Rehabilitation Research and Training Center for Traumatic Brain Injury Interventions--Teen Online Problem Solving Study

Traumatic brain injury (TBI) in adolescents is a significant stressor for both the teen and
his or her family. Existing interventions are rare and access to treatment can be restricted
by distance and finances. Based on previous findings and participant feedback, we propose to
expand the previously developed TOPS intervention by conducting a multi-site study comparing
the efficacy of TOPS to that of TOPS-Teen Only (TOPS-TO) in improving child behavior and
functioning, parental depression and distress and family functioning. The efficacy of both
active treatments would be examined in relation to an internet resource comparison group
(IRC). During years 1-3, we will recruit 165 children between the ages of 11 and 18 with
moderate to severe TBI and randomly assign them to receive TOPS, TOPS-TO, or IRC. We
anticipate that TOPS will result in improvements in child, caregiver, and family functioning
relative to IRC; but that TOPS-TO will only result in improvements in child behavior and
adjustment. Based on prior research, we anticipate that the family-level treatment model of
TOPS may be more effective than TOPS-TO in improving child behavior for children/adolescents
with fewer social resources. Given these expectations, we will test the following
hypotheses: 1) Children with TBI receiving either TOPS or TOPS-TO will have fewer behavior
problems, greater social competence, and better functioning than those receiving IRC at both
post-treatment and at a 6-month follow-up assessment. 2) Caregivers of children receiving
TOPS will report less depression and psychological distress, less parent-child conflict, and
better family functioning than those receiving TOPS-TO or IRC at both post-treatment and at
a 6-month follow-up assessment. 3) Social resources will moderate treatment efficacy, such
that children with limited social and economic resources will show greater improvements in
the more comprehensive TOPS intervention. We hypothesize better teen problem solving and
communication skills, fewer teen emotional/behavioral problems, less parental burden and
distress, and less parent-teen conflict at follow-up among the TOPS group compared to the
IRC group. TOPS makes use of emerging technology to address the multifaceted needs of teens
following TBI with the goal of improving the teen's social and emotional functioning,
thereby enabling him or her to better negotiate the complex transition to adulthood and
independent functioning.

Inclusion Criteria:

- Moderate to severe TBI that occurred within the last 18 months

- Overnight hospital stay

- English-speaking

- Parent must be willing to provide informed consent

Exclusion Criteria:

- Child does not live with parents or guardian

- Child or parent has history of hospitalization for psychiatric problem

- TBI is a result of child abuse

- Child suffered a non-blunt injury (e.g., projectile wound, stroke, drowning, or other
form of asphyxiation)

- Diagnosed with moderate or severe mental retardation, autism, or a significant
developmental disability