Online Family Based Problem Solving after Pediatric Traumatic Brain Injury: The Moderating Effect of Attention Problems

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 DESCRIPTION (provided by applicant): The candidate, Dr. Megan Narad, is currently a post-doctoral fellow in the Division of Physical Medicine and Rehabilitation at Cincinnati Children's Hospital Medical Center. Dr. Narad received her Ph.D. in Clinical Psychology from the University of Cincinnati in 2014. Her career goal is to become an independent clinical researcher conducting patient-oriented research in an academic medical center. She has significant training in the area of ADHD, and is looking to re-specialize for a career in pediatric traumatic brain injury (TBI). The proposed training plan includes goals in the following domains: 1) Develop an advanced knowledge of the neurocognitive consequences of pediatric TBI and the long term impact of injury and 2) Improve experimental design and statistical analysis skills, including training in intervention development and research. She has put together a mentoring team and unique set of training experiences that will facilitate her achievement of these goals. Dr. Wade is a well-established researcher with expertise in pediatric traumatic brain injury as well as intervention development and trials. Dr. Yeates is a pediatric neuropsychologist with expertise in long term behavioral, cognitive, and social outcomes following pediatric brain injury. Finally, Dr. Nanhua Zhang is a biostatistician at Cincinnati Children's Hospital Medical Center and agreed to be a statistical consultant on the project. Dr. Zhang has worked with Drs. Wade and Yeates on a number of projects including the trials in the current application. Therefore he has advanced knowledge of the datasets, and has agreed to provide additional statistical training and support to the applicant. Proposed research: Children who sustain traumatic brain injuries often experience difficulties with executive functioning and inattention following their injury. Additionally, children with pre-injury Attention Deficit Hyperactivity Disorder (ADHD) have greater behavioral symptoms and functional impairments following their injury. Family-based problem solving (FBPS) has shown effectiveness in improving executive functioning, externalizing behaviors, and caregiver efficacy following childhood TBI; however the impact of ADHD, either pre-injury or secondary, on treatment response has not been explicitly studied. Few psychosocial treatments, aside from behavioral parent training, have been shown to improve symptoms or functional impairments for children with ADHD. The proposed research study will examine ADHD, both pre-injury and secondary attention problems) as a moderator of treatment response. The project will combine the datasets from two randomized controlled trials of Dr. Wade's web-based FBPS intervention (study 1 n =132, study 2 n= 153) and provides a sample size sufficient to address study aims. First, it is hypothesized that children with attentio problems (either pre-injury ADHD or secondary attention problems) and TBI will demonstrate greater functional impairments than those with TBI alone. Additionally, it is hypothesized that attention problems (both pre-injury ADHD and secondary attention problems) will moderate treatment response. Based on the literature that ADHD is a performance deficit rather than a skills deficit, combined with the limited effectiveness of CBT in treating children and adolescents with ADHD, it is hypothesized that teens with a pre-injury history of ADHD will demonstrate smaller treatment effects than those with TBI. While previous studies have highlighted the limitations of CBT/problem solving interventions in ADHD treatment, the FBPS intervention in the present study addresses many of these limitations; therefore it is possible that patients with pre-injury ADHD may demonstrate equivalent improvements to patients with TBI alone. It is also possible that patients with pre-injury ADHD may demonstrated greater improvement with treatment should hypothesis 1 be correct, and this sub-group has greater room for improvement. Further, because learning new skills after TBI is fundamental different, and possibly more difficult, than rehabilitating skills affected by injury, it is hypothesized that chidren with secondary attention problems will demonstrate greater improvements with treatment than those with pre-injury ADHD.