Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes.

This was a baseline cross-sectional analysis from a trial sample, collected before randomisation, so it shows associations and not the effects of problem-solving therapy. Twenty of 153 consented participants were missing problem-solving data, and those missing were more likely to have severe TBI (65% versus 41%), so the analysed sample may not represent adolescents with severe injury. There was no uninjured comparison group from similar backgrounds, so problem-solving weaknesses and their links to functioning cannot be compared with typical adolescents beyond the available questionnaire norms. Problem-solving and some functioning outcomes relied on self-report, which can be distorted by cognitive or self-awareness problems after TBI; a higher total score may not mean better real-world problem-solving. TBI severity was based on Glasgow Coma Scale and neuroimaging without duration of unconsciousness or post-traumatic amnesia, so severity-related differences may have been missed. Participants were older than nonparticipants, and exclusion criteria removed people living outside the home, with pre-injury intellectual disability or psychiatric hospitalisation, non-English speakers, people unable to complete assessments, and families more than 3 hours away or without high-speed Internet. The sample had a higher proportion of boys than the normative comparison, which may affect self-reported problem-solving.

No conflict-of-interest or funding declaration is included in the supplied article text.

Do not read the higher total problem-solving score as better problem-solving. The TBI group also reported lower rational problem-solving, and these were baseline associations before randomisation, not an intervention effect.