This study provides preliminary evidence of the potential feasibility and efficacy of an online parenting skills intervention for improving positive parenting skills and for reducing child behavior problems following early TBI.

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Objective-To understand how traumatic brain injury (TBI) affects parent-child interactions acutely following injury.Participants-Young children hospitalized for TBI (n = 80) and orthopedic injuries (OI; n = 113). HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMethod-Raters coded videotaped interactions during free play and structured tasks for parental warmth/responsiveness and negativity and child warmth, behavior regulation, and cooperation. Raters also counted parental directives, critical/restricting statements, and scaffolds.Results-Parents of children with TBI exhibited less warm responsiveness and made more directive statements during a structured task than parents in the OI group. Children with TBI displayed less behavior regulation than children with OI. Parental warm responsiveness was more strongly related to child cooperativeness in the OI group than in the TBI group. Child behavior also mediated group differences in parental responsiveness and directiveness. TBI accounted for as much variance in parental behaviors as or more than did sociodemographic factors.Conclusion-TBI-related changes in child behavior may negatively influence parent-child interactions and disrupt the reciprocity between parent and child.Keywords early childhood; traumatic brain injury; parent-child interaction; family impactResearch has clearly documented the central role during early childhood that parenting behaviors play in a child's social, emotional, and cognitive development (Bornstein & Tamis-LeMonda, 1989;Landry, Smith, Swank, Assel, & Vellet, 2001;Weizman & Snow, 2001). These findings suggest that warm and responsive parenting, together with verbal stimulation and cognitive support, contributes to optimal cognitive and behavioral development in typically developing children. However, less is known about how medical conditions that affect the health and functioning of the child, such as traumatic brain injury (TBI), influence the quality and nature of the parent-child relationship. Some studies suggest that parents of young children with health problems display more negativity (PippSiegal & Biringen, 1998) and directiveness (Landry, Chapieski, Richardson, Palmer, & Hall, 1990) than parents of typically developing children in their interactions. However, research with other populations and somewhat older samples (e.g., preadolescents with spina bifida) found no differences in parent-child interactions as a function of the child's diagnosis (Seefeldt et al., 1997). Findings differ as a function of the methodology (e.g., parent report vs. observation) and population of interest, making it difficult to draw inferences regarding how specific health conditions affect the parent-child relationship.Research regarding children with mental retardation (MR) has provided some of the best and most extensive evidence regarding the potential effects of child cognitive status on parentchild interactions. This body of literature also underscores the potential complexity of these relati...

Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.

We examined the feasibility of and parental satisfaction with a training programme for parents with children who had suffered traumatic brain injury (TBI). Families who did not have a home computer and/or webcam were loaned the necessary equipment. Skype was used for videoconferencing. After the initial treatment session in the family's home, the remaining nine sessions were conducted online. Each session had two parts: (1) a self-guided web session with information about a particular skill; (2) a videoconference session with the therapist. Three of the 20 families (15%) dropped out prior to the final 6-month follow-up visit. Of the remaining 17 families, 13 (65% of those enrolled) completed 9-14 sessions. Almost all of the caregivers (87%) said that the Skype sessions were helpful compared to a conventional office visit. Almost all parents were satisfied with the programme and the technology that was used. Parental satisfaction with the programme was not influenced by prior computer ownership or comfort with technology. The programme appears to be feasible for a wide range of parents of children with TBI and provides an alternative to conventional office-based sessions that may not be accessible to all families.

Many parents who would benefit from parenting skills training via live coaching do not receive it due to barriers such as time, distance, and the unavailability of skilled providers. This report describes an innovative web-based parenting skills program for families of young children with traumatic brain injury (TBI)-Internet-Based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT). I-InTERACT is a web-based parenting skills program of 10-14 sessions that combines self-guided web modules with live coaching via videoconferencing. We describe the feasibility and utility of this approach, as well as the unique nature of the therapeutic process, detailing the perspectives of 13 parents of children with TBI who participated in the program and 6 therapists who delivered the program. Nine of 13 parents preferred the web-based coaching to traditional treatment; they cited its ease of use and the comfort of doing it at home. Therapists uniformly liked coaching over the web despite the need to address boundaries and troubleshoot technological difficulties. Therapeutic alliance was comparable to traditional therapy with nearly all families expressing a strong connection to the therapist. Individuals with less computer experience particularly liked the program because it gave them access to the web and a sense of empowerment. These preliminary findings support the utility of web-based parenting skills training for families from diverse backgrounds, while underscoring the potential for clinical use with other underserved populations.

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