A Parenting Program to Reduce Disruptive Behavior in Hispanic Children with Acquired Brain Injury: A Randomized Controlled Trial Conducted in Mexico

Family involvement in rehabilitation programmes for children and adolescents with acquired brain injury: A scoping literature review

Paediatric acquired brain injury (ABI) can adversely impact families, and it is widely accepted that families should be involved in the rehabilitation of children/adolescents with ABI. However, there is limited guidance about how to best involve families in paediatric ABI rehabilitation. Several programmes involving the families of children/adolescents with ABI have been developed, but there are no published reviews outlining their characteristics. This scoping literature review aimed to synthesize information about these programmes and develop an understanding of how families are involved in them. Four databases were systematically searched to identify sources of evidence that described programmes in paediatric ABI rehabilitation that involve family members. One hundred and eight sources of evidence describing 42 programmes were included. Programmes were categorized as: service coordination (n = 11), psychosocial (n = 17), support groups (n = 4), training/instruction (n = 9), and education (n = 1). Families' involvement in these programmes varied across programme development, delivery, and evaluation stages. The findings of this scoping literature review outline how families can be involved in paediatric ABI rehabilitation. While this review outlines many approaches to supporting families, it also highlights the need for models of family-centred care to better articulate how clinicians and services can involve families in paediatric ABI rehabilitation.

[Formula: see text] Interventions to improve executive functions in children and adolescents with acquired brain injury: a systematic review and multilevel meta-analysis

To investigate the effectiveness of interventions aiming to improve hot and cold executive functions (EFs) in children and adolescents with acquired brain injury (ABI) and to examine whether characteristics of the intervention, participants, etiology of ABI (Traumatic-brain-injury [TBI] or non-TBI), time of assessment, or study quality moderate intervention effects. Whereas cold EFs refer to purely cognitive EFs, hot EFs refer to the affective aspects of these cognitive skills. A total of 970 participants from 23 randomized-controlled-trial studies (112 effect sizes [ES]) were included. A three-level random effects approach (studies, ES, individual participants) was used. Moderation analyses were conducted through meta-regressions. The three-level random effects model showed a better fit than the two-level model. Almost all individual studies showed non-significant ES across outcomes but in combination interventions were effective (Cohen's d = 0.38, CI 0.16 ~ 0.61). Lower methodological quality, inclusion of participants with non-TBI, and parental participation predicted larger ES. Participants' age, time of assessment, number of sessions, and focus on hot or cold EFs were not related to ES. We found no evidence of publication bias. Interventions are effective with small to medium ES according to conventional criteria. Intervention effects do not seem to fade away with time. Parent participation in the intervention is important to improve EFs. The efficacy of interventions seems larger when non-TBI is part of the etiology of ABI. Variation between studies is relevant for tracing the effective intervention characteristics. Most studies are conducted in adolescence, and studies in early childhood are needed.

Group-based parent training programme for children with neurological conditions: a feasibility study

OBJECTIVE AND DESIGN

This study aimed to determine the feasibility and effectiveness of a parent training programme for parents of children with neurological conditions and behaviours that challenge.

SETTING

Child and adolescent mental health service within a specialist children's hospital.

PARTICIPANTS

Parents of 31 children with neurological conditions and behaviours that challenge.

INTERVENTIONS

Parents attended a 6-week evidence-based behavioural parenting programme delivered in a group format, either face-to-face or remote.

MAIN OUTCOME MEASURES

Feasibility was determined by attendance rates. Effectiveness was analysed primarily using parent-reported measures of child behaviour (Strengths and Difficulties Questionnaire, Paediatric Quality of Life and Goal-Based Outcomes). Secondary measures of parental well-being were also reported (Brief Parental Self-Efficacy Scale, Depression Anxiety Stress Scale Short Form and Parental Sense of Competence). Paired t-tests or Wilcoxon rank-sum tests were conducted to analyse differences preintervention and postintervention.

RESULTS

The attendance rates for the face-to-face and remote groups were 80% and 79%, respectively. Medium to large effect sizes were reported for most measures of child behaviour and parental well-being. There were statistically significant improvements found postintervention in children's behaviour (p=0.014), quality of life (p<0.001), goal-based outcomes (p<0.001), parental self-efficacy (p<0.001) and parental anxiety (p=0.030). Anecdotal feedback showed that parents indicated the group format was acceptable.

CONCLUSIONS

The group parenting intervention for parents of children with heterogeneous neurological conditions and behaviours that challenge appears feasible and effective in improving child behaviour and parental well-being.

Investigating parenting factors, traumatic brain injury and callous and unemotional traits among high school students in a South African setting

Aggressogenic parenting styles are associated with increased rates of callous and unemotional traits, and in turn, with antisocial behaviours. Traumatic brain injury is also associated with antisocial behaviour, but not callous and unemotional traits specifically. No study has previously investigated these three variables, aggressogenic parenting, traumatic brain injury, and callous and unemotional traits, in a single study. The study setting was Cape Town, South Africa. The sample included high school boys ( N = 54), aged 13–21 years in an observational, descriptive study. We hypothesised that boys who reported that they had sustained a traumatic brain injury and who had been exposed to aggressogenic parenting would display increased levels of callous and unemotional traits, and that those with traumatic brain injury but had experienced positive parenting would display lower levels of such traits. The main measures included the Comprehensive Health Assessment Tool, the Inventory of Callous/Unemotional traits, and the Alabama Parenting Questionnaire. Results show that almost 41% (22/54) of participants reported sustaining a traumatic brain injury. Aggressogenic parenting significantly moderated callous and unemotional traits only in participants with traumatic brain injury, F(1.46) = 4.76, p = .03, while positive parenting and substance use did not. In conclusion, traumatic brain injury in the presence of aggressogenic parenting is associated with greater callous and unemotional traits in this sample of adolescent boys.

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence

Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

Effectiveness of Training Programs for Reducing Adverse Psychological Outcomes in Parents of Children with Acquired Brain Injury: A Systematic Review and Meta-Analysis

INTRODUCTION

Parental stress following critical illness in their child has the potential to impact functional outcomes and quality of life for the child and whole family. Parent emotional functioning may also be an important clinical target to optimize child outcomes. This study assessed the effectiveness of training programs for parents aimed at reducing adverse psychological outcomes in parents of children with acute brain injury (ABI).

METHODS

We conducted searches of Embase, PubMed, Web of Science, and Cochrane Library to November 13, 2020. Randomized controlled trials (RCTs) that compared parent training programs with usual care, or an active comparator, and assessed psychological outcomes (depression, anxiety, stress) in parents of children with ABI were included. Two reviewers independently extracted data on study characteristics, participants, interventions, outcome measures, and results before and after intervention. Risk of bias was assessed using the Cochrane risk-of-bias tool.

RESULTS

Four RCTs involving 318 parents of children with ABI were eligible for review. Compared with usual care or active comparator, parent training was associated with significant reduction in parent stress (four RCTs; standardized mean difference [SMD], - 0.32 on a numerical rating scale [95% CI, - 0.60, - 0.05]; I-squared = 7.5%, p = 0.356); significant reduction in parent depression (three RCTs; SMD, - 0.43 [95% CI, - 0.72, - 0.14]; I-squared = 0.0%, p = 0.393); and significant reduction in parent anxiety (two RCTs; SMD, - 0.63 [95% CI, - 1.05, - 0.21]; I-squared = 0.0%, p = 0.629). Overall risk of bias was high for randomization process (one RCT), missing outcome data (three RCTs), measurement of the outcome (three RCTs), and selection of reported result (two RCTs). Heterogeneity between studies by country of study origin was not significant.

CONCLUSIONS

Compared with usual care or an active comparator, parent training was associated with short-term reduction in stress, depression, and anxiety in parents of children with ABI. Future clinical trials of parent interventions are needed as there may be some short-term beneficial effects.

Parent Interventions Improve Behavior After Pediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis

OBJECTIVE

To examine child behavior change scores from randomized controlled trials (RCTs) of parent interventions for pediatric traumatic brain injury (TBI).

METHODS

MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to identify studies that examined parent interventions for pediatric TBI. Inclusion criteria included (i) a parent intervention for children with TBI; (ii) an RCT study design; (iii) statistical data for child behavior outcome(s); and (iv) studies that were published in English.

RESULTS

Seven studies met inclusion criteria. All interventions reported improved child behavior after pediatric TBI; however, child and parent factors contributed to behavior change scores in some interventions. Factors found to contribute to the level of benefit included age of child, baseline behavior levels, sociodemographics (eg, parent income, parent education), and parent mental health.

CONCLUSION

Improved child behavior outcomes resulting from parent interventions for pediatric TBI are well supported by the evidence in the peer-reviewed literature. Clinicians are encouraged to consider child and parent factors as they relate to child behavior outcomes.