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Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury
Shari L Wade1, Amy E Cassedy2, Emily L Shultz3
1Cincinnati Children's Hospital Medical Center, Division of Physical Medicine and Rehabilitation, and the University of Cincinnati, College of Medicine, Cincinnati, OH.
Insights
Online parent training programs effectively reduced behavioral problems in children with early traumatic brain injury (TBI). The Internet-based Interacting Together Everyday (I-InTERACT) program showed significant improvements in parenting skills and child behavior.
Area of Science:
- Pediatric neurology
- Child psychology
- Rehabilitation medicine
Background:
- Traumatic brain injury (TBI) in children can lead to persistent behavioral problems.
- Parenting skills are crucial for managing these challenges.
- Effective interventions are needed to support families affected by childhood TBI.
Purpose of the Study:
- To compare the effectiveness of Internet-based Interacting Together Everyday (I-InTERACT) with abbreviated parent training (Express) and online resources (IRC) for improving parenting skills and reducing behavior problems after childhood TBI.
- To assess the impact of these interventions on children aged 3-9 years with moderate to severe TBI.
Main Methods:
- A randomized controlled trial involving 113 children with moderate to severe TBI.
- Interventions included I-InTERACT (10-14 online sessions + therapist coaching), Express (7 online sessions + coaching), and IRC (online resources only).
- Outcomes measured parenting skills and child behavior problems using blinded ratings and parent reports (Eyberg Child Behavior Inventory) at baseline, 3, and 6 months.
Main Results:
- Both Express and I-InTERACT groups showed improved positive parenting.
- The I-InTERACT group demonstrated reduced negative parenting at 6 months.
- Children with higher baseline symptoms in the Express and I-InTERACT groups showed greater behavioral improvements, mediated by parenting skill changes.
Conclusions:
- Brief online parent skills training, particularly I-InTERACT, is effective in decreasing behavioral problems in children with existing symptoms after early TBI.
- Parenting skill improvements mediate behavioral changes in children with higher baseline symptom levels.
- Online interventions offer a viable approach for supporting families post-childhood TBI.
Objective:
To evaluate the effectiveness of Internet-based Interacting Together Everyday: Recovery After Childhood TBI (I-InTERACT) versus abbreviated parent training (Express) or access to online resources (internet resources comparison [IRC]) in improving parenting skills and decreasing behavior problems after early traumatic brain injury (TBI).
Method:
In this randomized, controlled, clinical trial, 113 children 3 to 9 years old previously hospitalized for moderate to severe TBI were randomly assigned to receive Express (n = 36), I-InTERACT (n = 39), or IRC (n = 38). Express included 7 online parent skills sessions, and I-InTERACT delivered 10 to 14 sessions addressing parenting skills, TBI education, stress, and anger management. The 2 interventions coupled online modules with therapist coaching through a Health Insurance Portability and Accountability Act-compliant Skype link. The IRC group received access to online TBI and parent skills resources. Co-primary outcomes were blinded ratings of parenting skills and parent report of behavior problems and problem intensity on the Eyberg Child Behavior Inventory (ECBI). Outcomes were assessed before treatment and 3 and 6 months after treatment, with the latter constituting the primary endpoint.
Results:
The Express and I-InTERACT groups displayed higher levels of positive parenting at follow-up. Only the I-InTERACT group had lower levels of negative parenting at 6 months. The Express group had lower ECBI intensity scores than the IRC group. Baseline symptom levels moderated improvements; children in the Express and I-InTERACT groups with higher baseline symptoms demonstrated greater improvements than those in the IRC group. Changes in parenting skills mediated improvements in behavior in those with higher baseline symptoms.
Conclusion:
Brief online parent skills training can effectively decrease behavior problems after early TBI in children with existing behavioral symptoms. Clinical trial registration information-Internet-based Interacting Together Everyday, Recovery After Childhood TBI (I-InTERACT)-RRTC; http://clinicaltrials.gov/; NCT01214694.
