Cole Wesley R, Paulos Stephanie K, Cole Carolyn A S, Tankard Carol
Department of Neuropsychology, Kennedy Krieger Institute, 700 N. Broadway, Baltimore, MD 21207, USA.
Dev Disabil Res Rev. 2009;15(2):159-66. doi: 10.1002/ddrr.58.
Pediatric acquired brain injury (BI) not only affects the child with the injury, but also greatly impacts their family. Studies suggest there are higher rates of caregiver and sibling psychological distress after a child in the family has sustained a BI. Also, family functioning after BI impacts the child's recovery. In reviewing the literature, we identified seven theoretical clinical guidelines for working with families of children and adolescents with BI. These clinical guidelines are as follows: (1) select developmentally appropriate interventions, (2) match the intervention to the family, (3) provide advocacy, (4) provide injury education, (5) focus on family realignment, (6) appropriately adjust the child's environment, and (7) provide skills training to the family and child. The existing research on family interventions for BI is reviewed within the context of these theoretical guidelines, and the empirical support for each guideline is subsequently evaluated using specific criteria for empirically supported treatments. Unfortunately, very few randomized controlled studies exist, and continued research is needed to classify all clinical guidelines as "efficacious." In addition, continued research will aid in informing professionals of specific approaches to utilize when working with a family of a child with BI. Currently, clinicians and researchers can turn to the existing clinical guidelines to help address the numerous barriers posed by implementing and studying family interventions for pediatric BI.
小儿获得性脑损伤（BI）不仅会影响受伤的儿童，还会对其家庭产生重大影响。研究表明，家庭中的儿童遭受脑损伤后，照顾者和兄弟姐妹出现心理困扰的几率更高。此外，脑损伤后的家庭功能会影响儿童的康复。在查阅文献时，我们确定了七条针对有脑损伤的儿童和青少年家庭的理论临床指南。这些临床指南如下：（1）选择适合发育阶段的干预措施，（2）使干预措施与家庭相匹配，（3）提供支持，（4）提供损伤教育，（5）关注家庭重组，（6）适当调整儿童的环境，以及（7）为家庭和儿童提供技能培训。在这些理论指南的背景下，对现有的关于脑损伤家庭干预的研究进行了综述，随后使用实证支持治疗的具体标准对每条指南的实证支持进行了评估。不幸的是，几乎没有随机对照研究，需要继续进行研究才能将所有临床指南归类为“有效”。此外，持续的研究将有助于告知专业人员在与有脑损伤儿童的家庭合作时应采用的具体方法。目前，临床医生和研究人员可以参考现有的临床指南，以帮助应对实施和研究小儿脑损伤家庭干预所带来的众多障碍。
