Pastore et al.

(2011)

Italy

PCT

N=40

Population: TBI; Cognitive Behavioural Therapy Group (CBT, n=28): Mean Age=10.9yr; Gender: Male=21, Female=7; Mean Time Post Injury=2.5yr; Mean GCS=5.5. Control Group (n=12): Mean Age=8.9yr; Gender: Male=10, Female=2; Mean Time Post Injury=2. 5yr; Mean GCS=6.9.

Intervention: All patients were offered CBT in order to reduce dysfunctional behaviours and increase functional behaviours. CBT ranged from 4-8 mo in length with 2-3/wk lasting 45-60 min. Parents also received a weekly session. Patients and families who did not participate in therapy agreed to return for follow-up as controls. Follow-up was conducted at 12 mo.

Outcome Measure: Child Behaviour Checklist (CBCL), Vineland Adaptive Behaviour Scales-Expanded Form (VABS).

1.        Patients who received CBT reported significantly greater improvements on subscales: anxiety/depression, internalising, social problems, somatic complaints, and withdrawal (all p<0.050) compared to controls.

2.        After removing patients who received adjunct pharmacotherapy from the analysis, the aforementioned CBCL subscale improvements remained significant, in addition to improvements in aggressive (p=0.002) and externalizing (p=0.004) behaviour.

3.        The CBT group demonstrated significantly greater socialisation skills scores than controls (p<0.013) but no difference between groups was found regarding communication and daily living skills (p=0.392, p=0.436 respectively) according to VABS.

4.        Patients who did not receive adjunct pharmacotherapy demonstrated greater improvement on all CBCL scales except thought problems, and significantly greater improvement on the VABS socialisation scale (p<0.050) compared with those who received drugs.

Selznick & Savage

(2000)

USA

Pre-post

N=3

Population: TBI; Mean Age=14.0yr; Gender: Male=3, Female=0; Mean Time Post Injury=5.7 yr.

Intervention: Patients were trained to self-monitor their productivity, attention and accuracy in completing math assignments and then told to utilize their preferred methods of self-monitoring. A withdrawal phase followed with no audio cues and patients were asked to self-monitor if they chose to. Follow-up was collected after the first session following the withdrawal phase.

Outcome Measure: Percentage of On-task Behavior, Accuracy Percentage, Duration of Task Engagement.

1.        All three patients improved from a baseline of 64%, 55% and 71% of on-task behaviour to 92%, 98-100%, and 100% respectively.

2.        Follow-up data was available for two patients, with both maintaining performance at 89-99% and 98% respectively.

3.        Accuracy and task engagement remained variable throughout the study.

Slifer et al.

(1997)

USA

Case Study

N=3

Population: ABI; Mean Age=16.3yr; Gender: Male=0, Female=3; Mean Time Post Injury=31.3 d; Mean GCS=5.

Intervention: Patients initially received compliance training during two phases, starting with minimal demands before entering a regular therapy phase. Compliance during therapy was reinforced through offering of preferred tasks and/or removing less-preferred tasks in addition to positive reinforcement for compliant behaviours, a low-stimulation environment, and a 24 hr behavioural assistant. Data was recorded daily.

Outcome Measure: Agitation Rating Scale (ARS), Percentage of Therapy Sessions Attended, Percentage of Disruptive Behaviours.

1.        ARS scores were maintained at low levels during therapy at the minimal demands phase and remained low during the regular therapy phase.

2.        Mean attendances during the minimal demands phase were 51%, 66.3% and 46.1%. Attendance continued to improve at the regular therapy phase with mean attendances recorded at 85.5%, 100% and 100% respectively.

3.        Mean number of disruptive behaviours during the minimal demands phase were 7.8%, 7.1% and 12.1%. An improvement at the regular therapy phase was recorded with mean percentages of 2.4%, 2.8%, and 7.3% respectively.

Slifer et al.

(1995)

USA

Case series

N=6

Population: ABI: TBI=5, Encephalopathy=1; Mean Age=11.5yr; Gender: Male=4, Female=2; Mean Time Post Injury=55.5 d; Mean GCS=5.2.

Intervention: Patients participated in a behaviour management program with an emphasis on positive reinforcement for social and cooperative behaviour, planned ignoring for disruptive behaviour, and a loss of reward at the end of the session for aggressive behaviour.

Outcome Measure: Occurrence of Target Problem Behaviours (Inattention, Disruption, Elopement, Crying, Noncompliance), Children’s Orientation and Amnesia Test (COAT), Galveston Orientation and Amnesia Test (GOAT)

1.        Negative behaviours ceased in four patients during the course of the program.

2.        One patient continued to demonstrate negative behaviours but was still considered to be experiencing borderline Post-Traumatic Amnesia (PTA) by the end of the study with a GOAT score of 75.

3.        The final patient demonstrated a reduction in negative behaviours during the program and behaviours reduced further after emerging from PTA (COAT z-score =-0.1).

Slifer et al.

(1993)

USA

Case Study

N=4

Population: TBI; Mean Age=12.8yr; Gender: Male=3, Female=1; Mean Time Post Injury=46.5 d; Mean GCS=8.3.

Intervention: Patients participated in a behaviour management program with an emphasis on positive reinforcement for social and cooperative behaviour, planned ignoring for disruptive behaviour, and a loss of reward at the end of the session for aggressive behaviour.

Outcome Measure: Percentage of Rules Followed, Percentage of Disruptive Behaviour in Staff Notes.

1.        Two patients demonstrated an immediate reduction in negative behaviours after entering the program with a decrease from 80-100% to 33% and 0%.

2.        One patient also reduced to 33% but did not do so until week 6 of the study.

3.        One patient demonstrated an inconsistent trend in reducing negative behaviours but did not cease by the study end.

Pruneti et al.

(1989)

Italy

Case series

N=20

Population: TBI; Mean Age=11.2yr; Gender: Male=14, Female=6; Severity: Severe=20.

Intervention: Patients participated in a token economy program at home with parental emphasis on positive reinforcement. Patients also kept a diary and engaged in weekly sessions with a psychologist. Follow-up was conducted at 2yr post-intervention.

Outcome Measure: Occurrence of Maladaptive Behaviours.

1.        At the 20wk period following the introduction of the behavioral program, all Maladaptive behaviour was reduced or eliminated in every patiets.  At 2yr follow-up, all 20 patients demonstrated positive outcomes.

2.        Over 60% of patients demonstrated greater levels of autonomy after 2mo, rising to 81% after 14 wk.

3.        Immature behaviour decreased after 4wk and was found to have ceased in 8-19 wk.