Cincinnati Children's Hospital Medical Center, Division of Physical Medicine and Rehabilitation, and the University of Cincinnati, College of Medicine, Cincinnati, OH.
Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology.
J Am Acad Child Adolesc Psychiatry. 2017 Nov;56(11):930-939.e2. doi: 10.1016/j.jaac.2017.09.413. Epub 2017 Sep 14.
To evaluate the effectiveness of Internet-based Interacting Together Everyday: Recovery After Childhood TBI (I-InTERACT) versus abbreviated parent training (Express) or access to online resources (internet resources comparison [IRC]) in improving parenting skills and decreasing behavior problems after early traumatic brain injury (TBI).
In this randomized, controlled, clinical trial, 113 children 3 to 9 years old previously hospitalized for moderate to severe TBI were randomly assigned to receive Express (n = 36), I-InTERACT (n = 39), or IRC (n = 38). Express included 7 online parent skills sessions, and I-InTERACT delivered 10 to 14 sessions addressing parenting skills, TBI education, stress, and anger management. The 2 interventions coupled online modules with therapist coaching through a Health Insurance Portability and Accountability Act-compliant Skype link. The IRC group received access to online TBI and parent skills resources. Co-primary outcomes were blinded ratings of parenting skills and parent report of behavior problems and problem intensity on the Eyberg Child Behavior Inventory (ECBI). Outcomes were assessed before treatment and 3 and 6 months after treatment, with the latter constituting the primary endpoint.
The Express and I-InTERACT groups displayed higher levels of positive parenting at follow-up. Only the I-InTERACT group had lower levels of negative parenting at 6 months. The Express group had lower ECBI intensity scores than the IRC group. Baseline symptom levels moderated improvements; children in the Express and I-InTERACT groups with higher baseline symptoms demonstrated greater improvements than those in the IRC group. Changes in parenting skills mediated improvements in behavior in those with higher baseline symptoms.
Brief online parent skills training can effectively decrease behavior problems after early TBI in children with existing behavioral symptoms. Clinical trial registration information-Internet-based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT)-RRTC; http://clinicaltrials.gov/; NCT01214694.
评估基于互联网的互动日常：儿童期创伤性脑损伤后康复（I-InTERACT）与简化家长培训（Express）或在线资源（互联网资源比较[IRC]）相比，在改善创伤性脑损伤后早期育儿技能和减少行为问题方面的效果。
在这项随机、对照、临床试验中，113 名 3 至 9 岁因中度至重度创伤性脑损伤住院的儿童被随机分配接受 Express（n=36）、I-InTERACT（n=39）或 IRC（n=38）。Express 包括 7 个在线家长技能课程，而 I-InTERACT 则提供 10-14 个课程，内容涉及育儿技能、创伤性脑损伤教育、压力和愤怒管理。这两种干预措施都通过符合《健康保险携带和责任法案》的 Skype 链接，将在线模块与治疗师指导相结合。IRC 组可访问在线创伤性脑损伤和家长技能资源。主要结局指标为育儿技能的盲法评定、家长对儿童行为清单（ECBI）中行为问题和问题强度的报告。在治疗前和治疗后 3 个月和 6 个月进行评估，后者为主要终点。
Express 和 I-InTERACT 组在随访时表现出更高水平的积极育儿。只有 I-InTERACT 组在 6 个月时的消极育儿水平较低。Express 组的 ECBI 强度评分低于 IRC 组。基线症状水平调节了改善情况；Express 和 I-InTERACT 组中基线症状较高的儿童改善程度大于 IRC 组。基线症状较高的儿童中，育儿技能的变化介导了行为的改善。
简短的在线家长技能培训可以有效地减少儿童早期创伤性脑损伤后存在行为症状的儿童的行为问题。临床试验注册信息-基于互联网的互动日常，儿童创伤性脑损伤后康复（I-InTERACT）-RRTC；http://clinicaltrials.gov/；NCT01214694。
