Executive Functioning in the First Year After Pediatric Traumatic Brain Injury

Sesma, Heather Whitney; Slomine, Beth S.; Ding, Ru; McCarthy, Melissa L.

doi:10.1542/peds.2007-2461

“…[6][7][8][9][10][11][12][13] In particular, executive dysfunction after pediatric TBI is associated with functional problems across home, school, and community settings both in the shortand long-term after injury. [6][7][8][9][10][14][15][16][17][18][19][20] Better treatment of executive dysfunction after injury may lead to improved functioning in everyday settings. 21 Problem-solving training has demonstrated promise in various clinical populations [22][23][24][25][26] ; however, it has only been preliminarily explored in pediatric TBI.…”

Section: Discussionmentioning

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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“…[6][7][8][9][10][11][12][13] In particular, executive dysfunction after pediatric TBI is associated with functional problems across home, school, and community settings both in the shortand long-term after injury. [6][7][8][9][10][14][15][16][17][18][19][20] Better treatment of executive dysfunction after injury may lead to improved functioning in everyday settings. 21 Problem-solving training has demonstrated promise in various clinical populations [22][23][24][25][26] ; however, it has only been preliminarily explored in pediatric TBI.…”

Section: Discussionmentioning

confidence: 99%

“…The improvement in working memory is of particular interest in view of a previous report of poorer working memory in children with TBI compared with controls at 3 and 12 months after injury, indicating a special vulnerability of this skill to the effects of injury. 7 Future research will need to evaluate the longitudinal effects of an early intervention on longterm outcomes related to executive function.…”

Section: Discussionmentioning

confidence: 99%

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

2013

PEDIATRICS

0

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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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“…In general, the literature suggests that children experience decreased quality of life across cognitive, physical, and psychosocial domains (Cook et al, 2014;Sesma et al, 2008). Otero et al (2014) found that different types of interventions were most appropriate at different stages of development.…”

Section: Systematic Review Of Effective Crt Treatmentsmentioning

confidence: 99%

“…Individuals who learn only memory strategies do not necessarily show significant improvements in these areas (Cook, 2014). Improving reasoning skills also transfers to an injured child's academic performance (Sesma et al, 2008). Because children spend a majority of their time in school, the academic setting therefore provides the most opportunities for rehabilitation.…”

Section: Cognitive Interventionsmentioning

confidence: 99%

A systematic review of pediatric cognitive rehabilitation in the elementary and middle school systems

Shaw¹

2016

NRE

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Abstract. BACKGROUND:Cognitive Rehabilitation Therapy (CRT) is efficacious in remediating cognitive deficits, and has been demonstrated to be effective in a school setting. OBJECTIVE: The purpose of this paper is to review the literature on pediatric CRT as it relates to successful re-integration of TBI survivors into the school system and community. METHODS: This systematic review of the literature suggests that social re-integration strategies which incorporate problemsolving, reasoning, self-awareness, and positive social skills within a developmental framework are the most effective techniques for Pediatric CRT. RESULTS: Children and adolescents with cognitive impairments benefit from a holistic approach to rehabilitation which incorporates developmental, social, and emotional considerations, as well as, cognitive rehabilitation techniques. CONCLUSIONS: This systematic review identifies several avenues for effective therapeutic interventions for school aged TBI survivors. Many are supported by laboratory based efficacy studies. Future research should investigate optimal ages for particular treatments, as well as, the effectiveness of treatments across different social settings.

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Executive Functioning in the First Year After Pediatric Traumatic Brain Injury

Cited by 127 publications

References 43 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

A systematic review of pediatric cognitive rehabilitation in the elementary and middle school systems

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