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Context-sensitive goal management training for everyday executive dysfunction in children after severe traumatic
Agata Krasny-Pacini1, Jenny Limond, Jonathan Evans
1Institut Universitaire de Réadaptation Clemenceau-Strasbourg, Strasbourg, France, and Paediatric Surgery Department of Hautepierre University Hospital, Strasbourg, France (Drs Krasny-Pacini and Hiebel); Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France (Dr Chevignard); Mental Health and Wellbeing, Institute of Health & Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, Scotland, United Kingdom (Drs Limond and Evans); ER 6-UPMC, Pitié-Salpêtrière Hospital, University Pierre et Marie Curie-Paris 6, Paris, France (Drs Krasny-Pacini and Chevignard); and EMOI-TC 68, Hôpital du Hasenrain, Mulhouse cedex, France (Dr Bendjelida).
Objectives:
To assess the effectiveness of a metacognitive training intervention, based on an adapted Goal Management Training and Ylvisaker's principles, on 3 activity domains of executive functions: (1) prospective memory (PM) performance in ecological setting, (2) complex cooking task management, and (3) daily executive functioning (EF) at home and at school.
Participants:
Five children aged 8 to 14 years, who were 3 to 11 years post-severe traumatic brain injury, experiencing severe EF difficulties in daily life.
Design:
Single-case experimental design and assessment of EF twice prior to intervention, postintervention, and 3 and 6 months postintervention. Progress was monitored by a weekly ecological PM score. The effect on EF was assessed using the Children's Cooking Task. Transfer to the child's natural context was assessed by parental and teacher questionnaires and Goal Attainment Scaling.
Results:
All children improved both on the measure of PM and on questionnaires of daily EF. Two children improved on the Children's Cooking Task but returned to their preintervention level in a novel cooking task at follow-up. Participation of school personnel and parents in the program was low.
Conclusions:
It is feasible but challenging to use Goal Management Training in children with traumatic brain injury. Further research is needed in relation to how to promote generalization and how to increase the involvement of the child's "everyday people" in the intervention.
