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Objective: Traumatic brain injury (TBI) is a leading cause of acquired disability in childhood, impacting long-term health and functioning. Caregivers of children with TBI report worsening psychological health-and caregiver functioning and behaviors directly impact child recovery and outcomes. We developed and pilot tested road-torecovery-TBI (R2R-TBI), a self-guided, eHealth intervention to support caregivers during the acute phase following pediatric TBI and equip families with skills to promote a positive path to recovery. Method: Caregivers of children hospitalized for moderate-to-severe TBI were recruited within 3 months postinjury. Twenty primary caregivers completed measures assessing caregiver psychological functioning, family functioning, and child behavior prior to accessing the intervention and at follow-up 1 month later. Caregivers also completed postintervention satisfaction and usability surveys. Results: Thirty of 42 eligible caregivers consented to participate. Caregivers were diverse with regard to race/ethnicity (45% non-White), income (65% receiving public assistance), and child age (1 month to 15 years). All caregivers rated the intervention as helpful and 90% reported making positive changes. While average scores were in the nonclinical range at baseline and follow-up, percentages of caregivers reporting clinically elevated challenges across all measures (15% to 50%) were higher than instrument norms. There were no significant changes in caregiver, family, or child outcomes from baseline to follow-up. Conclusions: Given challenges that caregivers experience accessing in-office interventions that target their well-being and/or parenting, the R2R-TBI program may be a cost-effective and accessible approach to supporting families during a challenging phase of recovery. Further research is needed to examine the efficacy of the intervention. Implications for Impact StatementWe developed and pilot tested road-to-recovery-traumatic brain injury (R2R-TBI), a self-guided, eHealh intervention to support caregivers during the stressful and challenging acute phase following pediatric TBI and equip families with skills to promote a positive path to recovery. Caregivers in this pilot trial reported good satisfaction with intervention, though no overall changes in caregiver, family, or child functioning were noted between baseline and 1-month follow-up. With further efficacy trials, the R2R-TBI intervention may have promise as a form of preventative behavioral health care for children and families in the acute phase of pediatric TBI.

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Irritability and temper loss are common concerns among young children seen for mental health diagnostic evaluations and represent features of nearly a dozen childhood mental health conditions. Thus, careful assessment of irritability and temper loss is essential for informing case conceptualization, diagnosis, and treatment recommendations. The current case study provides a clinical description of a 6-year-old Black male (“Tyler”) seen in a tertiary pediatric medical center for concerns related to significant inattention, hyperactivity, impulsivity, oppositional behaviors, irritability, and severe temper loss displayed at home and school. The clinical description summarizes findings from rating scales and diagnostic evaluations, case conceptualization, as well as treatment recommendations. Detailed suggestions for clinicians regarding strategies for assessing irritability and temper loss and questions to consider when seeking clarification to inform differential diagnoses are provided.

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