Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury

Shari L Wade; Amy E Cassedy; Emily L Shultz; Huaiyu Zang; Nanhua Zhang; Michael W Kirkwood; Terry Stancin; Keith O Yeates; H Gerry Taylor

doi:10.1016/j.jaac.2017.09.413

Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury

J Am Acad Child Adolesc Psychiatry. 2017 Nov;56(11):930-939.e2. doi: 10.1016/j.jaac.2017.09.413. Epub 2017 Sep 14.

Authors

Shari L Wade¹, Amy E Cassedy², Emily L Shultz³, Huaiyu Zang², Nanhua Zhang², Michael W Kirkwood⁴, Terry Stancin⁵, Keith O Yeates⁶, H Gerry Taylor⁷

Affiliations

¹ Cincinnati Children's Hospital Medical Center, Division of Physical Medicine and Rehabilitation, and the University of Cincinnati, College of Medicine, Cincinnati, OH. Electronic address: shari.wade@cchmc.org.
² Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology.
³ Cincinnati Children's Hospital Medical Center, Division of Physical Medicine and Rehabilitation, and the University of Cincinnati.
⁴ Children's Hospital Colorado, Denver.
⁵ Metrohealth Medical Center and Case Western Reserve University, Cleveland.
⁶ University of Calgary, Calgary, ON, Canada.
⁷ Case Western Reserve University and Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland.

PMID: 29096775
DOI: 10.1016/j.jaac.2017.09.413

Abstract

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.

Keywords: behavior problems; parenting; traumatic brain injury.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Brain Injuries, Traumatic / nursing*
Child
Child Behavior*
Child, Preschool
Education, Nonprofessional / methods*
Female
Humans
Male
Parent-Child Relations*
Parenting*
Problem Behavior*

Associated data

ClinicalTrials.gov/NCT01214694