1. 2011 OSEP Leadership Mega Conference Collaboration 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 #

2. 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)

3. 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

4. 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

5. 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

6. BRIEF-SR GEC index

7. CBCL Externalizing Symptoms by Group and SES

8. 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

9. Thank You! Shari L. Wade, Ph.D., Research Professor Cincinnati Children’s Hospital Medical Center http://research.cchmc.org/tops/cincinnati Shari.Wade@cchmc.org 513-636-3370