2011 osep leadership mega conference collaboration to achieve success from cradle to career 2.0...
TRANSCRIPT
2011 OSEP Leadership Mega ConferenceCollaboration to Achieve Success from Cradle to Career 2.0
Randomized Clinical Trial (RCT) of Teen Online Problem Solving
Intervention
Shari L. Wade, Ph.D.206 NR-S
Presentation #
TBI and Adolescence
• Most common age range for TBI• Likely to affect executive functions and
behavior– Rapid developmental changes– Vulnerability of frontal lobes to TBI
• Deficits in EF may lead to poor outcomes– Direct effects on emotions, behaviors and
social relationships– Indirect effects via parents (> restrictions)
TOPS intervention
• Web-based, family-centered, problem-solving intervention– Designed to involve teen as well as parents– Focuses on self-regulation and family
coping• Differs from previous interventions– Emphasizes teen’s responsibility for
behavior– Two additional core sessions• Language pragmatics• Social skills and social information-processing
Randomized clinical trial• 40 Teens (ages 11-18), moderate-severe TBI– 35 completed treatment
• Randomly assigned to two conditions– TOPS– Internet Resource Comparison (IRC)
• Outcomes: Conflict Behavior Questionnaire, Behavior Rating of Executive Functions Global Executive Composite (BRIEF GEC) and Child Behavior Checklist (CBCL) Internalizing and Externalizing Scales– Pre- and post-treatment
• About 8 months apart
Results• Examined post-treatment group differences
– Controlling for pre-treatment ratings• Parents of teens receiving TOPS reported greater
reductions in parent-adolescent conflict than those receiving internet resources.
• Injury severity moderated treatment response with adolescents with severe TBI who received TOPS showing greater improvements in executive function skills and internalizing behavior problems.
• SES also moderated treatment response with adolescents of lower income who received TOPS demonstrating greater improvements in externalizing behaviors
BRIEF-SR GEC index
40
45
50
55
60
65
Pre- treatment Post- treatment
BRIE
F G
EC T
sco
re
TOPS- Severe TBI
TOPS- Moderate TBI
I RC- Severe TBI
I RC- Moderate TBI
CBCL Externalizing Symptoms by Group and SES
45
47
49
51
53
55
57
59
Pre- treatment Post- treatment
Exte
rnal
izin
g T
sco
re TOPS- Low SES
TOPS- High SES
I RC- Low SES
I RC- High SES
Discussion
• Preliminary evidence for efficacy of TOPS
• Improvements greatest in teens with severe TBI and of lower SES– For moderate TBI few problems
pretreament• Teen problem solving may be of greatest
utility for adolescents at elevated risk for long-term problems
Thank You!Shari L. Wade, Ph.D., Research ProfessorCincinnati Children’s Hospital Medical Center
http://research.cchmc.org/tops/cincinnati