Older Children, Lower-Income Families Benefit Most from Online Problem-Solving Tool

Published April 1, 2019 | Journal of Neurotrauma

When children suffer traumatic brain injury (TBI), many benefit from online family problem-solving treatment (OFPST)—especially older children, those with lower IQ scores, and those from lower-income families.

This form of treatment includes a series of self-guided web sessions and therapist-led video conferences to learn skills including self-management, anger management, communication and organization.

Nanhua Zhang, PhD, worked with colleagues at Cincinnati Children’s to perform a meta-analysis of five clinical trials conducted between 2002 and 2015 that tracked child and family-related outcomes after TBI. The combined study included data from 359 children, aged 5 to 18, to explore how OFPST performed considering factors such as age, race, sex, IQ, pre-treatment symptom levels, parental education, and other factors.

“This analysis revealed statistically strong evidence that parental education, child age at baseline, IQ, sex, and parental depression level pre-treatment moderated the effect of OFPST on various outcomes,” the co-authors state.

The study found that children of parents with less than a high school education exhibited fewer internalizing problems and better social competence after OFPST. Those injured at an older age exhibited fewer externalizing behaviors and less executive dysfunction following treatment.

Social competence measures post-treatment improved the most for children with lower IQ scores. Meanwhile, parents of lower IQ children showed the most improvement on depression scores after OFPST.

“These analyses inform a precision medicine approach for delivery of OFPST after pediatric TBI by defining baseline characteristics of children and parents most likely to benefit,” Zhang says.

Shari Wade, PhD, was senior co-author for this study. Cincinnati Children’s co-authors included Megan Narad, PhD, and Brad Kurowski, MD, MS.