The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury.

Objective: To examine whether an online cognitive-behavioral intervention could improve child adjustment following traumatic brain injury (TBI). Participants: Thirty-nine families of children with moderate to severe TBI. Intervention: Families were randomly assigned to the online family problem-solving (FPS) group or to the Internet resources comparison (IRC) group. Main Outcome Measures: Outcomes included child behavior problems, social competence, and self-management/compliance. Results: The FPS group reported better child self-management/compliance at follow-up than did the IRC group. The child's age and socioeconomic status (SES) moderated treatment effects, with older children and those of lower SES who received FPS showing greater improvements in self-management and behavior problems, respectively. Conclusions: Findings suggest that an online cognitive- behavioral approach can improve child adjustment after TBI, particularly in older children and children of lower SES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.

This study identified coping strategies associated with caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy. Families of 103 children with traumatic brain injury (TBI) and 71 children with orthopedic injuries were followed prospectively during the initial year postinjury. The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult. In hierarchical regression analyses, acceptance was associated with lower burden and denial was associated with greater distress in both groups. Active coping resulted in higher distress following TBI but not orthopedic injuries. Conversely, the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries. Results are discussed in terms of the implications for intervention following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can a Web-based family problem-solving intervention work for children with traumatic brain injury?

Objective: To examine the feasibility and efficacy of a Web-based intervention for children with traumatic brain injury (TBI). Participants: 6 families comprising 8 parents, 5 siblings, and 6 children with TBI (mean age=10.5 years). Intervention: Families received computers, Web cameras, and Internet access. Participants completed 7-11 online sessions and accompanying weekly videoconferences with the therapist. Main Outcome Measures: Outcomes included child behavior problems, social competence, executive function skills, and parent-child conflict. Results: Children with TBI rated Web site content as very to extremely helpful and reported high overall satisfaction. There was a trend for children with TBI to rate the videoconferences as less helpful than did other family members and relative to a face-to-face visit. Parents reported improvements in antisocial behaviors, and children with TBI reported reductions in conflict with parents regarding school. Conclusions: Web-based interventions hold promise for improving child outcomes following pediatric TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving and community integration in postacute rehabilitation outpatients with traumatic brain injury.

Objective: To enhance understanding of the role that social problem solving (SPS) plays in community integration following traumatic brain injury (TBI). Study Design: Regression analysis. Participants: Forty-five adults with TBI participating in higher level outpatient cognitive rehabilitation and 15 uninjured adults. Main Outcome Measures: Measures of community integration, problem-solving ability, and SPS self-appraisal and performance. Results: Individuals with TBI demonstrated poorer problem-solving as measured by both neuropsychological and SPS methods; however, the largest effect' size was observed for SPS self-appraisal. Only SPS self-appraisal predicted a significant proportion of the variance in community integration. Conclusions: It is important to assess brain-injured persons' confidence in their ability to cope with problems. A focus on objective test scores alone may lead to underdetection of disabling problem-solving deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in learning and memory after pediatric traumatic brain injury.

Thirty boys and 30 girls who sustained a traumatic brain injury (TBI) were evaluated within 1 year postinjury with the California Verbal Learning Test--Children's Version (CVLT-C; D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1994). Boys had statistically significantly lower performance on the CVLT-C than girls in the absence of statistically significant group differences on various demographic and neurological variables. Although the effect size for this difference was modest (η=.09), gender accounted for a statistically significant amount of the variance (5%) in CVLT-C scores in addition to effects of injury severity and age. It is concluded that male gender is associated with an increased risk for retrieval deficits after pediatric TBI, possibly because of reduced speed or efficiency of information processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent-child interactions during the initial weeks following brain injury in young children.

Objective: To understand how traumatic brain injury (TBI) affects parent-child interactions acutely following injury. Participants: Young children hospitalized for TBI (n = 80) and orthopedic injuries (OI; n = 113). Method: Raters coded videotaped interactions during free play and structured tasks for parental warmth/responsiveness and negativity and child warmth, behavior regulation, and cooperation. Raters also counted parental directives, critical/restricting statements, and scaffolds. Results: Parents of children with TBI exhibited less warm responsiveness and made more directive statements during a structured task than parents in the OI group. Children with TBI displayed less behavior regulation than children with OI. Parental warm responsiveness was more strongly related to child cooperativeness in the OI group than in the TBI group. Child behavior also mediated group differences in parental responsiveness and directiveness. TBI accounted for as much variance in parental behaviors as or more than did sociodemographic factors. Conclusion: TBI-related changes in child behavior may negatively influence parent-child interactions and disrupt the reciprocity between parent and child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multifamily group treatment for veterans with traumatic brain injury.

A common clinical problem encountered by clinicians treating veterans who incurred traumatic brain injury (TBI) while serving in Afghanistan in support of Operation Enduring Freedom (OEF) or in Iraq in support of Operation Iraqi Freedom (OIF) is lack of knowledge about TBI on the part of the veterans' family members. Insufficient information can exacerbate marital or family conflict and lead to psychological distress and social isolation for the veteran and family, and suboptimal illness management for the veteran. To address this problem, we adapted Multifamily Group Treatment (MFGT), an evidence-based practice for treatment of serious mental illness (SMI), for treatment of OEF/OIF veterans with TBI and their families. We have implemented the adapted treatment (MFG-TBI) in four groups of veterans and families (N = 20 veterans and 20 family members) across two sites: the Durham VA Medical Center (VAMC) in North Carolina and the JJ Peters VAMC in the Bronx, New York. Adaptations focused on contents and format of the educational components, specification of a protocol for conjugal couples, and the addition of an ecomap to identify support systems during the joining (i.e. assessment) phase, a shorter (9 months) intervention duration, and a more active clinician role including use of motivational enhancement, intersession support, and coordination with other service providers. Biweekly group sessions were supervised and rated for adherence. We illustrate how MFG-TBI both educates and builds problem-solving skills with clinical examples. Suggestions for effective use of problem-solving skills with this population are offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality and functional outcome following traumatic brain injury.

Objective: To investigate pre- to postinjury personality change in relation to outcomes following traumatic brain injury (TBI). Design: Prospective analysis of personality ratings, depression, and outcome using multiple regression analyses. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others (SO). Outcome Measures: Independent Living Scale, Vocational Independence Scale, and Mayo-Portland Adaptability Inventory, 1-2 years postinjury. Predictor Variables: Posttraumatic amnesia (PTA); patient and SO NEO Personality Inventory-Revised ratings of preinjury personality taken at 1-2 months postinjury. Results: Personality function was normal for all groups (regardless of rating source) and stable over time. Neuroticism, and specifically depression, accounted for small proportions of variance in functional outcome, beyond PTA. Conclusions: There is little empirical evidence for significant personality disturbance or change up to 2 years post-TBI. Personality and depression contribute modestly to functional outcomes. Results support a distinction between "personality change" and behavior change following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective attention deficits and subjective fatigue following traumatic brain injury.

The present study aimed to investigate the relationship between subjective fatigue and selective attention deficits following traumatic brain injury (TBI). Forty-six participants with mild-severe TBI and 46 healthy controls completed fatigue scales (Visual Analogue Scale--Fatigue, Fatigue Severity Scale [FSS] and Causes of Fatigue Questionnaire [COF]), and attentional measures including subtests from the Test of Everyday Attention, and the Complex Selective Attention Task (C-SAT). TBI participants reported greater fatigue on the FSS and COF, performed more slowly on attentional measures, and made more errors on the C-SAT. After controlling for anxiety and depression, fatigue was significantly correlated with performance only on the C-SAT. Findings suggest a relationship between subjective fatigue and impairment on tasks requiring higher order attentional processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Support across two generations: Children's closeness to grandparents following parental divorce and remarriage.

There has been relatively little research on the role of grandparents as a source of support for children during and following their parents' marital transitions. In this study, we examined children's contact with and closeness to grandparents in different family types (i.e., two biological parents, single mother, stepparent). Participants included 155 children from the Avon Brothers and Sisters Study. Parent and child interviews and questionnaires regarding the children's relationships with maternal and paternal biological and stepgrandparents were examined. There were family type differences in rates of contact with grandparents as well as children's closeness to grandparents. Furthermore, children's and parents' view about these relationships with grandparents were modestly correlated, suggesting that children often held different views about their closeness to their grandparents than did their parents. Greater closeness to grandparents was associated with fewer adjustment problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive functioning ten years following traumatic brain injury and rehabilitation.

Many previous studies investigating long-term cognitive impairments following traumatic brain injury (TBI) have focused on extremely severely injured patients, relied on subjective reports of change and failed to use demographically relevant control data. The aim of this study was to investigate cognitive impairments 10 years following TBI and their association with injury severity. Sixty TBI and 43 control participants were assessed on tests of attention, processing speed, memory, and executive function. The TBI group demonstrated significant cognitive impairment on measures of processing speed (Symbol Digit Modalities Test [SDMT], Smith, 1973; Digit Symbol Coding, Wechsler, 1997), memory (Rey Auditory Verbal Learning Test [RAVLT]; Rey, 1958; Lezak, 1976), Doors and People tests; Baddeley, Emslie & Nimmo-Smith, 1994) and executive function (Hayling C [Burgess & Shallice, 1997] and SART errors, Robertson, Manly, Andrade, Baddeley & Yiend, 1997). Logistic Regression analyses indicated that the SDMT, Rey AVLT and Hayling C and SART errors most strongly differentiated the groups in the domains of attention/processing speed, memory and executive function, respectively. Greater injury severity was significantly correlated with poorer test performances across all domains. This study shows that cognitive impairments are present many years following TBI and are associated with injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nighttime waking in children with asthma: An exploratory study of daily fluctuations in family climate.

Children with asthma are at increased risk for waking in the night, and there is the potential for the entire household to feel the effects. The authors conducted a telephone-based diary study to examine whether daily fluctuations in parent mood, parenting hassles, and family routines would distinguish nights in which waking occurred from nights in which they did not. Forty-seven families with a child with asthma were contacted 4 times a week every 3 months over a period of 1 year, resulting in 500 daily observations. Parent negative mood, perceived parenting hassles, and disruptions in bedtime routines were associated with increased odds that the child would wake in the middle of the night. Results underscore the importance of considering family climate in children's disturbed sleep. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recovery of time estimation following moderate to severe traumatic brain injury.

Objective: Accurate time estimation abilities are thought to play an important role in efficient performance of many daily activities. This study investigated the role of episodic memory in the recovery of time estimation abilities following moderate to severe traumatic brain injury (TBI). Method: Using a prospective verbal time estimation paradigm, TBI participants were tested in the early phase of recovery from TBI and then again approximately one year later. Verbal time estimations were made for filled intervals both within (i.e., 10 s, 25 s) and beyond (i.e., 45 s 60 s) the time frame of working memory. Results: At baseline, when compared to controls, the TBI group significantly underestimated time durations at the 25 s, 45 s and 60 s intervals, indicating that the TBI group perceived less time as having passed than actually had passed. At follow-up, despite the presence of continued episodic memory impairment and little recovery in episodic memory performance, the TBI group exhibited estimates of time passage that were similar to controls. Conclusion: The pattern of data was interpreted at suggesting that episodic memory performance did not play a noteworthy role in the recovery of temporal perception in TBI participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reported family dynamics and psychopathology: I. The reactions of schizophrenics and normals to parental dialogues.

The reactions of schizophrenics and normals were compared after direct exposure to ostensibly disturbed parents discussing various types of punitive actions to employ with a disobedient son. The measures obtained were accuracy of recall of the content of the parental dialogues and the opinions Ss had about the parents. Results were consistent with the widely prevailing clinical theory which differentiates between schizophrenics and normals on the basis of amount of exposure to family pathology. There was, however, no support for a more specific theory of schizophrenia which relates differential sensitivity for maternal and paternal cues to levels of premorbid adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors.

Objectives: To document the frequency, characteristics, and factors associated with fatigue following traumatic brain injury (TBI). Design: Survey methodology and multivariate statistical design. Setting: Rehabilitation center and community. Participants: 452 participants aged 16 years and over with minor to severe TBI who answered a questionnaire measuring diverse aspects of fatigue as well as different dimensions of psychological distress, pain, and sleep quality. Measures: Proportion of participants reporting being significantly fatigued. Validated measures of fatigue, sleep quality, and psychological distress. Results of a logistic regression analysis. Results: Significant fatigue was reported by 68.5% of participants. Mental fatigue was the most prominent type of fatigue, followed by physical fatigue. Fatigue was present even several years following the accident and had many perceived impacts on day-to-day function. Factors associated with fatigue were a shorter time since injury; being on long-term disability leave; and higher levels of sleep problems, cognitive disturbances, and anxiety. Conclusion: Fatigue is a prevalent problem after TBI that requires more clinical and scientific attention because it probably has important repercussions on the quality of rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inhibitory control following perinatal brain injury.

Evidence from developmental, lesion, and neuroimaging studies indicates that the prefrontal cortex plays a major role in executive abilities, including inhibitory control. Proficient executive performance, however, relies not only on the integrity of the prefrontal cortex but also on its interactions with other brain regions. In the current study, the authors focused on the effect that early damage to the white matter tracts interconnecting prefrontal and other brain regions has on inhibitory control. Data were collected from 13 children with bilateral spastic cerebral palsy and from a control group of 20 children with no history of neurologic compromise. Converging evidence from 3 separate paradigms is presented that strongly suggests these children experience impairments in inhibitory control. Findings are discussed within the context of current cognitive and neuroanatomical models of inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The expression of parental identifications in lesbian mothers' work and family arrangements.

This paper employs a multiple case study approach to explore the complex influences of parental identification on lesbian mothers' decisions about paid work and family life, and on their comfort with those decisions. Through four clinical research vignettes, we describe the breadth of experience observed in a sample of 13 lesbian women assembled as part of a larger study (Stuart, 2007) exploring the psychology of conflict between paid work and motherhood. A psychoanalytic theoretical perspective and research approach allow us to argue against some oversimple conceptions of lesbian motherhood advanced by other theorists and researchers. Variations in lesbian mothers' work-family arrangements cannot be explained in terms of either egalitarian relations between two maternally identified partners, or more traditional relations between one maternally identified and one paternally identified partner. Like heterosexual women, lesbians express a mixture of maternal and paternal, female and male identifications through varied arrangements of paid work and family life. However, lesbian mothers may be somewhat more reluctant than heterosexual mothers to acknowledge either current conflict around work and motherhood or its roots in personal history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy focusing on self-concept change following acquired brain injury: A pilot investigation.

Objective: The current study explored the effectiveness of a group therapy intervention that was focused specifically on self-concept changes following acquired brain injury (ABI). Method: Eighteen individuals in the postacute phase of recovery underwent a 6-week group therapy intervention and were administered a self-concept measure before and after the intervention. Results: Group members showed a significant increase (improvement) in self-concept ratings at the end of the group intervention. Conclusions: Although the results of this study suggest that this intervention may be helpful in improving self-concept following ABI, further exploration is clearly warranted. Future research is needed to investigate the impact of self-concept on emotional adjustment, participation in rehabilitation activities, and functional outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers.

It has been suggested that people engage in nonsuicidal self-injury (NSSI) because they (a) experience heightened physiological arousal following stressful events and use NSSI to regulate experienced distress and (b) have deficits in their social problem-solving skills that interfere with the performance of more adaptive social responses. However, objective physiological and behavioral data supporting this model are lacking. The authors compared adolescent self-injurers (n = 62) with noninjurers (n = 30) and found that self-injurers showed higher physiological reactivity (skin conductance) during a distressing task, a poorer ability to tolerate this distress, and deficits in several social problem-solving abilities. These findings highlight the importance of attending to increased arousal, distress tolerance, and problem-solving skills in the assessment and treatment of NSSI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)