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Updated: Feb 2, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Online Family Problem-solving Treatment for Pediatric Traumatic Brain Injury
Shari L Wade1,2, Eloise E Kaizar3, Megan Narad4
1Departments of Rehabilitation Medicine, shari.wade@cchmc.org.
Insights
Online family problem-solving treatment (OFPST) shows greater benefits for older children and when initiated later after pediatric traumatic brain injury. This approach may be more effective for improving behavioral outcomes in the initial months post-injury.
Area of Science:
- Neuroscience
- Pediatric Psychology
- Rehabilitation Medicine
Background:
- Pediatric traumatic brain injury (TBI) can lead to persistent behavioral challenges.
- Family-centered interventions are crucial for recovery.
- The optimal timing for interventions after pediatric TBI requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of online family problem-solving treatment (OFPST) for pediatric TBI.
- To determine if treatment effectiveness varies with time elapsed since injury.
Main Methods:
- Individual participant data meta-analysis of 5 randomized controlled trials (2003-2016).
- Included 359 children (ages 5-18) hospitalized for moderate-to-severe TBI 1-24 months prior.
- Assessed parent-reported externalizing, internalizing, executive function behaviors, and social competence pre- and post-treatment.
Main Results:
- Treatment efficacy was moderated by time since injury and age at injury.
- OFPST was more beneficial for older children and when initiated later post-injury.
- Improved executive functioning was observed with OFPST, particularly at later time points post-injury.
Conclusions:
- Online family problem-solving treatment may be more advantageous for older children and when implemented after the acute phase post-TBI.
- Findings inform the optimal application of family problem-solving interventions within two years of pediatric TBI.
Background And Objectives:
To determine whether online family problem-solving treatment (OFPST) is more effective in improving behavioral outcomes after pediatric traumatic brain injury with increasing time since injury.
Methods:
This was an individual participant data meta-analysis of outcome data from 5 randomized controlled trials of OFPST conducted between 2003 and 2016. We included 359 children ages 5 to 18 years who were hospitalized for moderate-to-severe traumatic brain injury 1 to 24 months earlier. Outcomes, assessed pre- and posttreatment, included parent-reported measures of externalizing, internalizing, and executive function behaviors and social competence.
Results:
Participants included 231 boys and 128 girls with an average age at injury of 13.6 years. Time since injury and age at injury moderated OFPST efficacy. For earlier ages and short time since injury, control participants demonstrated better externalizing problem scores than those receiving OFPST (Cohen's d = 0.44; P = .008; n = 295), whereas at older ages and longer time since injury, children receiving OFPST had better scores (Cohen's d = -0.60; P = .002). Children receiving OFPST were rated as having better executive functioning relative to control participants at a later age at injury, with greater effects seen at longer (Cohen's d = -0.66; P = .009; n = 298) than shorter (Cohen's d = -0. 28; P = .028) time since injury.
Conclusions:
OFPST may be more beneficial for older children and when begun after the initial months postinjury. With these findings, we shed light on the optimal application of family problem-solving treatments within the first 2 years after injury.
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