A randomized problem-solving trial for adolescent brain injury: Changes in social competence.
Sarah J Tlustos, Michael W Kirkwood, H Gerry Taylor and 3 others
PMID 27831729WHAT IT FOUND
A web-based problem-solving program did not improve social competence overall.
However, it helped specific subgroups: younger teens with moderate injuries and older teens with severe injuries showed gains on parent-rated social skills. These improvements did not extend to measures of actual social participation.
Key findings
01The intervention showed no significant main effect on social competence for the whole group; benefits were limited to specific interactions of age and injury severity.
02Gains were seen in prosocial behaviors and interpersonal skills (HCSBS, BERS-2) but not in social engagement or participation (CBCL).
03Baseline parent-rated executive dysfunction predicted lower social competence and less improvement over time, independent of IQ or processing speed.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Results rely entirely on parent-report measures, which are subject to rater bias and shared method variance. The study did not include a non-TBI control group, so it is unclear how much of the trajectory is specific to the injury versus general adolescent development. Baseline scores were in the average range, meaning statistically significant changes may not reflect clinically meaningful differences for individual patients. The sample was restricted to moderate-to-severe TBI, so findings do not generalize to mild TBI or younger children.
The easy way to misread this
Do not assume the intervention works for all adolescents with TBI. The main effect was null, and benefits were only found in specific subgroups (younger/moderate and older/severe). Furthermore, the improvement was in rated prosocial skills, not in actual social participation or engagement, which declined in the severe group.