Cognitive reserve as a moderator of responsiveness to an online problem-solving intervention for adolescents with complicated mild-to-severe traumatic brain injury

Abstract

Children and adolescents with traumatic brain injury (TBI) often experience behavior difficulties that may arise from problem-solving deficits and impaired self-regulation. However, little is known about the relationship of neurocognitive ability to post-TBI behavioral recovery. To address this question, we examined whether verbal intelligence, as estimated by Vocabulary scores from the Wechsler Abbreviated Scale of Intelligence, predicted improvements in behavior and executive functioning following a problem-solving intervention for adolescents with TBI. One hundred and thirty-two adolescents with complicated mild-to-severe TBI were randomly assigned to a six-month Web-based problem-solving intervention (CAPS; n = 65) or to an Internet resource comparison (IRC; n = 67) group. Vocabulary moderated the association between treatment group and improvements in metacognitive abilities. Examination of the mean estimates indicated that for those with lower Vocabulary scores, pre-intervention Metacognition Index scores from the Behavior Rating Inventory of Executive Function (BRIEF) did not differ between the groups, but post-intervention scores were significantly lower (more improved) for those in the CAPS group. These findings suggest that low verbal intelligence was associated with greater improvements in executive functioning following the CAPS intervention and that verbal intelligence may have an important role in response to intervention for TBI. Understanding predictors of responsiveness to interventions allows clinicians to tailor treatments to individuals, thus improving efficacy.

Keywords:

• Traumatic brain injury
• Adolescents
• Telehealth
• Problem solving
• Cognitive reserve

This work was supported in part by (a) grant R01-MH073764 from the National Institute of Mental Health, (b) a grant from the Colorado Traumatic Brain Injury Trust Fund Research Program, Colorado Department of Human Services, Division of Vocational Rehabilitation, Traumatic Brain Injury Program, and (c) the University of Cincinnati, University Research Counsel. The authors wish to acknowledge the contributions of Kendra McMullen, Robert Blaha, Elizabeth Hagesfeld, Michelle Jacobs, Daniel Maier, and Nina Fox in data collection and entry and John Stullenberger in Web site support. We would also like to acknowledge the contributions of the therapists JoAnne Carey, PsyD, Britt Nielsen, PsyD, and Brad Jackson, PhD.