Counselor-Assisted Problem Solving (CAPS) Improves Behavioral Outcomes in Older Adolescents With Complicated Mild to Severe TBI

Wade, Shari L.; Stancin, Terry; Kirkwood, Michael W.; Brown, Tanya M.; McMullen, Kendra M.; Taylor, H. Gerry

doi:10.1097/htr.0b013e31828f9fe8

“…Because CAPS provides training to teens and their families to improve problem solving and self-regulation, we hypothesized that CAPS would improve adolescent executive function as rated by parents 6 months after initiation of the intervention. In agreement with Wade et al, 36 we hypothesized that CAPS would be most effective in older adolescents. This study expands on previous work and evaluates the efficacy of an online problem solving intervention in a carefully controlled trial with a large (N = 132) sample of adolescents after TBI.…”

Section: Discussionsupporting

confidence: 88%

“…Families in the IRC 36 group also received a computer, web camera, and high-speed Internet access. 42 handling stress, and problem solving around common issues.…”

Section: Irc Interventionmentioning

confidence: 99%

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Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Cognitive and behavioral problems after pediatric traumatic brain injury lead to poor functioning across multiple settings and can persist long-term after injury. Executive dysfunction is particularly common; however, there is a paucity of evidence-based interventions to guide treatment. WHAT THIS STUDY ADDS:This study is among the largest randomized controlled trials performed in pediatric traumatic brain injury. It demonstrates the ability to use an online problemsolving-based intervention to improve caregiver ratings of executive dysfunction within 12 months after injury. abstract OBJECTIVE: Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant problems in functioning across multiple settings. The objective of this study was to evaluate the efficacy of a web-based counselor-assisted problem solving (CAPS) intervention compared with an Internet resource comparison (IRC) for treatment of executive dysfunction within 12 months after complicated mild to severe TBI in adolescents. We hypothesized that CAPS would significantly improve parent ratings of executive dysfunction compared with an IRC. METHODS:Participants included 132 adolescents aged 12 to 17 years who sustained a complicated mild to severe TBI within 1 to 6 months before study enrollment. Study design was a multisite, assessorblinded, randomized controlled trial. Study sites included 3 tertiary pediatric hospitals and 2 tertiary general medical centers. The main outcome measure was primary caregiver Behavioral Rating Inventory of Executive Function Global Executive Composite at baseline and 6-month follow-up. Generalized linear models that controlled for baseline scores were used to compare the CAPS and IRC scores. RESULTS:In older teens, the CAPS group showed significant improvement in executive function behaviors at 6-month follow-up compared with the IRC group (F = 6.74, P = .01, Cohen' s d = 0.63). CONCLUSIONS:Findings indicate that web-based CAPS improves primary caregiver-rated executive functioning within the first 12 months after TBI in older adolescents. Future research needs to define the optimal timing after injury for delivery of CAPS and characteristics of individuals and families who are most likely to benefit from CAPS. Pediatrics 2013;132:e158-e166 AUTHORS:

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“…36 Older adolescents may be developmentally more capable of using this training than younger adolescents, which may explain the differential effect. Alternative interventions that are beneficial to younger adolescents need to be explored in the future.…”

Section: Discussionmentioning

confidence: 99%

“…CAPS 36 consisted of a 6-month counselorassisted, web-based, family-centered intervention that focused on problem solving, communication, and self-regulation. During the initial face-to-face session in the family' s home, the psychologist performed his or her evaluation and instructed the family on how to access available treatment modules on the CAPS web site and log on to Skype for subsequent videoconference sessions.…”

Section: Caps Interventionmentioning

confidence: 99%

Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

Kurowski

¹

,

Wade

²

,

Kirkwood

³

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT:Cognitive and behavioral problems after pediatric traumatic brain injury lead to poor functioning across multiple settings and can persist long-term after injury. Executive dysfunction is particularly common; however, there is a paucity of evidence-based interventions to guide treatment. WHAT THIS STUDY ADDS:This study is among the largest randomized controlled trials performed in pediatric traumatic brain injury. It demonstrates the ability to use an online problemsolving-based intervention to improve caregiver ratings of executive dysfunction within 12 months after injury. abstract OBJECTIVE: Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant problems in functioning across multiple settings. The objective of this study was to evaluate the efficacy of a web-based counselor-assisted problem solving (CAPS) intervention compared with an Internet resource comparison (IRC) for treatment of executive dysfunction within 12 months after complicated mild to severe TBI in adolescents. We hypothesized that CAPS would significantly improve parent ratings of executive dysfunction compared with an IRC. METHODS:Participants included 132 adolescents aged 12 to 17 years who sustained a complicated mild to severe TBI within 1 to 6 months before study enrollment. Study design was a multisite, assessorblinded, randomized controlled trial. Study sites included 3 tertiary pediatric hospitals and 2 tertiary general medical centers. The main outcome measure was primary caregiver Behavioral Rating Inventory of Executive Function Global Executive Composite at baseline and 6-month follow-up. Generalized linear models that controlled for baseline scores were used to compare the CAPS and IRC scores. RESULTS:In older teens, the CAPS group showed significant improvement in executive function behaviors at 6-month follow-up compared with the IRC group (F = 6.74, P = .01, Cohen' s d = 0.63). CONCLUSIONS:Findings indicate that web-based CAPS improves primary caregiver-rated executive functioning within the first 12 months after TBI in older adolescents. Future research needs to define the optimal timing after injury for delivery of CAPS and characteristics of individuals and families who are most likely to benefit from CAPS. Pediatrics 2013;132:e158-e166 AUTHORS:

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Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children

Kurowski

¹

,

Wade

²

,

Kirkwood

³

et al. 2014

Self Cite

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IMPORTANCE Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant short- and long-term problems in functioning across multiple settings. We hypothesized that improvements in short-term executive function would be maintained to 24 months after injury and that improvements would increase over time in a counselor-assisted problem-solving (CAPS) intervention. OBJECTIVE To evaluate the efficacy of a CAPS intervention administered within 7 months of complicated mild to severe TBI compared with an Internet resource condition in improving long-term executive dysfunction. DESIGN, SETTING, AND PARTICIPANTS Multisite, assessor-blinded, randomized clinical trial at 3 tertiary pediatric hospitals and 2 tertiary general medical centers. Participants included 132 adolescents aged 12 to 17 years who sustained a moderate to severe TBI 1 to 7 months before study enrollment. INTERVENTION Web-based CAPS intervention. MAIN OUTCOMES AND MEASURES The primary outcome was the parent-reported Global Executive Composite (GEC) of the Behavior Rating Inventory of Executive Function. Secondary outcomes included the Behavioral Regulation Index (BRI) and Metacognition Index (MI) of the GEC. RESULTS In older (>14 to 17 years) adolescents, the CAPS intervention was associated with lower GEC ratings at 12 (β = −0.46; P = .03) and 18 (β = −0.52; P = .02) months after enrollment. Trends were also observed for older adolescents toward lower GEC ratings at 6 months (β = −0.40; P = .05), lower BRI ratings at 12 (β = −0.40; P = .06) and 18 (β = −0.47; P = .04) months, and lower MI ratings at 6 (β = −0.41; P = .05), 12 (β = −0.46; P = .03), and 18 (β = −0.50; P = .03) months. In younger (12–14 years) adolescents, no group differences were found on the GEC, BRI, or MI ratings. CONCLUSIONS AND RELEVANCE Delivery of the CAPS intervention early after TBI in older adolescents improves long-term executive function. This trial is, to our knowledge, one of the few large, randomized clinical treatment trials performed in pediatric TBI to demonstrate the efficacy of an intervention for management of executive dysfunction and long-term benefits of an intervention delivered soon after injury. Use of the CAPS intervention clinically should be considered; however, further research should explore ways to optimize delivery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00409448

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Counselor-Assisted Problem Solving (CAPS) Improves Behavioral Outcomes in Older Adolescents With Complicated Mild to Severe TBI

Cited by 83 publications

References 22 publications

Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury

Long-term Benefits of an Early Online Problem-Solving Intervention for Executive Dysfunction After Traumatic Brain Injury in Children

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