Article

OBJECTIVE: To examine the association of problem-solving with functioning in
youth with traumatic brain injury (TBI). DESIGN: Cross-sectional evaluation of
pretreatment data from a randomized controlled trial. SETTING: Four children's
hospitals and 1 general hospital, with level 1 trauma units. PARTICIPANTS: Youth,
ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months
(N=153). MAIN OUTCOME MEASURES: Problem-solving skills were assessed using the
Social Problem-Solving Inventory (SPSI) and the Dodge Social Information
Processing Short Stories. Everyday functioning was assessed based on a 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. RESULTS: The 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 higher
total problem-solving scores for the TBI group compared with a normative sample
(P<.001). Dodge Social Information Processing Short Stories dimensions were
correlated (r=.23-.37) with SPSI subscales in the anticipated direction. Although
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). CONCLUSIONS:
Problem-solving after TBI differs from normative samples and is associated with
functional impairments. The relation 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.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS