Online Family Problem Solving for Pediatric Traumatic Brain Injury: Influences of Parental Marital Status and Participation on Adolescent Outcomes.

The study text does not clearly name the primary outcome, so the reported adolescent functioning and behavior analyses may not reflect the trial's main question. Families were grouped by parent marital status for analysis, and three cohabiting caregivers were excluded, so these are subgroup comparisons. Black/African American and single-parent households had lower incomes at baseline, although income was controlled in the analyses. Families without high-speed internet were excluded, so the results may not apply to families with limited internet access. Adolescents were included even if they had no post-injury behavior problems, so effects might differ in a sample selected for behavior problems. Only about 40% of adolescents had severe TBI, so results may not apply to the most severely injured adolescents. For single-parent households, only the caregiver in the home where the adolescent spent most time received the intervention, which may have missed another household and increased inconsistency. The comparison group had less contact with research staff than the problem-solving group, so attention may have contributed to group differences. Attrition was much higher in single-parent households, especially in the problem-solving group, with 47% attrition in single-parent problem-solving families and 19% in married problem-solving families.

The authors declared no conflict of interest. The article is tagged as supported by NIH extramural and non-U.S. government research support.

Do not read the gains in married households as proof that online family problem solving works for every adolescent with traumatic brain injury. Adolescents from single-parent households did not show better outcomes than the comparison group, and attrition was much higher in single-parent homes.