Tlustos Sarah J, Kirkwood Michael W, Taylor H Gerry, Stancin Terry, Brown Tanya M, Wade Shari L
Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado.
Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University.
Rehabil Psychol. 2016 Nov;61(4):347-357. doi: 10.1037/rep0000098.
PURPOSE/OBJECTIVE: Traumatic brain injury (TBI) in adolescence has well documented effects on social competence. Few studies have examined the effects of behavioral interventions on social competence or identified factors associated with changes in social competence after injury. Research Method/Design: Adolescents with moderate to severe TBI ages 12-17 years were randomized within 6 months of injury to either a problem solving and communication (CAPS) group that received online counseling (n = 65) or an Internet resources comparison (IRC) group (n = 67) for a comparative effectiveness trial. Parent-report measures of social competence (Child Behavior Checklist, CBCL; Home and Community Social Behavior Scales, HCSBS; Behavioral and Emotional Rating Scale, BERS-2) were administered at baseline (preintervention) and approximately 6 months later. Analyses examined these measures in relation to treatment group, TBI severity, and age. Regression analyses were also conducted to examine baseline measures of cognition as predictors of social competence after TBI.
CAPS had a more positive effect than the comparison condition on the HCSBS and BERS-2 for younger teens with moderate TBI and older teens with severe TBI. More parent-rated executive dysfunction at baseline was related to both lower concurrent levels of social competence and less positive gains in competence over time, whereas higher baseline IQ predicted greater gains in competence.
CONCLUSIONS/IMPLICATIONS: CAPS may be effective for improving social competence for teens after TBI, with benefits dependent on the teen's age and injury severity. Parent-rated executive dysfunction, moreover, has utility in predicting both lower concurrent levels of social competence and subsequent postinjury gains in competence. (PsycINFO Database Record
目的/目标：青少年创伤性脑损伤（TBI）对社会能力的影响已有充分记录。很少有研究考察行为干预对社会能力的影响，或确定与损伤后社会能力变化相关的因素。研究方法/设计：12至17岁的中度至重度TBI青少年在受伤后6个月内被随机分为接受在线咨询的解决问题与沟通（CAPS）组（n = 65）或互联网资源对照组（IRC）组（n = 67），进行一项比较有效性试验。在基线（干预前）和大约6个月后采用家长报告的社会能力测量工具（儿童行为检查表，CBCL；家庭与社区社会行为量表，HCSBS；行为与情绪评定量表，BERS - 2）。分析考察了这些测量工具与治疗组、TBI严重程度和年龄的关系。还进行了回归分析，以检验认知的基线测量作为TBI后社会能力预测指标的情况。
对于中度TBI的较年轻青少年和重度TBI的较年长青少年，CAPS在HCSBS和BERS - 2上的效果比对照组更积极。基线时更多的家长评定的执行功能障碍与较低的社会能力并发水平以及随时间推移能力的积极提升较少有关，而较高的基线智商预测能力有更大提升。
结论/启示：CAPS可能对改善TBI后青少年的社会能力有效，其益处取决于青少年的年龄和损伤严重程度。此外，家长评定的执行功能障碍在预测较低的社会能力并发水平和损伤后能力的后续提升方面具有效用。（PsycINFO数据库记录）
