Parenting behaviors play a critical role in the child's behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm ...responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3-7 years, hospitalized for TBI (
n
= 80) or OI (
n
= 113), were seen acutely and again 6 months later. Parent-child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist;
T. M. Achenbach & L. A. Rescorla, 2001
) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems.
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Objective: To investigate the relationship of pre-injury and concurrent family functioning with health-related quality of life (HR QoL) following traumatic brain injury (TBI) or orthopedic injury ...(OI) in very young children. Method: Prospective enrollment of children ages 0-4 years who presented to the emergency department after sustaining either acute TBI or OI. This is a sub-analysis of children who completed at least one post-injury follow-up visit. At time of study enrollment, parents rated pre-injury family functioning (Family Assessment Device-General Functioning Scale) and the child's HR QoL (Pediatric Quality of Life Inventory
TM
). Family functioning and HR QoL were assessed at one and six months post-injury. Mixed models were used to examine family functioning as a moderator of a child's HR QoL following injury. Results: Data were analyzed for 42 children with TBI and 24 children with OI. For both groups, better pre-injury family functioning was significantly associated with better HR QoL over time. A triple interaction of injury type by time since injury by concurrent family functioning indicated that children with TBI and poor family functioning had significantly worse HR QoL at six months post-injury relative to other groups. Conclusion: Despite a small sample size, current results underscore the importance of family functioning to recovery following early childhood TBI and support the need for continued research and development of interventions to improve outcomes in this population.
The Ohio Head Injury Outcomes study was a 12-year longitudinal study of early childhood traumatic brain injury (TBI). This article reviewed the findings pertaining to caregiver and family functioning ...and child cognition, behavior, social competence, emotional functioning, and academics. We further considered individual and social-environmental influences on recovery and interventions.
Recruitment was completed at 3 children's hospitals and 1 general hospital.
Children aged 3 to 7 years at the time of injury with complicated mild to moderate and severe TBI or orthopedic injury requiring hospitalization were included.
A concurrent cohort/prospective research design was used. A baseline assessment was completed shortly after the injury. Follow-up assessments were completed at 6, 12, and 18 months and at an average of 38 and 82 months postinjury.
At baseline, parents/guardians completed retrospective ratings of their child's behavioral, emotional, and social functioning preinjury. At the subsequent assessments, ratings reflected current functioning. Information about current family and caregiver functioning was collected at each time point and cognitive testing was completed at selected time points.
Recovery after TBI is complex, varies over time, and involves injury-related and premorbid influences, cognition, genetics, and caregiver and family functioning. A sizable number of children with TBI have persisting unmet clinical needs.
To examine the prevalence of academic need, academic service utilization, and unmet need as well as factors associated with academic service utilization 6.8 years after traumatic brain injury (TBI) ...in early childhood.
Fifty-eight (16 severe, 14 moderate, 28 complicated mild) children with TBI and 72 children with orthopedic injury (OI) completed the long-term follow-up 6.8 years after injury in early childhood (ages 3-7 years). Injury group differences in rates of need for academic services, academic service utilization, and unmet need as well as factors associated with service utilization and unmet need were examined.
Students with moderate and severe TBI had significantly greater rates of need than those with OI. A greater proportion of the severe TBI sample was receiving academic services at long-term follow-up than the OI and complicated mild groups however, among those with an identified need, injury group did not affect academic service utilization. Below average IQ/achievement scores was the only area of need predictive of academic service utilization. Rates of unmet need were high and similar across injury groups (46.2%-63.6%).
The need for academic services among patients who sustained a TBI during early childhood remains high 6.8 years post injury. Findings underscore the importance of continued monitoring of behaviors and academic performance in students with a history of early childhood TBI. This may be especially true among children with less severe injuries who are at risk for being underserved.
Changes in daily life created by the novel coronavirus (COVID-19) pandemic have resulted in a largely unprecedented situation for millions of families worldwide. Families are under considerable ...stress, and parents may experience greater psychological distress and disruptions in the parent-child relationship. Some parents may be particularly vulnerable to recent stressors, including those with preexisting psychological disorders and family dysfunction. In the United States, military veterans are one such at-risk population. Recent challenges may exacerbate preexisting conditions and heighten parenting stress, thereby negatively impacting child and family functioning. In this article, we share our experiences developing and piloting a telepsychotherapy parenting skills program for military veterans. The intervention, Online Parenting Pro-Tips (OPPT), combined web-based educational modules addressing child development and positive parenting with live coaching (via videoconferencing link) of parenting skills. Forty-one veterans with a child between the ages of 3 and 9 years enrolled in this trial and 22 completed the 6-session intervention. Veterans who completed the intervention experienced significant reductions in depression, parenting stress, and family dysfunction, with medium to large effect sizes (Cohen's d ranged from .53 to .98). Veterans also reported significant improvements in their child's behaviors. These findings have important implications pertaining to the feasibility and effectiveness of telepsychotherapy interventions to support at-risk families and promote positive parent-child interactions and family functioning during the COVID-19 crisis and beyond. At a practical level, OPPT and similar telepsychotherapy interventions for families could be modified to be delivered via smartphone to increase accessibility and cost-effectiveness for families worldwide.
Prueba piloto de una intervención de habilidades de crianza por telepsicoterapia para familias veteranas: Implicaciones para el manejo de estrés parental durante COVID-19
Los cambios en la vida diaria creados por la nueva pandemia del virus corona (COVID-19) han resultado en una situación en gran medida sin precedentes para millones de familias en todo el mundo. Familias están bajo un estrés considerable y los padres pueden experimentar mayor angustia psicológica e rupturas en la relación padre-hijo. Algunos padres pueden ser particularmente vulnerable a estresores recientes, incluidos aquellos con preexistencia de trastornos psicológicos y disfunción familiar. En los Estados Unidos, veteranos militares son una de esas poblaciones en riesgo. Los desafíos recientes pueden exacerbar condiciones preexistentes y aumentar el estrés de los padres, lo que afecta negativamente al niño y funciones familiares. En este artículo, compartimos nuestras experiencias desarrollando y poniendo a prueba un programa de habilidades para padres de telepsicoterapia para veteranos militares. La intervención, consejos para padres en línea (OPPT), combinaron módulos educativos basados en la web que abordandan el desarrollo infantil y la crianza positiva, con coaching en vivo (a través de enlace de videoconferencia) de habilidades parentales. Cuarenta y un veteranos con un niño entre las edades de 3 y 9 años se inscribieron en este ensayo y 22 completaron la intervención de 6 sesiones. Los veteranos que completaron la intervención experimentaron reducciones significativas en depresión, estrés parental y disfunción familiar con efectos de tamaño medio a grande (El valor de Cohen oscilaba entre .53 y .98). Los veteranos también reportaron mejoras significativas en los comportamientos de sus hijos. Estos hallazgos tienen implicaciones importantes relacionadas con la viabilidad y efectividad de las intervenciones de telepsicoterapia para apoyar a familias en riesgo y promover interacciones positivas entre padres e hijos y el funcionamiento familiar durante la COVID-19 crisis y más allá. A nivel práctico, OPPT e intervenciones similares de telepsicoterapia para las familias podrían modificarse para ser entregadas a través de teléfonos inteligentes para aumentar accesibilidad y rentabilidad para familias de todo el mundo.
针对退役老兵家庭之育儿技巧干预远程咨询的试行：关于冠状病毒流行期间管理育儿压力的暗示
由新冠病毒流行病所导致的日常生活变化应激导致全世界百万家庭陷入几乎前所未有的境况。 家庭们正在经受着巨大的压力, 而且家长们可能经受着更大的心理痛苦和来自亲子关系中的扰乱。 部分家长可能更易受近期压力源影响，其中包括那些已经遭受先前存在心理障碍和家庭不协调的家长。在美国, 退役老兵就属于这类处于危险中的群体。最近的挑战可能会恶化已经存在的境况并且增加了育儿压力, 因此会对孩子与家庭的运作产生消极影响。在本文中, 关于发展和测试一个针对退役老兵家庭育儿技巧远程心理咨询项目, 我们分享了的经验。这个干预项目, 名为在线家教专业贴士 （OPPT), 将以网络为基础并以儿童发展和积极正面育儿为任务的教育模块与通过视频会议进行的在线育儿技巧辅导结合起来。41个老兵以及他们3-9岁间的孩子参与了此次试运行试验, 其中22人完成了时长为6期的干预治疗。那些完成了干预治疗的老兵感受到了抑郁，育儿的精神压力, 和家庭失衡方面的显著性降低以及中等到较大的效应值（科恩维处于0.53 到0.98). 老兵们也报道孩子的行为有了显著的改善。这些发现, 在关于在疫情期间支持高危家庭并且推进积极的亲子互动以及家庭运转的远程心理治疗干预的可行性和有效性, 有着重要的借鉴意义。在现实操作的层面, OPPT和针对家庭的其他远程心理治疗干预可以被改进从而可以通过智能手机传达来增加对全世界家庭的可及性和成本效益。
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To test the effectiveness of the Attention Improvement and Management (AIM) program, a cognitive intervention for improving impairments in attention and executive functions (EFs) after pediatric ...traumatic brain injury (TBI).
Tertiary care children's hospital.
A total of 13 children with complicated mild-to-severe TBI (average of 5 years postinjury) and 11 healthy comparison children aged 9 to 15 years completed the study.
Open-label pilot study with a nontreated control group.
Subtests from the Test of Everyday Attention-for Children (TEA-Ch) and the Delis-Kaplan Executive Function System (D-KEFS), the self- and parent-report from the Behavior Rating Inventory of Executive Function (BRIEF), and the Goal Attainment Scale (GAS).
Relative to the healthy comparison group, children with TBI demonstrated significant improvement postintervention on a neuropsychological measure of sustained attention, as well as on parent-reported EFs. The majority of families also reported expected or more-than-expected personalized goal attainment.
The study provides preliminary evidence for the effectiveness of AIM in improving parent-reported EFs and personalized real-world goal attainment in children with TBI.
This article addresses the need for age-relevant outcome measures for traumatic brain injury (TBI) research and summarizes the recommendations by the inter-agency Pediatric TBI Outcomes Workgroup. ...The Pediatric Workgroup's recommendations address primary clinical research objectives including characterizing course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements (CDE) Workgroups, the Pediatric TBI Outcomes Workgroup adopted the standard three-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in pediatric TBI from each identified domain including academics, adaptive and daily living skills, family and environment, global outcome, health-related quality of life, infant and toddler measures, language and communication, neuropsychological impairment, physical functioning, psychiatric and psychological functioning, recovery of consciousness, social role participation and social competence, social cognition, and TBI-related symptoms. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.
Deficits in executive functions (EF) are a common comorbidity among adolescents with epilepsy. EF deficits were previously correlated with altered connectivity of the fronto-parietal and ...cingulo-opercular neural networks. The current study investigated white matter integrity in adolescents with epilepsy (n = 29) relative to healthy controls (n = 19). Participants completed questionnaires, neuropsychological testing, and brain magnetic resonance imaging (MRI) that included diffusion tensor imaging (DTI) sequences.
On BRIEF parent-report questionnaires, adolescents with epilepsy demonstrated lower working memory and planning abilities than healthy controls. Among adolescents with epilepsy, DTI measurements revealed lower fractional anisotropy (FA) within the right superior longitudinal fasciculus, forceps minor, and the superior frontal segment of the corpus callosum, and higher FA in the left uncinate fasciculus, compared to healthy controls. Better working memory ability in the epilepsy group was associated with higher FA in the superior frontal segment of the corpus callosum. Only in healthy controls, working memory and planning were positively associated with FA values in the left UF, forceps minor and the superior frontal segment of the corpus callosum.
The current study complements previous functional studies on the same cohort and suggests that EF impairments among adolescents with epilepsy may be related to the altered anatomical organization of white matter tracts. Combining structural and functional data could potentially enrich the neuropsychological assessment of executive functioning in adolescents with epilepsy.
•Adolescents with epilepsy exhibited lower fractional anisotropy (FA) than healthy controls in the right superior longitudinal fasciculus, forceps minor, and the superior frontal portion of the corpus callosum. Conversely, adolescents with epilepsy showed comparatively higher FA in the left uncinate fasciculus.•Among adolescents with epilepsy, better working memory scores were associated with higher FA in the superior frontal portion of the corpus callosum.•Among healthy controls, working memory and Planning (on BRIEF parental reports) were positively correlated with FA in the left uncinate fasciculus, forceps minor, and superior frontal portions of the corpus callosum.•Altered structural connectivity may be associated with EF impairments in adolescents with epilepsy.
Summary
Objective
To examine the preliminary feasibility and acceptability of a Web‐based program, Epilepsy Journey, to improve executive function behaviors in adolescents with epilepsy.
Methods
We ...conducted a proof of concept single‐arm pilot trial of Epilepsy Journey with 31 adolescents (average age = 15.3 ± 1.3 years) who had an epilepsy diagnosis and executive function (EF) deficits on the caregiver‐report version of the Behavior Rating Inventory of Executive Function (BRIEF). Epilepsy Journey coupled a gamified problem‐solving website comprised of 10 learning modules targeting EF deficits (eg, working memory, organization, problem‐solving) with Skype sessions with a trained therapist. Outcomes included feasibility (attrition, sessions completed) and acceptability (satisfaction ratings). Exploratory analyses examined changes in caregiver‐, self‐, and teacher‐reported BRIEF scores from baseline to posttreatment and at 2‐ and 5‐month follow‐ups.
Results
Seventy‐nine percent of participants completed the program. Satisfaction was high, with 97% of caregivers and adolescents rating the program as helpful and indicating they would recommend it to others. Caregivers and adolescents reported global improvements on the BRIEF, with caregivers reporting significant improvements on all BRIEF subscales. EF symptoms rebounded slightly between the 2‐ and 5‐month follow‐ups for some of the self‐ and caregiver‐reported BRIEF scales. Notably, clinically meaningful improvements (eg, clinical/subclinical to normative levels) were reported for several caregiver‐reported BRIEF subscales, including the Global Executive Composite (62% to 33‐34%) and Metacognitive Index (74% to 41‐42%) from baseline to 2‐ and 5‐month follow‐up.
Significance
Findings suggest that a Web‐based problem‐solving intervention tailored to EF deficits for adolescents with epilepsy is both feasible and acceptable and may contribute to improvements in EF behaviors across domains.
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