Spotlight, Volume 1 Number 4

Helping children with TBI and their parents live happily ever after (at least for a while)

Kids can be a handful, especially during that period when preschool aged children find their voices and start testing limits. For parents of children with traumatic brain injury (TBI), this period can be even more challenging. Working with a therapist can help, but some families live too far from the nearest clinic or office to take advantage of these programs. A new online program is bridging this gap by teaching parents to build positive parenting skills and helping them reduce behavioral problems in their children.

TBI can affect cognitive functioning, social skill building, and other important areas that are still developing in preschool aged children. In addition to cognitive deficits, these children may develop social and behavioral problems beyond those of the average toddler. Interventions that foster positive parent-child interaction may help reduce problem behaviors. This approach, generally identified as parent-child interaction therapy (PCIT), is one of the well-studied approaches to deal with children’s behavioral problems by focusing on parents’ skills. It helps parents build a warm and responsive relationship with their children and trains them to effectively manage negative behaviors.

PCIT typically relies significantly on live coaching from a trained therapist. The challenge for researchers at Cincinnati Children’s Hospital, in a study funded by NIDRR, was to create an Internet-based program to help parents learn and build on these skills regardless of how far they live from the nearest clinic or office. They developed a PCIT program called I-InTERACT: Internet-based Interacting Together Everyday, Recovery After Childhood TBI. I-InTERACT consists of web-based learning modules combined with videoconferencing to provide live coaching sessions. The coaching sessions reinforce what the parents learn in each lesson.

Lessons cover aspects of positive parenting such as giving praise and showing enthusiasm, coping with stress, giving good commands, time-outs and dealing with anger, and addressing cognitive problems. Each lesson includes real parents talking about their experiences in raising a child with TBI. The lessons are designed with text, video, and activities to appeal to different learning styles.

Dr. Shari Wade, the lead investigator, says the program offers parents a set of skills they wouldn’t necessarily learn on their own. “Parents need to see how their own positive behavior affects their child’s behavior. Parents find that giving specific praise and reflecting on good behaviors like ‘I really appreciated the way you helped me with picking up the toys’ lead to less conflict, less stress, and improved relationships with their kids.”

For parents who are not be able to access in-clinic services, a program like InTERACT, which can be completed at home and in the child’s most comfortable environment, may be a viable alternative approach to establish a healthy family relationship. Parents in the study found that the resources, tools, and information were helpful and easy to use, especially information on brain injury, anger management, and stress management. They felt comfortable and connected to the counselors, even if they never met face-to-face. They especially liked the live coaching via videoconferences, which gave them a better grasp of how to apply the skills learned in each lesson.

Preliminary results are encouraging: Researchers saw significant changes in parenting skills as early as Session 2 of the I-InTERACT program. Parents learned quickly to use praise and reflection rather than questions and commands, leading to reports of improved relationships overall. The project is in the final follow-up stages. Dr. Wade is hopeful their results will encourage other people to try this or similar programs and build up the evidence base for PCIT for children with TBI.

The resources from this project, along with the original training program, are available online at http://wadeprograms.org/i-interact/. Researchers, clinicians, parents, and others interested in the program are encouraged to contact the project managers through that website. Program developments and preliminary results are discussed in the article below.

Wade, S.L., Oberjohn, K., Burkhardt, A., & Greenberg, I. (2009). Feasibility and preliminary efficacy of a web-based parenting skills program for young children with traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(4), 239-2470. This article is available through NARIC's document delivery services.