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Jenkin T, Anderson VA, D'Cruz K, Scheinberg A, Knight S. Family-centred service in paediatric acquired brain injury rehabilitation: Bridging the gaps. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1085967. [PMID: 36619530 PMCID: PMC9816340 DOI: 10.3389/fresc.2022.1085967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Background Children and adolescents who sustain an acquired brain injury (ABI) can experience acute and ongoing difficulties in a range of cognitive and functional domains, and their families often experience significant life changes and challenges. Family-centred service is therefore considered best practice in paediatric ABI rehabilitation. Despite widespread acceptance of family-centred service in this context, recent literature indicates that family needs are often unrecognised and unmet following paediatric ABI. Although family-centred service was introduced in the field of developmental disability over five decades ago, there remains a lack of clarity about how this approach is implemented in practice. Additionally, limited literature has discussed the implementation of family-centred service in paediatric ABI rehabilitation despite key differences between ABI and developmental disability, including nature and timing of onset, rehabilitation foci, and impacts on families. Aims In this review, we aim to: (i) outline common sequelae of paediatric ABI with a focus on family outcomes; (ii) summarise paediatric rehabilitation and highlight opportunities for family support and involvement; (iii) discuss and synthesise literature across paediatric ABI rehabilitation and family-centred service to highlight gaps in knowledge and practice; and (v) identify clinical implications and future research directions. Conclusions There is a clear need for greater clarity and consensus regarding the implementation of family-centred service in paediatric ABI rehabilitation. This review highlights the importance of providing professional development opportunities for clinicians to increase competency in practising in a family-centred manner, and opportunities to actively involve, empower and support families within rehabilitation. This review also emphasises the importance of services implementing relevant supports to address family needs where possible and developing clear referral pathways so that families can access further support elsewhere when needed.
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Affiliation(s)
- Taylor Jenkin
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Vicki A. Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Brain and Mind, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Psychology Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kate D'Cruz
- Summer Foundation, Melbourne, VIC, Australia
| | - Adam Scheinberg
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah Knight
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, VIC, Australia
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Davies SC. School-Based Support for Families of Students with Traumatic Brain Injuries. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1734708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Susan C. Davies
- Department of Counselor Education, University of Dayton, Dayton, Ohio, USA
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Lantagne A, Peterson RL, Kirkwood MW, Taylor HG, Stancin T, Yeates KO, Wade SL. Featured Article: Interpersonal Stressors and Resources as Predictors of Adolescent Adjustment Following Traumatic Brain Injury. J Pediatr Psychol 2019; 43:703-712. [PMID: 29617953 DOI: 10.1093/jpepsy/jsy020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The present study sought to examine adolescents' perceptions of their interpersonal stressors and resources across parent, sibling, friend, and school relationships, and the longitudinal associations with self-reported adjustment after traumatic brain injury (TBI) over a 12-month period. Methods We examined the main effects of stressors and resources on internalizing and externalizing symptoms in 152 adolescents who had sustained complicated mild-to-severe TBI. We also investigated the conjoint effects of stressors and resources and the moderating effects of TBI severity with stressors and resources on outcomes. Results High stressors consistently predicted worse adjustment. High resources were generally only associated with fewer internalizing symptoms. Main effects were qualified by interactions between school stressors and resources in predicting externalizing symptoms and between friend stressors and resources in predicting internalizing and externalizing symptoms. For school stressors, the effects of resources on externalizing symptoms functioned as a buffer. In comparison, the buffering effects of friend resources on internalizing and externalizing symptoms disappeared at moderate-to-high levels of friend stress. Moderating effects of TBI severity were also observed, such that as family resources increased, only adolescents with complicated mild-to-moderate TBI, but not those with severe TBI, experienced decreases in internalizing and eternalizing symptoms. Conclusion Interpersonal stressors and social support have important implications for adolescent adjustment after TBI. Adolescents with low levels of school resources, with high levels of friend stress, and who sustain severe TBI are at greatest risk for difficulties with adjustment.
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Affiliation(s)
- Ann Lantagne
- Department of Rehabilitation, Children's Hospital Colorado.,Department of Child Clinical Psychology, University of Denver
| | - Robin L Peterson
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - Michael W Kirkwood
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - H Gerry Taylor
- Case Western Reserve University.,Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Terry Stancin
- Case Western Reserve University.,Department of Psychiatry, MetroHealth Medical Center
| | | | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Narad ME, Raj S, Yeates KO, Taylor HG, Kirkwood MW, Stancin T, Wade SL. Randomized Controlled Trial of an Online Problem-Solving Intervention Following Adolescent Traumatic Brain Injury: Family Outcomes. Arch Phys Med Rehabil 2019; 100:811-820. [PMID: 30738021 PMCID: PMC11047263 DOI: 10.1016/j.apmr.2019.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine parent and family outcomes of a randomized controlled trial (RCT) comparing Teen Online Problem-Solving with Family (TOPS-F), Teen Online Problem-Solving-Teen Only (TOPS-TO), or access to Internet resources alone (Internet resource comparison [IRC]). DESIGN Three-arm RCT. SETTING Four children's hospitals and 1 general medical center in Ohio and Colorado. PARTICIPANTS Children and adolescents (N=152), 11-18 years old, hospitalized for complicated mild to severe traumatic brain injury in the previous 18 months. INTERVENTIONS Intervention groups: TOPS-F, TOPS-TO, and IRC. MAIN OUTCOME MEASURE Parental depression (CES-D), parental psychological distress (SCL-90-GSI), family functioning (FAD-GF), cohesiveness (PARQ), and conflict (IBQ) were assessed pre- and post-treatment. Treatment effects and the moderating effect of the number of parents in the home (single vs 2-parent families). RESULTS Number of parents moderated treatment effects with effects ranging from trending to statistically significant for depression, family functioning, cohesion, and conflict. Among single parents, TOPS-TO reported better family functioning than TOPS-F and greater cohesion and less conflict than IRC. Among 2-parent families, TOPS-F reported less depression than IRC and less depression and greater cohesion than TOPS-TO. The effect of family composition was also noted within TOPS-TO and TOPS-F. In TOPS-F, 2-parent families reported less depression than single-parent families. In TOPS-TO single parents reported greater cohesion and better family functioning than 2-parent families. CONCLUSIONS Findings support the TOPS intervention improves family outcomes, with differential effects noted for single vs 2-parent households. The TOPS-TO format appeared more beneficial for single-parent households, while TOPS-F was more beneficial for 2-parent households, highlighting the importance of considering family composition when determining the best treatment modality.
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Affiliation(s)
- Megan E Narad
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Stacey Raj
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Gerry Taylor
- Biobehavioral Health Center, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Michael W Kirkwood
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Terry Stancin
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio
| | - Shari L Wade
- Division of Physical Medicine & Rehabilitation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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A Comparison of 2 Online Parent Skills Training Interventions for Early Childhood Brain Injury: Improvements in Internalizing and Executive Function Behaviors. J Head Trauma Rehabil 2019; 34:65-76. [DOI: 10.1097/htr.0000000000000443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Labrell F, Câmara-Costa H, Dufour C, Grill J, Dellatolas G, Chevignard M. Parental stress and paediatric acquired brain injury. Brain Inj 2018; 32:1780-1786. [DOI: 10.1080/02699052.2018.1524931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Florence Labrell
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- INSHEA, Suresnes, France
| | - Hugo Câmara-Costa
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | - Georges Dellatolas
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Mathilde Chevignard
- Rehabilitation Department for children with acquired neurological injury, and Outreach Team for children and adolescents with acquired brain injury, Saint Maurice Hospitals, Saint Maurice, France
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Hickey L, Anderson V, Hearps S, Jordan B. Family Forward: a social work clinical trial promoting family adaptation following paediatric acquired brain injury. Brain Inj 2018; 32:867-878. [DOI: 10.1080/02699052.2018.1466195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lyndal Hickey
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Vicki Anderson
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Brigid Jordan
- The Royal Children’s Hospital, University of Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
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Influence of Catechol-O-methyltransferase on Executive Functioning Longitudinally After Early Childhood Traumatic Brain Injury: Preliminary Findings. J Head Trauma Rehabil 2018; 31:E1-9. [PMID: 26394291 DOI: 10.1097/htr.0000000000000162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To elucidate the association of a functional catechol-O-methyltransferase (COMT) genotype (rs4680) with recovery of executive functions up to 18 months after early childhood traumatic brain injury (TBI) compared with an orthopedic injury (OI) group. SETTING Outpatient. PARTICIPANTS A total of 134 children with a moderate to severe TBI (n = 63) or OI (n = 71) between the ages of 3 and 6 years who were followed 18 months postinjury. DESIGN Case-comparison, longitudinal cohort MAIN MEASURES : The Behavior Rating Inventory of Executive Function, developmental NEuroPSYchological Assessment (NEPSY) of Verbal Fluency, and a modified Stroop Test for young children (Shape School). RESULTS The low-activity COMT enzyme genotype (AA) was associated with better scores on the developmental NEPSY of Verbal Fluency (F = 3.80; P = .02) and the Shape School (F = 2.89; P = .06) in all participants when controlling for injury type (TBI vs OI) over the first 18 months after injury. Injury type (TBI vs OI) did not significantly moderate the effect of the COMT genotypes on executive function recovery. CONCLUSION This study provides preliminary evidence for a role of COMT genotypes in long-term recovery of executive function after pediatric TBI and OI. Larger studies are needed to determine the exact link between genetic variation in the COMT gene and TBI recovery in children.
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The Relationship Between Traumatic Injury in Children and Long-Term Use of Health and Social Services by Children and Their Families. J Trauma Nurs 2017; 23:215-26. [PMID: 27414144 DOI: 10.1097/jtn.0000000000000219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To increase understanding of relationships between general traumatic injury in children and long-term use of resources in the health care and social services (HSS) sectors by these children and their families 8-10 years after traumatic injury. This study was a cross-sectional retrospective cohort study of prognosis from 2001 to 2003 that quantified recent expenditures on and use of HSS by children and also by their parents. Forty-eight cases of children were selected from the Hamilton Health Sciences pediatric trauma database in the period from January 2001 to December 2003 after incurring a traumatic injury with Injury Severity Score greater than 12. The average total cost to the HSS system per child's family was $4,326.62 during the preceding 6 months. During the same period, average use of HSS was 7 visits. Total service costs incurred by caregivers of injured children increased with severity of the traumatic injury (p= .009). Caregiver HSS use was higher when the injury was caused by a motor vehicle accident than by other types of accidents (p< .001) and increased with the injury severity (p< .001). HSS use by children was related to gender (p< .001), injury mechanism (p< .001), age at accident (p< .001), and time since accident (p= .012), among other factors. Pediatric trauma appears to have long-term effects on expenditures on and use of HSS by the affected children and their families. The findings emphasize the need for long-term assessment and possible delivery of services to the families of the injured children.
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McKinlay A, Linden M, DePompei R, Aaro Jonsson C, Anderson V, Braga L, Castelli E, de Koning P, Hawley CA, Hermans E, Kristiansen I, Madden A, Rumney P, Savage R, Wicks B. Service provision for children and young people with acquired brain injury: Practice recommendations. Brain Inj 2016; 30:1656-1664. [DOI: 10.1080/02699052.2016.1201592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Audrey McKinlay
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Mark Linden
- School of Nursing and Midwifery, Queen’s University, Belfast, UK
| | - Roberta DePompei
- School of Speech and Language Pathology, University of Akron, Akron, OH, USA
| | | | - Vicki Anderson
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Lucia Braga
- Rede Sarah de Hospitais de Reabilitação, Salvador, Brazil
| | | | - Peter de Koning
- Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Carol A. Hawley
- Faculty of Medicine, The University of Warwick, Coventry, UK
| | | | - Ingela Kristiansen
- Department of Pediatric Neurology, Uppsala University Hospital, Uppsala, Sweden
| | | | - Peter Rumney
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Ron Savage
- Sarah Jane Brain Foundation, NY, NY, USA
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11
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Web-Based Parenting Skills Program for Pediatric Traumatic Brain Injury Reduces Psychological Distress Among Lower-Income Parents. J Head Trauma Rehabil 2016; 30:347-56. [PMID: 24842588 DOI: 10.1097/htr.0000000000000052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine changes in parent depression, psychological distress, parenting stress, and self-efficacy among participants in a randomized trial of a Web-based parent training program for pediatric traumatic brain injury (TBI). METHODS Primary caregivers of 37 children aged 3 to 9 years who sustained a moderate/complicated mild to severe TBI were randomly assigned to the intervention or control group, and both groups were equipped with home Internet access. The online parent training program was designed to increase positive parenting skills and improve caregiver stress management. It consisted of 10 core sessions and up to 4 supplemental sessions. Each session included self-guided Web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Families in the control group received links to TBI Web resources. RESULTS Parent income moderated treatment effects on parent functioning. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences were found among higher-income parents for depression, parenting stress, or caregiver efficacy. CONCLUSIONS Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.
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Wade SL, Zhang N, Yeates KO, Stancin T, Taylor HG. Social Environmental Moderators of Long-term Functional Outcomes of Early Childhood Brain Injury. JAMA Pediatr 2016; 170:343-9. [PMID: 26902662 PMCID: PMC5488264 DOI: 10.1001/jamapediatrics.2015.4485] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. OBJECTIVE To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. DESIGN, SETTING, AND PARTICIPANTS A prospective, longitudinal, observational cohort study conducted at each child's home, school, and hospital, including 3 children's hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67% of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. MAIN OUTCOMES AND MEASURES Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). RESULTS Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P < .05). Children with complicated mild TBI had greater impairments in school (odds ratio = 2.93; 95% CI = 1.10-7.82) and with thinking (odds ratio = 15.72; 95% CI = 3.31-74.73) than those with OIs. Functional impairments in children with TBI were more pronounced among children from families with higher levels of permissive (mean CAFAS of 49.71, 35.74, 58.14, and 16.16 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 33.55; P < .001] and complicated mild TBI and OI [difference = 41.98; P < .001]) or authoritarian (mean CAFAS of 56.45, 41.80, 54.90, and 17.12 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 39.33; P < .001], moderate TBI and OI [difference = 24.68; P = .003], and complicated mild TBI and OI [difference = 37.78; P < .001]) parenting or with fewer home resources (mean CAFAS of 69.57, 47.45, 49.00, and 23.81 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 45.77; P < .001], moderate TBI and OI [difference = 23.64; P < .001], and complicated mild TBI and OI [difference = 25.20; P < .001]). CONCLUSIONS AND RELEVANCE Even children with relatively mild early TBI experience long-term functional impairments, particularly in the context of less favorable home environments. These findings suggest that improving parenting skills and the quality of the home environment may promote functional recovery following early TBI.
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Affiliation(s)
- Shari L Wade
- Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nanhua Zhang
- University of Cincinnati College of Medicine, Cincinnati, Ohio3Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada5Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada6Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary
| | - Terry Stancin
- Division of Child & Adolescent Psychiatry & Psychology, Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio8MetroHealth Medical Center, Cleveland, Ohio
| | - H Gerry Taylor
- Division of Developmental and Behavioral Pediatrics and Psychology, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio10Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
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Brown FL, Whittingham K, Boyd RN, McKinlay L, Sofronoff K. Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial. Behav Res Ther 2015; 73:58-66. [PMID: 26255172 DOI: 10.1016/j.brat.2015.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 05/28/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a behavioural family intervention, Stepping Stones Triple P (SSTP), combined with an Acceptance and Commitment Therapy (ACT) workshop in improving parent, family and couple outcomes following paediatric acquired brain injury (ABI). PARTICIPANTS AND SETTING Fifty-nine parents (90% mothers) of children (mean age 7 years; 35 males, 24 females) with ABI. INTERVENTION Participants were randomly assigned to a treatment (10-week group SSTP and ACT program) or a care-as-usual (CAU) control condition (10 weeks). Those in the CAU condition received the treatment after the waitlist period. OUTCOMES Self-report measures of parent psychological distress, parent psychological flexibility, parenting confidence, family functioning, and couple relationship, assessed at: pre-intervention, post-intervention, and 6-months post-intervention. RESULTS Post-intervention, the treatment group showed significant, small to medium improvements relative to the CAU group (at the p < .05 level) on parent psychological distress, parent psychological flexibility, parent confidence in managing behaviours, family adjustment,and number of disagreements between parents. Most improvements were maintained at 6-months. CONCLUSIONS Parent skills training and ACT may be efficacious in improving parent, family, and couple outcomes in families of children with an ABI.
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Affiliation(s)
- Felicity L Brown
- The School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia; Queensland Children's Medical Research Institute, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia.
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia; The School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia
| | - Lynne McKinlay
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Australia; Queensland Paediatric Rehabilitation Service, Royal Children's Hospital, Brisbane, Australia
| | - Kate Sofronoff
- The School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Australia
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Sluys KP, Lannge M, Iselius L, Eriksson LE. Six years beyond pediatric trauma: child and parental ratings of children's health-related quality of life in relation to parental mental health. Qual Life Res 2015; 24:2689-99. [PMID: 26001639 PMCID: PMC4592698 DOI: 10.1007/s11136-015-1002-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
Purpose To examine the relationship between child self-report and parent proxy report of health-related quality of life (HRQL) and how parents’ mental health status relates to the HRQL ratings 6 years after minor to severe injury of the child. Materials and methods This cross-sectional cohort study was performed at a regional pediatric trauma center in Stockholm, Sweden. The PedsQL 4.0 versions for ages 5–7, 8–12, and 13–18 years were completed by 177 child–parent dyads 6 years after injury to the child. The parents also rated their own mental health through the mental health domain (MH) in the SF-36 Health Survey. Results The children’s median age was 13 years (IQR 10–16 years), 54 % were males, and the median ISS was 5 (IQR 2–9). Most of the parents were female (77 %), born in Sweden (79 %), and half had university degrees. There was no statistically significant difference between child self-report and parent proxy report in any of the PedsQL 4.0 scales or summary scales. The levels of agreement between child self-report and parent proxy reports were excellent (ICC ≥ 0.80) for all scales with the exception of emotional functioning (ICC 0.53) which also was the scale with the lowest internal consistency in child self-report (α 0.60). Multiple regression analyses showed that worse parental mental health status correlated with worse child self-report and parent proxy report of children’s HRQL.
Conclusions Children and their parents’ reports on child’s HRQL were in agreement. Decreased mental health in parents was associated with lower scores on parent proxy reports and child self-reports of HRQL after injury. The current investigation highlights the possible relationship between parent’s mental health status and children’s HRQL long after an injury, which should be considered in future investigations and in clinical care.
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Affiliation(s)
- Kerstin Prignitz Sluys
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, L1:00, Solna, 171 76, Stockholm, Sweden.
- Department of Technology and Welfare, Red Cross University College, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Margaretha Lannge
- Department of Pediatric Emergency Surgery, Astrid Lindgrens' Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lennart Iselius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lars E Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases Karolinska University Hospital, Huddinge, Sweden
- School of Health Sciences, City University London, London, UK
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15
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Petranovich CL, Wade SL, Taylor HG, Cassedy A, Stancin T, Kirkwood MW, Maines Brown T. Long-Term Caregiver Mental Health Outcomes Following a Predominately Online Intervention for Adolescents With Complicated Mild to Severe Traumatic Brain Injury. J Pediatr Psychol 2015; 40:680-8. [PMID: 25682211 DOI: 10.1093/jpepsy/jsv001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the efficacy of counselor-assisted problem solving (CAPS) in improving long-term caregiver psychological functioning following traumatic brain injury (TBI) in adolescents. METHODS This randomized clinical trial compared CAPS (n = 65), a predominantly online problem-solving intervention, with an Internet resource comparison (n = 67) program. Families of adolescents with TBI completed a baseline assessment and follow-up assessments 6, 12, and 18 months later. General linear mixed models were used to examine longitudinal changes in caregiver global psychological distress, depressive symptoms, and caregiving self-efficacy. Family income and injury severity were examined as moderators of treatment efficacy. RESULTS Family income moderated long-term changes in caregiver psychological distress. For lower-income caregivers, the CAPS intervention was associated with lower levels of psychological distress at 6, 12, and 18 months post baseline. CONCLUSIONS These findings support the utility of Web-based interventions in improving long-term caregiver psychological distress, particularly for lower-income families.
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Affiliation(s)
- Christine L Petranovich
- Department of Psychology, University of Cincinnati, Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center,
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati
| | - H Gerry Taylor
- Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center
| | - Terry Stancin
- Case Western Reserve University, MetroHealth Medical Center
| | - Michael W Kirkwood
- Children's Hospital Colorado and University of Colorado School of Medicine, and
| | - Tanya Maines Brown
- Department of Psychiatry and Psychology, Mayo Clinic, and Mayo Medical School
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Wade SL, Karver CL, Taylor HG, Cassedy A, Stancin T, Kirkwood MW, Brown TM. Counselor-assisted problem solving improves caregiver efficacy following adolescent brain injury. Rehabil Psychol 2014; 59:1-9. [PMID: 24611923 DOI: 10.1037/a0034911] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The purpose of the current study is to examine the efficacy of Counselor-Assisted Problem Solving (CAPS) in improving caregiver adaptation following traumatic brain injury (TBI). RESEARCH METHOD/DESIGN In a randomized clinical trial comparing CAPS (n = 65), an online problem-solving intervention with accompanying Web-based counseling sessions, with an information-based Internet Resource Comparison (IRC; n = 67) program, participants included families of 12- to 17-year-olds who had sustained a TBI in the past 6 months. Linear regression analyses were used to identify main effects and to examine whether caregiver education, race, or prior computer use moderated treatment efficacy. RESULTS Computer experience moderated postintervention improvements in caregiving self-efficacy following CAPS, Specifically, parents in CAPS with low levels of prior use reporting the greatest improvements. CAPS participants who completed 5 or more sessions reported greater reductions in depression than did the IRC; however, the groups did not differ on global distress. CONCLUSIONS/IMPLICATIONS Findings support the potential utility of counselor-supported Web-based interventions particularly for individuals with limited computer expertise following adolescent TBI.
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Affiliation(s)
- Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center
| | | | - H Gerry Taylor
- Department of Pediatrics, Case Western Reserve University, Department of Pediatrics, University Hospitals Case Medical Center
| | - Amy Cassedy
- Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center
| | - Terry Stancin
- Department of Psychiatry, Case Western Reserve University
| | - Michael W Kirkwood
- Department of Physical Medicine and Rehabilitation, Children's Hospital of Colorado
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T. Woods D, Catroppa C, Godfrey C, Giallo R, Matthews J, A. Anderson V. A telehealth intervention for families caring for a child with traumatic brain injury (TBI). ACTA ACUST UNITED AC 2014. [DOI: 10.1108/scn-01-2013-0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to determine the preliminary clinical utility of a telephone-support format of the “Signposts” (Hudson et al., 2003) behavioural intervention programme to be used with a paediatric traumatic brain injury (TBI) population.
Design/methodology/approach
– Nine families caring for a child with moderate or severe TBI, participated in a pilot study of a TBI adapted “Signposts for Building Better Behaviour” manualised programme. The programme is designed to help parents learn positive parenting skills and strategies that empower them to successfully manage their child's challenging behaviour post-TBI. The programme consists of seven core sessions and two supplemental sessions. Parents work through the sessions with an accompaniment of guiding information booklets, a DVD with scenes modelling positive parenting strategies, and a workbook containing written exercises. At the completion of each session parents receive a telephone-support call from a trained Signposts practitioner who provides assistance and feedback on programme content.
Findings
– On average parents completed eight sessions (range seven to nine) and every family completed the seven core sessions. Participation in the telephone-support calls was high with 96 per cent of calls having been successfully received by families. All parents agreed that the telephone calls were a useful part of the programme and felt that the materials were helpful for managing challenging behaviour. Paired-samples t-tests showed significant reductions for challenging behaviour from pre- to post-intervention. Parenting practices also significantly improved over the course of the intervention. In general, parents rated a high level of consumer satisfaction with the Signposts programme and its content.
Originality/value
– Overall, these preliminary findings support the potential clinical utility of a telephone-support version of the Signposts programme to improve parenting skills and to reduce challenging child behaviour following TBI. This study has provided the impetus for a larger clinical research trial to be conducted.
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Brown FL, Whittingham K, Sofronoff K, Boyd RN. Parenting a child with a traumatic brain injury: Experiences of parents and health professionals. Brain Inj 2013; 27:1570-82. [DOI: 10.3109/02699052.2013.841996] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Trenchard SO, Rust S, Bunton P. A systematic review of psychosocial outcomes within 2 years of paediatric traumatic brain injury in a school-aged population. Brain Inj 2013; 27:1217-37. [DOI: 10.3109/02699052.2013.812240] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Stewart Rust
- Paediatric Psychosocial Service, Royal Manchester Children’s Hospital
ManchesterUK
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Exploring the connections between traumatic brain injury caregiver mental health and family dynamics in Mexico City, Mexico. PM R 2013; 5:839-49. [PMID: 23735587 DOI: 10.1016/j.pmrj.2013.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the patterns of family dynamics that are most associated with the mental health of traumatic brain injury (TBI) caregivers from Mexico. It was hypothesized that healthier family dynamics would be associated with better caregiver mental health. DESIGN A cross-sectional study of self-reported data collected from TBI caregivers through the Mexican National Institute of Rehabilitation in Mexico City, Mexico, the premier public medical facility in Mexico that provides rehabilitation services to patients with various disabilities. SETTING One public outpatient medical and rehabilitation facility. PARTICIPANTS Sixty-eight caregivers of individuals with moderate-to-severe TBI from Mexico City, Mexico, were related to an individual with TBI who was ≥3 months after injury, a primary caregiver for ≥3 months, familiar with the patient's history, and without neurologic or psychiatric conditions. The average (standard deviation) age of caregivers was 50.94 ± 12.85 years), and 82% were women. METHODS The caregivers completed Spanish versions of instruments that assessed their own mental health and family dynamics. MAIN OUTCOME MEASUREMENTS Outcomes assessed included family dynamics (Family Adaptability and Cohesion Evaluation Scale-Fourth Edition; Family Communication Scale; Family Satisfaction Scale; Family Assessment Device-General Functioning; and Relationship-Focused Coping Scale), and caregiver mental health (Patient Health Questionnaire-9, Zarit Burden Interview, and Satisfaction with Life Scale). RESULTS Results of canonical correlation analyses suggested that caregiver mental health and family dynamics were positively related, with a large effect size. Caregivers with high family satisfaction and cohesion tended to have a low burden and high satisfaction with life. In addition, caregiver depression and burden were positively related to each other and were both inversely related to caregiver satisfaction with life. CONCLUSIONS TBI caregiver interventions in Latino populations would likely benefit from including programming or techniques to improve family dynamics, especially family cohesion, given the strong potentially reciprocal influence of these dynamics on caregiver mental health.
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Parental distress, parenting practices, and child adaptive outcomes following traumatic brain injury. J Int Neuropsychol Soc 2012; 18:343-50. [PMID: 22314012 DOI: 10.1017/s1355617711001792] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Moderate and severe pediatric traumatic brain injuries (TBI) are associated with significant familial distress and child adaptive sequelae. Our aim was to examine the relationship between parental psychological distress, parenting practices (authoritarian, permissive, authoritative), and child adaptive functioning 12-36 months following TBI or orthopedic injury (OI). Injury type was hypothesized to moderate the relationship between parental distress and child adaptive functioning, demonstrating a significantly stronger relationship in the TBI relative to OI group. Authoritarian parenting practices were hypothesized to mediate relationship between parental distress and child adaptive functioning across groups. Groups (TBI n = 21, OI n = 23) did not differ significantly on age at injury, time since injury, sex, race, or SES. Parents completed the Brief Symptom Inventory, Parenting Practices Questionnaire, and Vineland-II. Moderation and mediation hypotheses were tested using hierarchical multiple regression and a bootstrapping approach, respectively. Results supported moderation and revealed that higher parental psychological distress was associated with lower child adaptive functioning in the TBI group only. Mediation results indicated that higher parental distress was associated with authoritarian parenting practices and lower adaptive functioning across groups. Results suggest that parenting practices are an important area of focus for studies attempting to elucidate the relationship between parent and child functioning following TBI.
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McCauley SR, Wilde EA, Anderson VA, Bedell G, Beers SR, Campbell TF, Chapman SB, Ewing-Cobbs L, Gerring JP, Gioia GA, Levin HS, Michaud LJ, Prasad MR, Swaine BR, Turkstra LS, Wade SL, Yeates KO. Recommendations for the use of common outcome measures in pediatric traumatic brain injury research. J Neurotrauma 2012; 29:678-705. [PMID: 21644810 PMCID: PMC3289848 DOI: 10.1089/neu.2011.1838] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Stephen R McCauley
- Department of Physical Medicine and Rehabilitation, Neurology, and Pediatrics, Baylor College of Medicine, and the Michael E. DeBakey Veterans Administration Medical Center, Houston, Texas 77030, USA.
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Woods DT, Catroppa C, Barnett P, Anderson VA. Parental disciplinary practices following acquired brain injury in children. Dev Neurorehabil 2012; 14:274-82. [PMID: 21870951 DOI: 10.3109/17518423.2011.586371] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study describes the disciplinary practices of parents following acquired brain injury (ABI) of their child and examines the relationship between disciplinary use, family-parental adversities and children's behavioural sequelae. METHOD Participants were 48 parent respondents of children between 3-12 years with mild, moderate and severe ABI. Parents provided demographic information and completed questionnaires investigating disciplinary strategy use, parental-family functioning and child behaviour. RESULTS Over-reactive and lax disciplinary strategies were endorsed most by parents. Dysfunctional levels of disciplinary use were associated with children who displayed more behaviour problems, parents with elevated distress and families experiencing more dysfunction and social adversity. CONCLUSION Dysfunctional parenting practices, if not ameliorated, could exacerbate problematic child behaviour following ABI, as well as parent and family difficulties. Parental assessment may be useful as a method of screening for parental factors that put children at risk for ongoing behaviour problems and families for ongoing stress.
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Affiliation(s)
- Damith T Woods
- Murdoch Children's Research Institute, Melbourne, Australia.
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24
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Schmidt AT, Orsten KD, Hanten GR, Li X, Levin HS. Family environment influences emotion recognition following paediatric traumatic brain injury. Brain Inj 2011; 24:1550-60. [PMID: 21058900 DOI: 10.3109/02699052.2010.523047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated the relationship between family functioning and performance on two tasks of emotion recognition (emotional prosody and face emotion recognition) and a cognitive control procedure (the Flanker task) following paediatric traumatic brain injury (TBI) or orthopaedic injury (OI). METHODS A total of 142 children (75 TBI, 67 OI) were assessed on three occasions: baseline, 3 months and 1 year post-injury on the two emotion recognition tasks and the Flanker task. Caregivers also completed the Life Stressors and Resources Scale (LISRES) on each occasion. Growth curve analysis was used to analyse the data. RESULTS Results indicated that family functioning influenced performance on the emotional prosody and Flanker tasks but not on the face emotion recognition task. Findings on both the emotional prosody and Flanker tasks were generally similar across groups. However, financial resources emerged as significantly related to emotional prosody performance in the TBI group only (p = 0.0123). CONCLUSIONS Findings suggest family functioning variables--especially financial resources--can influence performance on an emotional processing task following TBI in children.
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Affiliation(s)
- Adam T Schmidt
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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Abstract
OBJECTIVE The purpose of this study was to examine family adaptation to a traumatic brain injury (TBI) in young children during the first 18-month postinjury, when compared with children who had an orthopedic injury. METHODS A concurrent cohort/prospective research design was used with repeated assessments of children aged 3 to 6 years with TBI or orthopedic injury requiring hospitalization and their families. Shortly after injury and at 6-, 12-, and 18-month postinjury, parents of 99 children with TBI (20 severe, 64 moderate, 15 mild) and 117 with orthopedic injury completed standardized assessments of family functioning, parental distress and coping, injury-related burden, and noninjury-related parent stressors and resources. Mixed models analyses examined group differences in parental burden and distress adjusted for race and social demographic factors. RESULTS Both moderate and severe TBI were associated with higher levels of injury-related stress than orthopedic injury, with stress levels diminishing over time in all groups. Severe TBI was also associated with greater psychological distress on the Brief Symptom Inventory but not with more depressive symptoms. Family functioning and social resources moderated the relationship of TBI severity to injury-related burden and caregiver distress, respectively. Lower child adaptive skills were associated with poorer family outcome but group differences remained even when controlling for this effect. CONCLUSIONS Severe TBI in young children has adverse consequences for parents and families during the first 18-month postinjury. The consequences lessen over time for many families and vary as a function of social resources.
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Caregivers' Well-Being After Traumatic Brain Injury: A Multicenter Prospective Investigation. Arch Phys Med Rehabil 2009; 90:939-46. [DOI: 10.1016/j.apmr.2009.01.010] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 11/20/2022]
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Predicting family burden following childhood traumatic brain injury: a cumulative risk approach. J Head Trauma Rehabil 2009; 23:357-68. [PMID: 19033828 DOI: 10.1097/01.htr.0000341431.29133.a8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI). PARTICIPANTS One hundred eight children with severe or moderate TBI and their families participated in the study. MEASURES The measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory--Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Children's Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts. METHODS Participants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up. RESULTS Risk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the chi statistic indicated a good fit to the data. CONCLUSIONS The current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified "at-risk" subgroups immediately following injury.
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Abstract
OBJECTIVE The purpose of this study was to examine factors that affect parental burden and distress during the first few months following a traumatic brain injury (TBI) in young children. METHODS Participants were consecutively enrolled children ages 3 through 6 years with either a TBI (n = 89; 21 severe, 22 moderate, and 45 complicated mild) or orthopedic injury (OI; n = 119) requiring hospitalization. During the post-acute period, parents provided information regarding the preinjury family environment and current caregiver functioning and injury-related burden. RESULTS Compared with parents of young children with OI, parents of children with TBI reported greater overall caregiver burden and greater burden related to the injury. Parents of children with severe TBI also reported more stress with spouses and siblings and higher levels of parental depression and global distress relative to the OI comparison group. Parents of 5- to 6-year-old children reported significantly higher levels of both injury-related burden and distress than parents of 3- to 4-year-old children. Parents of children with mild TBI based on the Glasgow Coma Scale (GCS) who also had positive neuroimaging findings reported greater injury-related burden than parents of children with moderate TBI. Parents reported using a variety of coping strategies, with higher levels of denial and disengagement corresponding with greater injury-related burden and distress. CONCLUSIONS Consistent with previous research on family adaptation to TBI in school-age children, chronic life stresses and interpersonal resources accounted for significant variance in measures of acute injury-related burden and parental distress in parents of younger children, although differences were small. TBI severity defined by GCS scores alone may not be sufficient to identify families at risk of increased burden. Findings suggest that services aimed at facilitating family adjustment following TBI in young children may need to consider a broader definition of risk factors when identifying families who would benefit from interventions.
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Vilela T, Phillips M, Minnes P. A comparison of challenges faced by parents of children with ABI with and without access to third party funding. Dev Neurorehabil 2008; 11:149-58. [PMID: 18415820 DOI: 10.1080/17518420701780115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In Canada, allocation of rehabilitation services is often based on the assumption that families who have third party insurance funding are well served by the private sector system and are not in need of publicly funded rehabilitation services. However, there has been little research comparing the experiences of caregivers with and without access to third party insurance funding; data that could inform service planning and provision. METHOD The current study compared the stresses, resources and psychological health of caregivers of children with Acquired Brain Injury (ABI) with and without third party funding. RESULTS Caregivers with third party funding (MVA) reported a similar level of stress in comparison to caregivers without funding (non-MVA); however there were differences in what these families perceived as stressful. CONCLUSIONS Although results indicated significant psychological distress and depressive symptoms for both groups, parents in both groups reported high availability of and satisfaction with services, although they used very few services. Implications for clinical services are discussed.
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Affiliation(s)
- Tania Vilela
- School of Social Work, University of Toronto, Ontario, Canada
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Glang A, McLaughlin K, Schroeder S. Using interactive multimedia to teach parent advocacy skills: an exploratory study. J Head Trauma Rehabil 2007; 22:198-205. [PMID: 17510596 DOI: 10.1097/01.htr.0000271121.42523.3a] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the efficacy of Brain Injury Partners: Advocacy Skills for Parents, an interactive multimedia intervention that provides training in educational advocacy skills for parents of children with traumatic brain injury (TBI). DESIGN Randomized trial, with participants assigned to treatment (Brain Injury Partners CD-ROM) or control (alternate CD-ROM) conditions. MAIN OUTCOME MEASURES Knowledge; skill application; and attitude, behavioral intention, and self-efficacy to use key advocacy skills. PARTICIPANTS Thirty-one parents of children with TBI. RESULTS The Brain Injury Partners group reported higher postintervention adjusted means for application, knowledge, and attitudes scale scores than did the control group. CONCLUSIONS The results demonstrate the utility of a computer-delivered intervention for training parents in key skills for communicating with school personnel.
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Affiliation(s)
- Ann Glang
- Oregon Center for Applied Science, Eugene, OR 97401, USA.
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Abstract
The complex management of ventilator-assisted children cared for in the home can place emotional and mental strain on parents, in particular, mothers. The purpose of this study was to explore the relationships among functional status of the child, impact of ventilator-assistance on the family, coping, social support, and depression in mothers caring for ventilator-assisted children at home. Thirty-eight mothers participated in the study. Almost half of the mothers experienced depressive mood symptoms. Impact on family was positively related to depression and social support was inversely related to depression. In addition, social support was a significant predictor of depression. The findings show that the high demands related to the care of ventilator-assisted children can be a significant risk factor for poor mental health outcomes of those mothers providing care at home. Interventions by mental health and pediatric nurses should focus on enhancing mothers' coping skills and assisting mothers in accessing a positive social network to help mediate the stress related to caring for their child.
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Affiliation(s)
- Patricia A Kuster
- College of Nursing, University of South Florida, Tampa, FL 33612-4766, USA.
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32
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Holmbeck GN, Greenley RN, Coakley RM, Greco J, Hagstrom J. Family functioning in children and adolescents with spina bifida: an evidence-based review of research and interventions. J Dev Behav Pediatr 2006; 27:249-77. [PMID: 16775524 DOI: 10.1097/00004703-200606000-00012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research on the adjustment of families of children with spina bifida is reviewed, with a focus on delineating the impact of spina bifida on family functioning, the strengths and weaknesses of past research, and the needs for future evidence-based research on family interventions with this population. PsychINFO and MEDLINE literature searches were used to identify studies of family functioning and family-based interventions for children with spina bifida. Identified studies were empirically evaluated for the presence or absence of key methodological or analytic criteria. Thirty-two studies of family functioning were identified from 25 separate research groups; most studies displayed significant methodological limitations. No published studies of interventions to promote adaptive family functioning were identified. Methodologically sound, longitudinal, and theory-driven studies of family functioning are needed, as are randomized family-based intervention trials to promote adaptive functioning and better psychosocial outcomes in families of children with spina bifida. Specific recommendations for future work as well as clinical implications are noted.
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Affiliation(s)
- Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Illinois 60626, USA.
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Wade SL, Michaud L, Brown TM. Putting the pieces together: preliminary efficacy of a family problem-solving intervention for children with traumatic brain injury. J Head Trauma Rehabil 2006; 21:57-67. [PMID: 16456392 DOI: 10.1097/00001199-200601000-00006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a family-centered problem-solving intervention (FPS) for pediatric traumatic brain injury (TBI), and to assess the efficacy of the intervention in a randomized clinical trial. PARTICIPANTS Families of 32 school-aged children with moderate to severe TBI randomly assigned to FPS or usual care (UC) group. MAIN OUTCOME MEASURES Child Behavior Checklist, Brief Symptom Inventory, Conflict Behavior Questionnaire. INTERVENTION Seven-session problem-solving/skill-building intervention delivered over a 6-month period for the participating families. RESULTS Parents in the FPS group reported significantly greater improvements in their children in internalizing symptoms, anxiety/depression, and withdrawal than did parents in the UC comparison group. CONCLUSIONS FPS holds promise for reducing child behavior problems, the most common and persistent sequelae of TBI.
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Affiliation(s)
- Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio 45229, USA.
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34
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Wade SL, Gerry Taylor H, Yeates KO, Drotar D, Stancin T, Minich NM, Schluchter M. Long-term Parental and Family Adaptation Following Pediatric Brain Injury. J Pediatr Psychol 2005; 31:1072-83. [PMID: 16150875 DOI: 10.1093/jpepsy/jsj077] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine whether parents of children with traumatic brain injuries (TBI) report increased injury-related burden, distress, and family dysfunction and to examine the effects of attrition on the results. METHODS Children with severe TBI, moderate TBI, and orthopedic injuries were followed at six time points from baseline to 6 years after injury. Parents completed measures of injury-related burden, psychological distress, and family functioning at each assessment. Mixed model analysis was used to examine long-term changes. RESULTS Attrition was higher among families in the severe TBI group with lower burden thereby amplifying group differences. The severe TBI group reported higher injury-related burden over time after injury than the other groups. Family functioning was moderated by social resources. Families of children with severe TBI and low resources reporting deteriorating functioning over the follow-up interval. CONCLUSIONS Although environmental advantages moderate long-term effects on family functioning, families of children with severe TBI experience long-standing injury-related burden.
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Affiliation(s)
- Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
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Moore M, Gerry Taylor H, Klein N, Minich N, Hack M. Longitudinal Changes in Family Outcomes of Very Low Birth Weight. J Pediatr Psychol 2005; 31:1024-35. [PMID: 16150877 DOI: 10.1093/jpepsy/jsj075] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although children with very low birth weight (VLBW, <1500 g) are at high risk for developmental impairments, we know little about the long-term effects of VLBW on families. This study examined long-term family outcomes and their stability over time. METHODS Participants were the families of 64 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Family burden and parental distress were assessed annually as part of longitudinal follow-up of the children from mean ages 11-14 years. RESULTS Family burden and parental distress were higher in the <750 g group than in the term-born group, but differences varied with the child's age and family environment. CONCLUSIONS The findings document long-term effects of VLBW on families that are moderated by the degree of low birth weight, child's age, and family environment.
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Affiliation(s)
- Melisa Moore
- Department of Psychology, Case Western Reserve University, USA
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Holmbeck GN, Franks Bruno E, Jandasek B. Longitudinal research in pediatric psychology: an introduction to the special issue. J Pediatr Psychol 2005; 31:995-1001. [PMID: 16150879 DOI: 10.1093/jpepsy/jsj070] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, 6525 North Sheridan Road, Chicago, Illinois 60626, USA.
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