321-327. [PMID: 34280320 DOI: 10.1176/appi.neuropsych.20120309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that presents significant challenges to family communication. The investigators examined observations of communication between parents with HD and their offspring talking about the challenges of HD and explored potential correlates of their communication. METHODS The sample included parents with HD and their adolescent and young-adult offspring (N=64). Parent communication and chorea were independently coded from video recordings. Parents and offspring completed working memory assessments and self-reports of neuropsychiatric symptoms, stress, and coping. RESULTS Evidence was found for the association of observed parent-offspring communication with disease markers, psychosocial characteristics, and neurocognitive function. For parents, disease markers and working memory were correlates of communication, whereas offspring's psychiatric symptoms, stress, and coping were associated with their communication. CONCLUSIONS These findings have potential implications for clinical interventions to enhance communication and quality of life for HD families.
Collapse
Affiliation(s)
- Kelly H Watson
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Abagail E Ciriegio
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Anna C Pfalzer
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Lisa Hale
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Maile T Jones
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Brittany Brown
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Victoria Grice
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Sarah Moroz
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Katherine E McDonell
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Daniel O Claassen
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tenn. (Watson, Ciriegio, Jones, Grice, Compas); and Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn. (Pfalzer, Hale, Brown, Moroz, McDonell, Claassen)
| |
Collapse
|
8
|
Behavior Problems Following Childhood TBI: The Role of Sex, Age, and Time Since Injury. J Head Trauma Rehabil 2021; 35:E393-E404. [PMID: 32108717 DOI: 10.1097/htr.0000000000000567] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the frequency of behavioral problems after childhood traumatic brain injury (TBI) and their associations with injury severity, sex, and social environmental factors. SETTING Children's hospitals in the Midwestern/Western United States. PARTICIPANTS 381 boys and 210 girls with moderate (n = 359) and severe (n = 227) TBI, with an average age at injury of 11.7 years (range 0.3-18) who were injured ≤3 years ago. DESIGN Secondary data analysis of a multistudy cohort. MAIN MEASURES Child Behavior Checklist (CBCL) administered pretreatment. RESULTS Thirty-seven percent had borderline/clinical elevations on the CBCL Total Problem Scale, with comparable rates of Internalizing and Externalizing problems (33% and 31%, respectively). Less parental education was associated with higher rates of internalizing, externalizing, and total problems. Time since injury had a linear association with internalizing symptoms, with greater symptoms at longer postinjury intervals. Younger boys had significantly higher levels of oppositional defiant symptoms than girls, whereas older girls had significantly greater attention-deficit hyperactivity disorder symptoms than boys. CONCLUSIONS Pediatric TBI is associated with high rates of behavior problems, with lower socioeconomic status predicting substantially elevated risk. Associations of higher levels of internalizing symptoms with greater time since injury highlight the importance of tracking children over time.
Collapse
|
9
|
Ryan NP, Catroppa C, Hughes N, Painter FL, Hearps S, Beauchamp MH, Anderson VA. Executive function mediates the prospective association between neurostructural differences within the central executive network and anti-social behavior after childhood traumatic brain injury. J Child Psychol Psychiatry 2021; 62:1150-1161. [PMID: 33624844 DOI: 10.1111/jcpp.13385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite increasing evidence of a link between early life brain injury and anti-social behavior, very few studies have assessed factors that explain this association in children with traumatic brain injury (TBI). One hypothesis suggests that childhood TBI elevates risk for anti-social behavior via disruption to anatomically distributed neural networks implicated in executive functioning (EF). In this longitudinal prospective study, we employed high-resolution structural neuroimaging to (a) evaluate the impact of childhood TBI on regional morphometry of the central executive network (CEN) and (b) evaluate the prediction that lower EF mediates the prospective relationship between structural differences within the CEN and postinjury anti-social behaviors. METHODS This study involved 155 children, including 112 consecutively recruited, hospital-confirmed cases of mild-severe TBI and 43 typically developing control (TDC) children. T1-weighted brain magnetic resonance imaging (MRI) sequences were acquired sub-acutely in a subset of 137 children [TBI: n = 103; TDC: n = 34]. All participants were evaluated using direct assessment of EF 6 months postinjury, and parents provided ratings of anti-social behavior 12 months postinjury. RESULTS Severe TBI was associated with postinjury volumetric differences within the CEN and its putative hub regions. When compared with TD controls, the TBI group had significantly worse EF, which was associated with more frequent anti-social behaviors and abnormal CEN morphometry. Mediation analysis indicated that reduced EF mediated the prospective association between postinjury volumetric differences within the CEN and more frequent anti-social behavior. CONCLUSIONS Our longitudinal prospective findings suggest that detection of neurostructural abnormalities within the CEN may aid in the early identification of children at elevated risk for postinjury executive dysfunction, which may in turn contribute to chronic anti-social behaviors after early life brain injury. Findings underscore the potential value of early surveillance and preventive measures for children presenting with neurostructural and/or neurocognitive risk factors.
Collapse
Affiliation(s)
- Nicholas P Ryan
- School of Psychology, Deakin University, Geelong, Vic., Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Cathy Catroppa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Nathan Hughes
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | | | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, QC, Canada.,Research Centre, Ste-Justine Hospital, Montreal, QC, Canada
| | - Vicki A Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| |
Collapse
|
10
|
Ewing-Cobbs L, Montroy JJ, Clark AE, Holubkov R, Cox CS, Keenan HT. As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury. Front Neurol 2021; 12:687740. [PMID: 34290664 PMCID: PMC8287068 DOI: 10.3389/fneur.2021.687740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes. Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4-15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire. Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery. Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.
Collapse
Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Janelle J. Montroy
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Amy E. Clark
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard Holubkov
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heather T. Keenan
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| |
Collapse
|
11
|
Jones KM, Ameratunga S, Starkey NJ, Theadom A, Barker-Collo S, Ikeda T, Feigin VL. Psychosocial functioning at 4-years after pediatric mild traumatic brain injury. Brain Inj 2021; 35:416-425. [PMID: 33539250 DOI: 10.1080/02699052.2021.1878553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Behavioral and emotional difficulties are reported following pediatric mild traumatic brain injury (TBI). But few studies have used a broad conceptual approach to examine children's long-term psychosocial outcomes. This study examines children's psychosocial outcomes at 4-years after mild TBI and associated factors.Methods: Parents of 93 children (<16 years) with mild TBI completed subscales of age-appropriate versions of the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function, the Pediatric Quality of Life Inventory, and the Adolescent Scale of Participation questionnaire at 4-years post-injury.Results: Mean group-level scores were statistically significantly higher for hyperactivity/inattention and lower for emotional functioning than published norms. Levels of participation were greater compared to those observed in normative samples. More than 19% met published criteria for clinically significant hyperactivity/inattention, emotional functioning problems, peer relationship problems, and social functioning difficulties. Lower family socio-economic status and greater parental anxiety and depression were associated with overall psychosocial difficulties.Conclusions: Findings indicate that as a group, children with mild TBI are characterized by elevated rates of behavioral, emotional, and social difficulties at 4-years post-injury. Parent mental health may be an untapped opportunity to support children's psychosocial development following mild TBI, with replication required in larger samples.
Collapse
Affiliation(s)
- Kelly M Jones
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Nicola J Starkey
- School of Psychology, Division of Arts, Law, Psychology & Social Sciences, The University of Waikato, Hamilton, New Zealand
| | - Alice Theadom
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Takayoshi Ikeda
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery L Feigin
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
12
|
Caregiver and Child Behavioral Health Service Utilization Following Pediatric Traumatic Brain Injury. Res Child Adolesc Psychopathol 2021; 49:491-501. [PMID: 33404944 DOI: 10.1007/s10802-020-00737-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.
Collapse
|
13
|
Lloyd O, Ownsworth T, Fleming J, Jackson M, Zimmer-Gembeck M. Impaired Self-Awareness after Pediatric Traumatic Brain Injury: Protective Factor or Liability? J Neurotrauma 2021; 38:616-627. [PMID: 33107366 DOI: 10.1089/neu.2020.7191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children and adolescents with traumatic brain injury (TBI) can experience impaired self-awareness, or difficulty in accurately perceiving their personal abilities. This study aimed to identify the neuro-developmental and socio-environmental factors associated with self-awareness impairment and determine how self-awareness is associated with psychosocial functioning. Parents and their children age 8-16 years with TBI (n = 107, 65.4% male, mean [M] age = 12.66 years, standard deviation [SD] = 2.6 years) were consecutively recruited from an outpatient clinic over a 4-year period. Children completed the Paediatric Awareness Questionnaire (PAQ) to report their functional abilities, and the Beck Youth Inventories to report their self-concept, and anxiety and depression symptoms. Parents completed the PAQ and measures of family functioning, parenting style, and children's emotional and behavioral problems. Self-awareness impairments were defined as more negative parent-child discrepancy scores on the PAQ. Younger age at injury, more severe injury, and more family dysfunction were significantly associated with poorer self-awareness. Poorer self-awareness was associated with worse parent-rated child adaptive functioning and emotional and behavioral problems. However, poorer self-awareness was also significantly associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children. Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).
Collapse
Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Megan Jackson
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | | |
Collapse
|
14
|
Longitudinal Growth Curve Trajectories of Family Dynamics after Pediatric Traumatic Brain Injury in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228508. [PMID: 33212863 PMCID: PMC7698393 DOI: 10.3390/ijerph17228508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
Pediatric traumatic brain injury (TBI) represents a serious public health concern. Family members are often caregivers for children with TBI, which can result in a significant strain on familial relationships. Research is needed to examine aspects of family functioning in the context of recovery post-TBI, especially in Latin America, where cultural norms may reinforce caregiving by family members, but where resources for these caregivers may be scarce. This study examined caregiver-reported family satisfaction, communication, cohesion, and flexibility at three time points in the year post-injury for 46 families of a child with TBI in comparison to healthy control families. Families experiencing pediatric TBI were recruited from a large hospital in Guadalajara, Mexico, while healthy controls were recruited from a local educational center. Results from multilevel growth curve models demonstrated that caregivers of children with a TBI reported significantly worse family functioning than controls at each assessment. Families experiencing pediatric TBI were unable to attain the level of functioning of controls during the time span studied, suggesting that these families are likely to experience long-term disruptions in family functioning. The current study highlights the need for family-level intervention programs to target functioning for families affected by pediatric TBI who are at risk for difficulties within a rehabilitation context.
Collapse
|
15
|
Beauchamp MH, Séguin M, Gagner C, Lalonde G, Bernier A. The PARENT model: a pathway approach for understanding parents’ role after early childhood mild traumatic brain injury. Clin Neuropsychol 2020; 35:846-867. [DOI: 10.1080/13854046.2020.1834621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- M. H. Beauchamp
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - M. Séguin
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - C. Gagner
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - G. Lalonde
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - A. Bernier
- Department of Psychology, University of Montreal, Canada
| |
Collapse
|
16
|
A Randomized Comparative Effectiveness Trial of Family-Problem-Solving Treatment for Adolescent Brain Injury: Parent Outcomes From the Coping with Head Injury through Problem Solving (CHIPS) Study. J Head Trauma Rehabil 2020; 34:E1-E9. [PMID: 31033747 DOI: 10.1097/htr.0000000000000487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine changes in depression and distress in parents of adolescents receiving family-problem-solving therapy (F-PST) following traumatic brain injury. METHOD Families of adolescents hospitalized for moderate to severe traumatic brain injury were randomized to face-to-face F-PST (34), therapist-guided online F-PST (56), or self-guided online F-PST (60). Outcomes were assessed pretreatment and 6 and 9 months later. Parents rated depression and distress on the Center for Epidemiological Studies Depression Scale and the Brief Symptom Inventory, respectively. Mixed modeling was used to examine changes over time and treatment moderators. RESULTS The therapist-guided online group had significant reductions in parental depression over time. Analyses of slopes of recovery revealed differential improvement on the Center for Epidemiological Studies Depression Scale between the 2 online groups, with no significant change in depressive symptoms following self-guided F-PST. On the Brief Symptom Inventory Global Severity Index, the therapist-guided online group reported significant improvement from baseline to 6 months that was maintained at 9 months. The face-to-face and self-guided online groups reported significant reductions in distress between 6 and 9 months with corresponding large effect sizes. Differences on the Center for Epidemiological Studies Depression Scale between therapist-guided and self-guided online groups at the 9-month follow-up were more pronounced in families of lower socioeconomic status, t103 = -2.87; P = .005. CONCLUSIONS Findings provide further support for the utility of therapist-guided online F-PST in reducing parental depression and distress following pediatric traumatic brain injury and offer limited evidence of the efficacy of self-guided online treatment for these outcomes. Families of lower socioeconomic status may benefit more from therapist involvement.
Collapse
|
17
|
Peterson RK, Williams T, Dlamini N, Westmacott R. Parent experiences and developmental outcomes following neonatal stroke. Clin Neuropsychol 2020; 35:973-987. [PMID: 32924802 DOI: 10.1080/13854046.2020.1815855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Parents of children with neonatal stroke offer critical insight into potential avenues to direct neuropsychological care from the time of diagnosis through the early years. The aims of this study were to (1) describe what parents remember about early prognostic discussions with the medical team and (2) to examine the relationships between initial prognoses and the child's current neurodevelopmental status and parents' mental health. Method: Thirty parents of children with neonatal stroke completed the Depression Anxiety Stress Scales (DASS) and Parent Experiences Questionnaire (PEQ). The children of these parents were also seen for neurodevelopmental/neuropsychological assessments. Results: Parents recalled discussions with the medical team about motor, language, cognitive, and academic outcomes, with fewer discussions about the impact of neonatal stroke on their child's social skills, behavior, attention, mental health, and adaptive functioning. Many parents recalled poor initial prognoses following their child's diagnosis, with better than expected outcomes 3 years later. Parent self-reported depression, anxiety, and stress were associated with higher ratings of externalizing symptoms in their child. There were no significant correlations between parent mental health and their perception of their child's internalizing symptoms, neurodevelopmental functioning, or any of the child's medical/demographic factors. Conclusions: This study highlights the role of the neuropsychologist in the child's care in educating families and monitoring outcomes, emphasizes mental health support for parents of children with a history of neonatal stroke, and reiterates how environmental factors outside of the neonatal stroke itself can impact the child's functioning.
Collapse
Affiliation(s)
- Rachel K Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| | - Nomazulu Dlamini
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, USA
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, USA
| |
Collapse
|
18
|
Jones KM, Barker-Collo S, Parmar P, Starkey N, Theadom A, Ameratunga S, Feigin VL. Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children: findings from the BIONIC Study. J Prim Health Care 2019; 10:81-89. [PMID: 30068456 DOI: 10.1071/hc17038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There is growing consensus that adverse child outcomes may be evident in the early recovery phase following mild traumatic brain injury (TBI). However, controversy remains around the nature of children's longer-term recovery. AIM To examine child cognitive, behavioural and quality-of-life outcomes over 12 months following mild injury, and to identify prognostic factors associated with outcomes. METHODS A prospective sample of 222 children (aged 2-15 years at injury) with mild TBI was assessed using a cognitive testing battery and parent-report questionnaires at ≤ 14 days, 1, 6 and/or 12-months post-injury. RESULTS Parents reported significant improvements in their child's behavioural adjustment between baseline and 6 months (P = 0.003), with further improvements at 12 months following injury (P = 0.001). Cognitive recovery and quality-of-life improvements were more gradual with minimal changes in the first month (P > 0.05), but significant improvements by 12-months post-injury (P = 0.03, P = 0.02, respectively). Time since injury, male gender, living rurally and parent anxiety were associated with extent of recovery beyond the acute period. CONCLUSIONS Children's recovery from mild TBI continues beyond the initial 6 months following injury. Health-care providers need to be vigilant about the varying trajectories in children's recovery from TBI. On-going monitoring of children following injury will enable timely and proactive responses to persistent difficulties, with a view to minimising longer-term adverse consequences.
Collapse
Affiliation(s)
- Kelly M Jones
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Suzanne Barker-Collo
- School of Psychology, Tamaki Campus, The University of Auckland, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Starkey
- School of Psychology, Faculty of Arts & Social Sciences, The University of Waikato, Hamilton, New Zealand
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | | |
Collapse
|
19
|
Murphy LK, Preacher KJ, Rights JD, Rodriguez EM, Bemis H, Desjardins L, Prussien K, Winning AM, Gerhardt CA, Vannatta K, Compas BE. Maternal Communication in Childhood Cancer: Factor Analysis and Relation to Maternal Distress. J Pediatr Psychol 2019; 43:1114-1127. [PMID: 30016505 DOI: 10.1093/jpepsy/jsy054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 06/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.
Collapse
Affiliation(s)
- Lexa K Murphy
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Jason D Rights
- Department of Psychology & Human Development, Vanderbilt University
| | - Erin M Rodriguez
- Department of Psychology & Human Development, Vanderbilt University
| | - Heather Bemis
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Kemar Prussien
- Department of Psychology & Human Development, Vanderbilt University
| | | | - Cynthia A Gerhardt
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Kathryn Vannatta
- The Research Institute at Nationwide Children's Hospital.,The Ohio State University
| | - Bruce E Compas
- Department of Psychology & Human Development, Vanderbilt University
| |
Collapse
|
20
|
Effects of Web-Based Parent Training on Caregiver Functioning Following Pediatric Traumatic Brain Injury: A Randomized Control Trial. J Head Trauma Rehabil 2019; 33:E19-E29. [PMID: 29601344 DOI: 10.1097/htr.0000000000000388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effects of a Web-based parenting intervention (I-InTERACT), and an abbreviated version (Express), on caregiver depression, psychological distress, parenting stress, and parenting efficacy following pediatric traumatic brain injury (TBI). SETTING Four children's hospitals and 1 general hospital in the United States. PARTICIPANTS 148 caregivers of 113 children aged 3 to 9 years with a moderate to severe TBI. DESIGN Multicenter randomized controlled trial. Participants were randomly assigned to I-InTERACT, Express, or an active control condition. Caregiver data were collected at baseline and postintervention (6 months later). INTERVENTION I-InTERACT (10-14 sessions) and Express (7 sessions) combine live coaching of parenting skills and positive parenting strategies. MAIN MEASURES Center for Epidemiologic Studies Depression Scale (CES-D); Global Severity Index of the Symptom Checklist-90-R (GSI), Parenting Stress Index (PSI), and Caregiver Self-Efficacy Scale (CSES). RESULTS Analyses revealed no main effects of treatment on caregiver distress (GSI), parenting stress (PSI), or parenting efficacy (CSES). However, analyses examining baseline severity as a moderator found that caregivers with elevated levels of depression in I-InTERACT experienced significantly greater reductions in CES-D scores compared with caregivers in the active control condition. CONCLUSIONS I-InTERACT reduced caregiver depression but no other facets of caregiver psychological functioning. Modifications to the treatment content may be necessary to reduce parenting stress and improve caregiver efficacy.
Collapse
|
21
|
McCarty CA, Zatzick D, Hoopes T, Payne K, Parrish R, Rivara FP. Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial. Trials 2019; 20:567. [PMID: 31533799 PMCID: PMC6749638 DOI: 10.1186/s13063-019-3662-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022] Open
Abstract
Background Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition. Methods/design This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline. Discussion The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated. Trial registration ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3662-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carolyn A McCarty
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center 325 9th Avenue, Box 359911, Seattle, WA, 98104-2499, USA
| | - Teah Hoopes
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Katelyn Payne
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Rebecca Parrish
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA
| | - Frederick P Rivara
- Seattle Children's Research Institute, P.O. Box 5371, M/S: CW8-5, Seattle, WA, 98145-5005, USA.,Department of Pediatrics, University of Washington, Seattle, USA
| |
Collapse
|
22
|
Narad ME, Raj S, Yeates KO, Taylor HG, Kirkwood MW, Stancin T, Wade SL. Randomized Controlled Trial of an Online Problem-Solving Intervention Following Adolescent Traumatic Brain Injury: Family Outcomes. Arch Phys Med Rehabil 2019; 100:811-820. [PMID: 30738021 PMCID: PMC11047263 DOI: 10.1016/j.apmr.2019.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine parent and family outcomes of a randomized controlled trial (RCT) comparing Teen Online Problem-Solving with Family (TOPS-F), Teen Online Problem-Solving-Teen Only (TOPS-TO), or access to Internet resources alone (Internet resource comparison [IRC]). DESIGN Three-arm RCT. SETTING Four children's hospitals and 1 general medical center in Ohio and Colorado. PARTICIPANTS Children and adolescents (N=152), 11-18 years old, hospitalized for complicated mild to severe traumatic brain injury in the previous 18 months. INTERVENTIONS Intervention groups: TOPS-F, TOPS-TO, and IRC. MAIN OUTCOME MEASURE Parental depression (CES-D), parental psychological distress (SCL-90-GSI), family functioning (FAD-GF), cohesiveness (PARQ), and conflict (IBQ) were assessed pre- and post-treatment. Treatment effects and the moderating effect of the number of parents in the home (single vs 2-parent families). RESULTS Number of parents moderated treatment effects with effects ranging from trending to statistically significant for depression, family functioning, cohesion, and conflict. Among single parents, TOPS-TO reported better family functioning than TOPS-F and greater cohesion and less conflict than IRC. Among 2-parent families, TOPS-F reported less depression than IRC and less depression and greater cohesion than TOPS-TO. The effect of family composition was also noted within TOPS-TO and TOPS-F. In TOPS-F, 2-parent families reported less depression than single-parent families. In TOPS-TO single parents reported greater cohesion and better family functioning than 2-parent families. CONCLUSIONS Findings support the TOPS intervention improves family outcomes, with differential effects noted for single vs 2-parent households. The TOPS-TO format appeared more beneficial for single-parent households, while TOPS-F was more beneficial for 2-parent households, highlighting the importance of considering family composition when determining the best treatment modality.
Collapse
Affiliation(s)
- Megan E Narad
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Stacey Raj
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Michael W Kirkwood
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Terry Stancin
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
| | - Shari L Wade
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
23
|
Kurowski BG, Stancin T, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, King E, Sklut M, Narad ME, Wade SL. Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial. Contemp Clin Trials Commun 2018; 10:111-120. [PMID: 30023445 PMCID: PMC6046511 DOI: 10.1016/j.conctc.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction The objective of this manuscript is to describe the methodology that will be used to test the comparative effectiveness, feasibility, and acceptability of three formats of family problem solving therapy (F-PST) for improving functional outcomes of complicated mild to severe adolescent TBI. Methods Three-arm comparative effectiveness, randomized clinical trial (RCT) design. We describe the protocol of a three-arm RCT comparing the effectiveness of three modalities of F-PST to reduce executive dysfunction and behavior problems following TBI in adolescence. The RCT will compare the relative effectiveness among face-to-face; online and self-directed; and therapist-supported online modes of treatment. Ethics and dissemination It is anticipated that findings from this work will inform future clinical care practices, with implications for treatment of other patient populations of youth with psychological symptoms arising from neurological conditions. Institutional review board approval will be obtained from all sites prior to commencement of the study.
Collapse
Affiliation(s)
- Brad G. Kurowski
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Corresponding author. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 4009, Cincinnati, OH, 45229-3039, USA.
| | - Terry Stancin
- Case Western Reserve University and MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
| | - H. Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, The Ohio State University, Columbus, OH, USA
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kelly A. McNally
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Michael W. Kirkwood
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - McKenna Sklut
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan E. Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shari L. Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
24
|
Pastore V, Galbiati S, Recla M, Colombo K, Beretta E, Strazzer S. Psychological and behavioural difficulties following severe TBI in adolescence: a comparison with a sample of peers with brain lesions of other origin and with a control group. Brain Inj 2018; 32:1011-1020. [PMID: 29738269 DOI: 10.1080/02699052.2018.1469041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe behavioural and adjustment problems in a group of 57 adolescents with severe traumatic brain injury (TBI) and compare them with a clinical group of peers with brain lesions of other origin (N = 33) and a control group of healthy adolescents (N = 48). METHODS All subjects received an age-appropriate assessment, including the child behaviour checklist (CBCL) 4/18, the strengths and difficulties questionnaire (SDQ) and the vineland adaptive behaviour scales (VABS). RESULTS Compared with healthy peers, adolescents with TBI presented with more marked behavioural problems on most CBCL scales (Internalization and Externalization domains were both affected) and on the SDQ Hyperactivity and Peer problems scales. They also showed a more impaired functioning in most VABS domains. Compared with adolescents with brain lesions of other aetiology, patients with TBI showed more conduct problems on the SDQ scale, but no significant differences were found on the CBCL scales. Regarding the VABS, patients with other lesions presented with the worst outcome in the Motor and Daily Living Skills domains. CONCLUSIONS Adolescents with TBI are exposed at a very high risk to develop behavioural and psychological disturbances with the potential to severely affect their social re-entry. Further knowledge is needed to plan early and well-timed interventions.
Collapse
Affiliation(s)
- Valentina Pastore
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Susanna Galbiati
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Monica Recla
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Katia Colombo
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Elena Beretta
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Sandra Strazzer
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| |
Collapse
|
25
|
Keenan HT, Clark AE, Holubkov R, Cox CS, Ewing-Cobbs L. Psychosocial and Executive Function Recovery Trajectories One Year after Pediatric Traumatic Brain Injury: The Influence of Age and Injury Severity. J Neurotrauma 2017; 35:286-296. [PMID: 28854841 DOI: 10.1089/neu.2017.5265] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Time since traumatic brain injury (TBI) and developmental stage at injury may affect the trajectory of outcomes associated with adjustment and school success. We prospectively enrolled a cohort of 519 children with either TBI or orthopedic injury (OI) age 2.5-15 years to examine children's psychosocial and executive function outcomes at 3- and 12-months post-injury. Outcome measures included the Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Behavior Rating Inventory of Executive Function (BRIEF) ratings. Controlling for pre-injury ratings and using the OI group as the reference, children with TBI, regardless of age or injury severity, had affective, anxiety, and attention-deficit/hyperactivity disorder (ADHD) problems on the CBCL. Symptom trajectories differed both by injury severity and age at injury. Children with mild and complicated mild TBI had a decreasing anxiety trajectory, whereas children with severe TBI had increasing symptoms. Children 6-11 years of age had high ADHD and affective scores; however, the youngest children had increasing symptoms over time. On the SDQ, peer relationships and prosocial behaviors were not significantly affected by TBI but were associated with family environment. Children with severe TBI had the worst executive function scores; however, mild and complicated mild/moderate TBI groups had clinically important working memory deficits. Hispanic ethnicity and strong social capital were positively associated with multiple outcomes. Children's recovery trajectories differed by injury severity, time since injury, and developmental stage when injured. Schools need to reassess children's skills over time as new problems in behavior and learning may emerge.
Collapse
Affiliation(s)
- Heather T Keenan
- 1 Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Amy E Clark
- 1 Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Richard Holubkov
- 1 Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Charles S Cox
- 2 Department of Pediatric Surgery, University of Texas Medical School at Houston , Houston, Texas
| | - Linda Ewing-Cobbs
- 3 Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston , Houston, Texas
| |
Collapse
|
26
|
Treble-Barna A, Zang H, Zhang N, Taylor HG, Stancin T, Yeates KO, Wade SL. Observed parent behaviors as time-varying moderators of problem behaviors following traumatic brain injury in young children. Dev Psychol 2017; 52:1777-1792. [PMID: 27786528 DOI: 10.1037/dev0000208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parent behaviors moderate the adverse consequences of pediatric traumatic brain injury (TBI); however, it is unknown how these moderating effects change over time. This study examined the moderating effect of observed parent behaviors over time since injury on the relation between TBI and behavioral outcomes. Participants included children, ages 3-7 years, hospitalized for moderate (n = 52) or severe (n = 20) TBI or orthopedic injury (OI; n = 95). Parent-child dyads were videotaped during structured task and free play conditions, and parents completed child behavior ratings. Linear mixed models using a lagged, time-varying moderator analysis examined the relationship of observed parent behaviors at the baseline, 6-month, and 12-month assessments to child behavior problems at 6 months, 12 months, and 18 months postinjury, after controlling for preinjury levels of child behavior problems. The effect of TBI on behavior was exacerbated by less favorable parent behaviors, and buffered by more favorable parent behaviors, in children with severe TBI over the first 12 months postinjury. By 18 months postinjury, however, the moderating effect of parent behaviors diminished, such that children with severe TBI showed more behavior problems relative to children with moderate TBI or OI regardless of parent behaviors or in response to parent behaviors that were initially protective. The results suggest that the moderating effects of the family environment are complex and likely vary in relation to both recovery and developmental factors, with potentially important implications for targets and timing of intervention. (PsycINFO Database Record
Collapse
Affiliation(s)
- Amery Treble-Barna
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center
| | - Huaiyu Zang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center
| | - H Gerry Taylor
- Division of Developmental and Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital
| | - Terry Stancin
- Department of Psychiatry, Case Western Reserve University School of Medicine
| | | | - Shari L Wade
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center
| |
Collapse
|
27
|
Narad ME, Taylor HG, Yeates KO, Stancin T, Kirkwood MW, Wade SL. Internet-based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT): Protocol for a multi-site randomized controlled trial of an internet-based parenting intervention. Digit Health 2017; 3:2055207617719423. [PMID: 29942608 PMCID: PMC6001211 DOI: 10.1177/2055207617719423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/06/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives We discuss the rationale and description of the Internet-Based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT), a telehealth intervention designed to promote positive parenting skills through live in-session skills practice and coaching. A second objective is to describe the protocol of a three-armed (Internet Resource Comparison, I-InTERACT, and I-InTERACT Express) multi-site randomized controlled trial (RCT) designed to examine intervention effectiveness. Method Participants included parents of children ages 3–9 who sustained a moderate or severe traumatic brain injury (TBI) any time since birth. Measures assessing parenting behaviors, parent–child interaction, parent/family factors, and child factors were collected prior to intervention, 3 months after enrollment and 6-months after enrollment. Results This protocol manuscript was submitted before the completion of data collection and prior to any data analysis. It is expected that the I-InTERACT and I-InTERACT Express interventions will be associated with an increase in positive parenting behaviors, and a decrease in negative parenting behaviors, parental distress, and child behavior problems. Finally it is expected that socioeconomic status, life stressors, and social resources will moderate treatment effects. Conclusions The study described in this protocol paper represents one of the first large multi-site RCTs of a parenting intervention designed to promote positive parenting skills in families with young children who sustained a TBI. We plan to disseminate findings to patients and families as well as clinical and research professionals, and begin to develop a research base for this telehealth intervention.
Collapse
Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - H Gerry Taylor
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Terry Stancin
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Michael W Kirkwood
- Children's Hospital Colorado and University Colorado School of Medicine, Aurora, CO, USA
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
28
|
Johnson VM, Donders J. Correlates of verbal learning and memory after pediatric traumatic brain injury. APPLIED NEUROPSYCHOLOGY-CHILD 2017; 7:298-305. [DOI: 10.1080/21622965.2017.1330688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Velisa M. Johnson
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan, USA
| | - Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan, USA
| |
Collapse
|
29
|
Managing challenging behaviour in preschool children post-traumatic brain injury with online clinician support: protocol for a pilot study. Pilot Feasibility Stud 2017; 3:30. [PMID: 28580165 PMCID: PMC5452385 DOI: 10.1186/s40814-017-0140-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/03/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) in children is associated with a range of poor long-term outcomes, including behavioural disturbances. Parents can experience high levels of stress and injury-related burden, and evidence suggests that distressed parents are less likely to adopt positive parenting styles to manage their child's behaviour. The 'Signposts for Building Better Behaviour' program is a parenting programme that was originally developed to assist parents of children with an intellectual disability in managing their child's behaviour. More recently, it has been adapted to include a TBI module, to assist parents in managing post-TBI behaviour. However, geographical and financial barriers remain, preventing many parents from accessing the programme in the standard face-to-face modality. This project aims to investigate the feasibility and acceptability of the programme when delivered with clinician support via videoconferencing. METHODS/DESIGN The sample for this feasibility study will be recruited from the Royal Children's Hospital, Melbourne, and the Victorian Paediatric Rehabilitation Service. Participants will be the parents of a child who sustained a TBI between the ages of 2.0 and 6.11, within the previous 2 years. The parents of 15 children will complete the programme, with clinician support via videoconferencing, while the parents of a further 15 children will form a treatment as usual wait-list control group. Parents complete questionnaires assessing their child's behaviour, as well as assessing their own mental health, sense of parenting competency, disciplinary style, and family functioning. These will be completed upon enrolment in the study regarding their child's pre-injury behaviour and then again pre-intervention, immediately post-intervention, and 4 months post-intervention. Parents who complete the intervention will also complete questionnaires assessing their satisfaction with the programme and its delivery. Information will be collected on the feasibility, clinical practicality, and acceptability of the programme when delivered through this medium. DISCUSSION This study is the first to investigate the feasibility of delivering post-child TBI behavioural intervention via videoconferencing in Australia. Preliminary findings from this study may support the development of a larger randomised controlled trial. It is hoped that programme delivery through this medium would facilitate better access to the programme, enabling improved long-term outcomes for families. TRIAL REGISTRATION ANZCTR, ACTRN12616001574437.
Collapse
|
30
|
Narad ME, Yeates KO, Taylor HG, Stancin T, Wade SL. Maternal and Paternal Distress and Coping Over Time Following Pediatric Traumatic Brain Injury. J Pediatr Psychol 2017; 42:304-314. [PMID: 27633324 PMCID: PMC5896624 DOI: 10.1093/jpepsy/jsw079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 11/12/2022] Open
Abstract
Objective Examine differences in maternal and paternal coping and distress following traumatic brain injury (TBI) and orthopedic injuries (OI). Method Concurrent cohort/prospective design with five assessments between 1 and an average of 7 years after injury of children aged 3-6 years hospitalized for TBI ( n = 87) or OI ( n = 119). Mixed models analyses were used to examine hypotheses. Results Overall, fathers reported greater depression and general distress than mothers 18 months after injury, but not at long-term follow-up. Active and acceptance coping were unrelated to parental sex, injury factors, or time since injury. A group × rater × time interaction was noted for Denial coping. Following severe TBI, fathers reported greater denial at 18 months, whereas mothers reported greater denial at the long-term follow-up. Denial coping did not differ between mothers and fathers following OI and moderate TBI. Conclusions Parental response to early TBI is complex and may warrant clinical intervention even years after injury.
Collapse
Affiliation(s)
- Megan E. Narad
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Keith O. Yeates
- Department of Psychology, Alberta Children’s Hospital Research Institute, Hotchkiss Brain Institute, University of Calgary
| | - H. Gerry Taylor
- Rainbow Babies & Children’s Hospital, University Hospitals Case Medical Center, Case Western Reserve University
| | - Terry Stancin
- MetroHealth Medical Center, Case Western Reserve University
| | - Shari L. Wade
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
31
|
Babikian T, Merkley T, Savage RC, Giza CC, Levin H. Chronic Aspects of Pediatric Traumatic Brain Injury: Review of the Literature. J Neurotrauma 2015; 32:1849-60. [DOI: 10.1089/neu.2015.3971] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Tricia Merkley
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Christopher C. Giza
- Department of Pediatrics and Neurosurgery, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, California
| | - Harvey Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
32
|
Hobart-Porter L, Wade S, Minich N, Kirkwood M, Stancin T, Taylor HG. Determinants of Effective Caregiver Communication After Adolescent Traumatic Brain Injury. PM R 2015; 7:836-844. [PMID: 25687111 PMCID: PMC5437845 DOI: 10.1016/j.pmrj.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/31/2015] [Accepted: 02/10/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the effects of caregiver mental health and coping strategies on interactions with an injured adolescent acutely after traumatic brain injury (TBI). DESIGN Multi-site, cross-sectional study. SETTING Outpatient setting of 3 tertiary pediatric hospitals and 2 tertiary general medical centers. PARTICIPANTS Adolescents (N = 125) aged 12-17 years, 1-6 months after being hospitalized with complicated mild to severe TBI. METHODS Data were collected as part of a multi-site clinical trial of family problem-solving therapy after TBI. Multiple regression analyses were used to examine the relationship of caregiver and environmental characteristics to the dimensions of effective communication, warmth, and negativity during caregiver-adolescent problem-solving discussions. MAIN OUTCOMES MEASURES Adolescent and caregiver interactions, as measured by the Iowa Family Interaction Rating Scales. RESULTS Caregivers who utilized problem-focused coping strategies were rated as having higher levels of effective communication (P < .01), as were those with higher socioeconomic status (P < .01). Problem-focused coping style and higher socioeconomic status were also associated lower levels of negative interactions (P < .01 and P < .05, respectively). Female gender of the adolescent and fewer children in the home were associated with increased parental warmth during the interaction (P < .01 and P < .05, respectively). Neither adolescent TBI severity nor caregiver depression significantly influenced caregiver-teen interactions. CONCLUSIONS Problem-focused coping strategies are associated with higher levels of effective communication and lower levels of caregiver negativity during the initial months after adolescent TBI, suggesting that effective caregiver coping may facilitate better caregiver-adolescent interactions after TBI.
Collapse
Affiliation(s)
| | - Shari Wade
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nori Minich
- Case Western Reserve University, Cleveland, OH
| | | | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE Investigate effectiveness of an online Counselor-Assisted Problem-Solving (CAPS) intervention on family functioning after traumatic brain injury. METHODS Participants were randomized to CAPS (n = 65) or Internet resource comparison (IRC; n = 67). CAPS is a counselor-assisted web-based program. IRC was given access to online resources. Outcomes were examined at 6, 12, and 18 months after baseline. Injury severity, age, and socioeconomic status were examined as moderators. RESULTS A main effect of time was noted for teen-reported conflict and parent-reported problem solving. CAPS had decreased parent-reported conflict and a reduction in parental effective communication. Effects were specific to subsets of the sample. CONCLUSION CAPS, a family-based problem-solving intervention designed to address problem behaviors, had modest effects on some aspects of family functioning compared with IRC. Effects were generally limited to subsets of the families and were not evident across all follow-up assessments.
Collapse
|
34
|
Antonini TN, Raj SP, Oberjohn KS, Cassedy A, Makoroff KL, Fouladi M, Wade SL. A pilot randomized trial of an online parenting skills program for pediatric traumatic brain injury: improvements in parenting and child behavior. Behav Ther 2014; 45:455-68. [PMID: 24912459 DOI: 10.1016/j.beth.2014.02.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 01/26/2014] [Accepted: 02/01/2014] [Indexed: 10/25/2022]
Abstract
This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n=20) or access to Internet resources on managing brain injury (n=17). Parent-child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.
Collapse
Affiliation(s)
| | | | | | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center
| | | | | | | |
Collapse
|