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Published on: August 16, 2019
A review of family intervention guidelines for pediatric acquired brain injuries
Wesley R Cole1, Stephanie K Paulos, Carolyn A S Cole
1Department of Neuropsychology, Kennedy Krieger Institute, 700 N. Broadway, Baltimore, MD 21207, USA. colew@kennedykrieger.org
Insights
Pediatric acquired brain injury (BI) significantly impacts families, increasing psychological distress. Seven clinical guidelines exist to support families, but more research is needed to confirm their effectiveness for children with BI.
Area of Science:
- Neuroscience
- Psychology
- Family Studies
Background:
- Pediatric acquired brain injury (BI) affects not only the child but also their family system.
- Elevated rates of psychological distress are observed in caregivers and siblings following a child's BI.
- Family functioning is a critical factor influencing the recovery of children with BI.
Purpose of the Study:
- To review and evaluate existing theoretical clinical guidelines for interventions with families of children and adolescents with BI.
- To assess the empirical support for seven identified clinical guidelines.
- To identify research gaps and inform future clinical practice and research.
Main Methods:
- Literature review of theoretical clinical guidelines for pediatric BI family interventions.
- Evaluation of empirical support for each guideline using criteria for empirically supported treatments.
- Analysis of existing research within the framework of the seven guidelines.
Main Results:
- Seven theoretical clinical guidelines for working with families of children with BI were identified.
- Limited randomized controlled studies exist, with insufficient empirical support to classify most guidelines as "efficacious."
- Existing guidelines offer a framework for clinicians and researchers despite research limitations.
Conclusions:
- Further research, particularly randomized controlled trials, is essential to establish the efficacy of current clinical guidelines for pediatric BI family interventions.
- Continued research will help professionals identify optimal approaches for supporting families affected by childhood BI.
- The identified guidelines provide a valuable, albeit empirically limited, foundation for addressing challenges in pediatric BI family support.
Abstract:
Pediatric acquired brain injury (BI) not only affects the child with the injury, but also greatly impacts their family. Studies suggest there are higher rates of caregiver and sibling psychological distress after a child in the family has sustained a BI. Also, family functioning after BI impacts the child's recovery. In reviewing the literature, we identified seven theoretical clinical guidelines for working with families of children and adolescents with BI. These clinical guidelines are as follows: (1) select developmentally appropriate interventions, (2) match the intervention to the family, (3) provide advocacy, (4) provide injury education, (5) focus on family realignment, (6) appropriately adjust the child's environment, and (7) provide skills training to the family and child. The existing research on family interventions for BI is reviewed within the context of these theoretical guidelines, and the empirical support for each guideline is subsequently evaluated using specific criteria for empirically supported treatments. Unfortunately, very few randomized controlled studies exist, and continued research is needed to classify all clinical guidelines as "efficacious." In addition, continued research will aid in informing professionals of specific approaches to utilize when working with a family of a child with BI. Currently, clinicians and researchers can turn to the existing clinical guidelines to help address the numerous barriers posed by implementing and studying family interventions for pediatric BI.
