Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, Case Western University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH.
J Dev Behav Pediatr. 2018 Feb/Mar;39(2):154-162. doi: 10.1097/DBP.0000000000000519.
Adolescent traumatic brain injury (TBI) contributes to deficits in executive functioning and behavior, but few evidence-based treatments exist. We conducted a randomized clinical trial comparing Teen Online Problem Solving with Family (TOPS-Family) with Teen Online Problem Solving with Teen Only (TOPS-TO) or the access to Internet Resources Comparison (IRC) group.
Children, aged 11 to 18 years, who sustained a complicated mild-to-severe TBI in the previous 18 months were randomly assigned to the TOPS-Family (49), TOPS-TO (51), or IRC group (52). Parent and self-report measures of externalizing behaviors and executive functioning were completed before treatment and 6 months later. Treatment effects were examined using linear regression models, adjusting for baseline symptom levels. Age, maternal education, and family stresses were examined as moderators.
The TOPS-Family group had lower levels of parent-reported executive dysfunction at follow-up than the TOPS-TO group, and differences between the TOPS-Family and IRC groups approached significance. Maternal education moderated improvements in parent-reported externalizing behaviors, with less educated parents in the TOPS-Family group reporting fewer symptoms. On the self-report Behavior Rating Inventory of Executive Functions, treatment efficacy varied with the level of parental stresses. The TOPS-Family group reported greater improvements at low stress levels, whereas the TOPS-TO group reported greater improvement at high-stress levels. The TOPS-TO group did not have significantly lower symptoms than the IRC group on any comparison.
Findings support the efficacy of online family problem solving to address executive dysfunction and improve externalizing behaviors among youth with TBI from less advantaged households. Treatment with the teen alone may be indicated in high-stress families.
青少年创伤性脑损伤（TBI）会导致执行功能和行为缺陷，但目前几乎没有有效的治疗方法。我们进行了一项随机临床试验，比较了青少年在线家庭问题解决（TOPS-Family）与青少年在线单一问题解决（TOPS-TO）或互联网资源比较（IRC）组。
在过去 18 个月内遭受过复杂轻度至重度 TBI 的 11 至 18 岁儿童被随机分配到 TOPS-Family（49 人）、TOPS-TO（51 人）或 IRC 组（52 人）。在治疗前和 6 个月后，对父母和自我报告的外化行为和执行功能进行了评估。使用线性回归模型，根据基线症状水平进行调整，检验治疗效果。还检查了年龄、母亲教育程度和家庭压力作为调节因素。
与 TOPS-TO 组相比，TOPS-Family 组在随访时父母报告的执行功能障碍水平较低，而 TOPS-Family 组与 IRC 组之间的差异接近显著。母亲教育程度调节了父母报告的外化行为的改善，TOPS-Family 组中受教育程度较低的父母报告的症状较少。在自我报告的行为评定量表中，治疗效果因父母压力水平而异。在低压力水平下，TOPS-Family 组报告有更大的改善，而在高压力水平下，TOPS-TO 组报告有更大的改善。TOPS-TO 组在任何比较中都没有比 IRC 组的症状显著降低。
研究结果支持在线家庭问题解决治疗方法对改善 TBI 青少年的执行功能障碍和外化行为的疗效，对于来自弱势家庭的青少年尤其有效。在高压力家庭中，可能需要对青少年单独进行治疗。
