Problem Solving following Traumatic Brain Injury in Adolescence: Associations with Functional Outcomes

Publication date: Available online 4 April 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Shari L. Wade, Amy E. Cassedy, Lauren E. Fulks, H. Gerry Taylor, Terry Stancin, Michael W. Kirkwood, Keith O. Yeates, Brad G. Kurowski
ObjectiveTo examine the association of problem solving with functioning in youth with traumatic brain injury (TBI).DesignCross-sectional evaluation of pre-treatment data from a randomized clinical trial.SettingFour children's hospitals and one general hospital, with level 1 trauma units.ParticipantsYouth, ages 11 to 18, who sustained moderate or severe TBI in the past 18 months (n = 133).Main Outcome and MeasuresProblem-solving skills were assessed using the Social Problem Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories (SIP-SR). Everyday functioning was assessed based on structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures.ResultsThe TBI group endorsed lower levels of maladaptive problem solving: negative problem orientation, careless/impulsive responding, and avoidant style, and lower levels of rational problem solving, resulting in a higher total problem solving scores for the TBI group compared to a normative sample (p < .001). SIP-SR dimensions were correlated (r=.23 to .37) with SPSI subscales in the anticipated direction. While both maladaptive (p<.001) and adaptive (p=.006) problem solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (p<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (p = .001).Conclusionand Relevance: Problem solving following TBI differs from normative samples and is associated with functional impairments. The relationship of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem solving interventions on functional outcomes.



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