Online Family Problem-Solving Program May Improve Behavioral Outcomes in Older Children With TBI

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Benefits of online family problem-solving treatment on externalizing and executive function behaviors were more apparent for older children with traumatic brain injury who began treatment longer after injury.

An online family problem-solving treatment (OFPST) may be more beneficial than usual care in improving behavioral outcomes in older children with traumatic brain injury (TBI) and is more beneficial when begun after the initial months of postinjury, according to a study published in Pediatrics.

A total of 5 randomized controlled trials conducted between 2003 and 2016 were included in the meta-analysis. Researchers analyzed outcome data of 368 pediatric patients with TBI (age range, 5-18 years; mean age at injury, 13.6 years) who underwent OFPST or usual care approximately 1 to 24 months following injury.

The pooled OFPST cohort underwent 7 to 10 online sessions with parents and/or caregivers and siblings involving cognitive reframing, problem solving, communication skills, and behavior management. The control group underwent usual psychosocial care or received access to online pediatric TBI resources.

Children age 9.83 years who were enrolled 0.13 years since time of injury had lower average externalizing problem scores following usual care vs OFPST (Cohen d =0.44; P =.008). Conversely, children age 16.88 years who were seen 1.1 years since time of injury had better scores if they were randomly assigned to OFPST vs usual care (Cohen d =-0.60; P =.002). Executive functioning was better in the OFPST vs usual care interventions at a later age at time of injury. Greater effects on executive function were observed with longer (Cohen d =-0.66; P =.009) vs shorter (Cohen d =-0.28; P =.028) times since injury.

The retrospective nature of data analysis as well as the lack of racial and ethnic diversity across studies were likely limitations of the study.

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“Future research in which other factor that characterize the individuals who are most likely to benefit from treatment, such as genetic and environmental factors, are determined will be important,” the researchers wrote. “Overall, these findings can be used to inform the clinical delivery of OFPST and other family-centered treatments involving children.”


Wade SL, Kaizar EE, Narad M, et al. Online family problem-solving treatment for pediatric traumatic brain injury. Pediatrics. 2018;142(6).