Recovery Trajectories of Child and Family Outcomes Following Online Family Problem-Solving Therapy for Children and Adolescents after Traumatic Brain Injury

Abstract

Objectives: We conducted joint analyses from five randomized clinical trials (RCTs) of online family problem-solving therapy (OFPST) for children with traumatic brain injury (TBI) to identify child and parent outcomes most sensitive to OFPST and trajectories of recovery over time.

Methods: We examined data from 359 children with complicated mild to severe TBI, aged 5-18, randomized to OFPST or a control condition. Using profile analyses, we examined group differences on parent-reported child (internalizing and externalizing behavior problems, executive function behaviors, social competence) and family outcomes (parental depression, psychological distress, family functioning, parent-child conflict).

Results: We found a main effect for measure for both child and family outcomes [F(3, 731) = 7.35, p < .001; F(3, 532) = 4.79, p = .003, respectively], reflecting differing degrees of improvement across measures for both groups. Significant group-by-time interactions indicated that children and families in the OFPST group had fewer problems than controls at both 6 and 18 months post baseline [t(731) = -5.15, p < .001, and t(731) = -3.90, p = .002, respectively, for child outcomes; t(532) = -4.81, p < .001, and t(532) = -3.80, p < .001, respectively, for family outcomes].

Conclusions: The results suggest limited differences in the measures' responsiveness to treatment while highlighting OFPST's utility in improving both child behavior problems and parent/family functioning. Group differences were greatest at treatment completion and after extended time post treatment.

Trial registration: ClinicalTrials.gov NCT00178022 NCT00409058 NCT01042899.

Keywords: Behavior; Brain injury; Parent; Pediatric; Profile analysis; Randomized controlled trial; Treatment.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors have nothing to disclose.

Figures

Fig. 1.

Model-based Post hoc post-treatment Z score separately averaged across child behavior and family function measures within groups defined by time since treatment initiation (horizontal axis) and treatment group (shape; circle = online family problem-solving therapy [OFPST], triangle = control group). Vertical lines span 95% confidence intervals for the mean Z score in each group.