Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury

Abstract

Purpose: To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI).

Methods: A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47-17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy.

Results: Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied.

Conclusion: Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants.

FIGURE 1

Means for the CBCL externalizing scale at baseline and follow-up according to group and SES. The influence of SES, as defined by family income, on improvement from baseline to follow-up according to group (TOPS and IRC) is shown. Group differences between the TOPS and IRC groups in externalizing symptoms at follow-up approached significance among families of lower SES (F_1,15 = 3.45; P = .09).

FIGURE 2

Means for the YSR externalizing scale at baseline and follow-up according to group and SES. The influence of SES, as defined by family income, on improvement from baseline to follow-up according to group (TOPS and IRC) on externalizing symptoms on the YSR is shown. Teens of higher SES in the TOPS group reported significant improvements in externalizing symptoms from baseline to follow-up (t₇ = 10.05; P = .001), whereas those of lower SES in the TOPS group and those in the IRC group reported minimal change.