Psychological interventions for externalising behaviours following paediatric traumatic brain injury: a systematic review and clinical practice recommendations
Benjamin D. Diplock
A * , Alexey Urusov A , Alisa Torchia A , Gary R. Turner A and Mary E. Desrocher A
A
Abstract
To identify and examine whether evidence-based psychological interventions reduce externalising behaviours in persons who sustained a traumatic brain injury (TBI) in childhood and adolescence.
This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases (i.e. MEDLINE, PsycINFO, PubMed, EMBASE and ERIC) were systematically searched, with publication dates ranging from 1946 to February 2025. Terms, such as ‘TBI’, ‘externalising’, ‘aggression’, and ‘paediatric’, were employed in the search.
The overall searches returned 3551 articles. Of the total, 535 duplicates were excluded, and 2973 records were excluded through screening titles and abstracts. Seventy studies met preliminary established criteria. Of these, 10 studies met inclusion criteria; one (10%) was a nonrandomised study (quasi-experimental design), six (60%) were randomised controlled trials (RCTs) with one-group comparison and three (30%) were RCTs with two-group comparison.
Despite a limited number of studies, five preliminary clinical practice recommendations were developed. Specifically, this review has identified Family Problem-Solving Therapy and Teen Online Problem Solving as having potential efficacy for adolescence to emerging adulthood (moderate to severe TBI) and late childhood to adolescence (mild to severe TBI) age groups. Additional clinical and methodological implications, along with limitations and future directions, are considered.
Keywords: Emerging Adult, Externalizing, Pediatric, Psychological Intervention, Survivor, Systematic Review, Traumatic Brain Injury.
References
Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J (2000) Recovery of Intellectual Ability following Traumatic Brain Injury in Childhood: Impact of Injury Severity and Age at Injury. Pediatric Neurosurgery 32(6), 282-290.
| Crossref | Google Scholar | PubMed |
Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J (2005) Functional Plasticity or Vulnerability After Early Brain Injury? Pediatrics 116(6), 1374-1382.
| Crossref | Google Scholar | PubMed |
Araki T, Yokota H, Morita A (2017) Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurologia Medico-Chirurgica 57(2), 82-93.
| Crossref | Google Scholar | PubMed |
Babikian T, Merkley T, Savage RC, Giza CC, Levin H (2015) Chronic Aspects of Pediatric Traumatic Brain Injury: Review of the Literature. Journal of Neurotrauma 32(23), 1849-1860.
| Crossref | Google Scholar | PubMed |
Baumel A, Mathur N, Pawar A, Muench F (2021) Psychosocial Interventions for Children With Externalized Behavior Problems: An Updated Meta-analysis of Moderator Effects. Journal of Child and Family Studies 30(1), 65-86.
| Crossref | Google Scholar |
Catroppa C, Crossley L, Hearps SJC, Yeates KO, Beauchamp M, Rogers K, Anderson V (2015) Social and Behavioral Outcomes: Pre-Injury to Six Months following Childhood Traumatic Brain Injury. Journal of Neurotrauma 32(2), 109-115.
| Crossref | Google Scholar | PubMed |
Cattelani R, Lombardi F, Brianti R, Mazzucchi A (1998) Traumatic brain injury in childhood: Intellectual, behavioural and social outcome into adulthood. Brain Injury 12(4), 283-296.
| Crossref | Google Scholar | PubMed |
Costeff H, Groswasser Z, Landman Y, Brenner T (1985) Survivors of severe traumatic brain injury in childhood. II. Late residual disability. Scandinavian Journal of Rehabilitation Medicine. Supplement 12, 10-15.
| Google Scholar | PubMed |
Dewan MC, Mummareddy N, Wellons JC, Bonfield CM (2016) Epidemiology of Global Pediatric Traumatic Brain Injury: Qualitative Review. World Neurosurgery 91, 497-509.e1.
| Crossref | Google Scholar | PubMed |
Dodge KA, Bierman KL, Coie JD, Greenberg MT, Lochman JE, McMahon RJ, Pinderhughes EE, for the Conduct Problems Prevention Research Group (2015) Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25. American Journal of Psychiatry 172(1), 59-70.
| Crossref | Google Scholar | PubMed |
Ewing-Cobbs L, Prasad MR, Kramer L, Cox CS, Baumgartner J, Fletcher S, Mendez D, Barnes M, Zhang X, Swank P (2006) Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood. Journal of Neurosurgery: Pediatrics 105(4), 287-296.
| Crossref | Google Scholar | PubMed |
Fritz MS, MacKinnon DP (2007) Required sample size to detect the mediated effect. Psychological Science 18, 233-9.
| Crossref | Google Scholar | PubMed |
Fuentes MM, Wang J, Haarbauer-Krupa J, Yeates KO, Durbin D, Zonfrillo MR, Jaffe KM, Temkin N, Tulsky D, Bertisch H, Rivara FP (2018) Unmet Rehabilitation Needs After Hospitalization for Traumatic Brain Injury. Pediatrics 141(5), e20172859.
| Crossref | Google Scholar | PubMed |
Ganesalingam K, Sanson A, Anderson V, Yeates KO (2006) Self-regulation and social and behavioral functioning following childhood traumatic brain injury. Journal of the International Neuropsychological Society 12(5), 609-621.
| Crossref | Google Scholar | PubMed |
Garcia D, Hungerford GM, Bagner DM (2015) Topical Review: Negative Behavioral and Cognitive Outcomes Following Traumatic Brain Injury in Early Childhood. Journal of Pediatric Psychology 40(4), 391-397.
| Crossref | Google Scholar | PubMed |
Glenton C, Lewin S, Downe S, Paulsen E, Munabi-Babigumira S, Agarwal S, Ames H, Cooper S, Daniels K, Houghton C, Karimi‐Shahanjarini A, Moloi H, Odendaal W, Shakibazadeh E, Vasudevan L, Xyrichis A, Bohren MA (2022) Cochrane Effective Practice and Organisation of Care (EPOC) Qualitative Evidence Syntheses, Differences From Reviews of Intervention Effectiveness and Implications for Guidance. International Journal of Qualitative Methods 21, 160940692110619.
| Crossref | Google Scholar |
Goldman L, Siddiqui EM, Khan A, Jahan S, Rehman MU, Mehan S, Sharma R, Budkin S, Kumar SN, Sahu A, Kumar M, Vaibhav K (2022) Understanding Acquired Brain Injury: A Review. Biomedicines 10(9), 2167.
| Crossref | Google Scholar | PubMed |
Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, Alderson P, Glasziou P, Falck-Ytter Y, Schünemann HJ (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. Journal of Clinical Epidemiology 64(4), 395-400.
| Crossref | Google Scholar | PubMed |
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group, & Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343, d5928.
| Crossref | Google Scholar | PubMed |
Kauten R, Barry CT (2020). Externalizing Behavior. In ‘Encyclopedia of Personality and Individual Differences’. (Ed. V Zeigler-Hill, TK Shackelford) pp. 1509–1512. (Springer International Publishing). 10.1007/978-3-319-24612-3_894
Khalaf HKS, Martin AF, De Brito SA, Barker ED (2023) The Underlying Mechanisms in the Association Between Traumatic Brain Injury in Childhood and Conduct Disorder Symptoms in Late Adolescence. Research on Child and Adolescent Psychopathology 51(5), 709-725.
| Crossref | Google Scholar | PubMed |
Kurowski BG, Stancin T, Taylor HG, McNally KA, Kirkwood MW, Cassedy A, King E, Sklut M, Narad ME, Wade SL (2018) Comparative effectiveness of family problem-solving therapy (F-PST) for adolescents after traumatic brain injury: Protocol for a randomized, multicenter, clinical trial. Contemporary Clinical Trials Communications 10, 111-120.
| Crossref | Google Scholar | PubMed |
Laatsch L, Harrington D, Hotz G, Marcantuono J, Mozzoni MP, Walsh V, Hersey KP (2007) An Evidence-based Review of Cognitive and Behavioral Rehabilitation Treatment Studies in Children With Acquired Brain Injury. Journal of Head Trauma Rehabilitation 22(4), 248-256.
| Crossref | Google Scholar | PubMed |
Li L, Liu J (2013) The effect of pediatric traumatic brain injury on behavioral outcomes: A systematic review: Review. Developmental Medicine & Child Neurology 55(1), 37-45.
| Crossref | Google Scholar | PubMed |
Linden MA, O’Rourke C, Lohan M (2020) Traumatic brain injury and social competence among young male offenders. Disability and Rehabilitation 42(17), 2422-2429.
| Crossref | Google Scholar | PubMed |
Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, et al. (2022) Traumatic brain injury: Progress and challenges in prevention, clinical care, and research. The Lancet Neurology 21(11), 1004-1060.
| Crossref | Google Scholar | PubMed |
Maresca G, Lo Buono V, Anselmo A, Cardile D, Formica C, Latella D, Quartarone A, Corallo F (2023) Traumatic Brain Injury and Related Antisocial Behavioral Outcomes: A Systematic Review. Medicina 59(8), 1377.
| Crossref | Google Scholar | PubMed |
Max JE, Robin DA, Lindgren SD, Smith WL, Sato Y, Mattheis PJ, Stierwalt JAG, Castillo CS (1997) Traumatic Brain Injury in Children and Adolescents: Psychiatric Disorders at Two Years. Journal of the American Academy of Child & Adolescent Psychiatry 36(9), 1278-1285.
| Crossref | Google Scholar | PubMed |
Max JE, Levin HS, Landis J, Schachar R, Saunders A, Ewing-Cobbs L, Chapman SB, Dennis M (2005) Predictors of Personality Change Due to Traumatic Brain Injury in Children and Adolescents in the First Six Months After Injury. Journal of the American Academy of Child & Adolescent Psychiatry 44(5), 434-442.
| Crossref | Google Scholar | PubMed |
Mingebach T, Kamp-Becker I, Christiansen H, Weber L (2018) Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems. PLoS One 13(9), e0202855.
| Crossref | Google Scholar | PubMed |
Moreno MA, Binger K, Zhao Q, Eickhoff J, Minich M, Uhls YT (2022) Digital Technology and Media Use by Adolescents: Latent Class Analysis. JMIR Pediatrics and Parenting 5(2), e35540.
| Crossref | Google Scholar | PubMed |
National Collaborating Centre for Mental Health (UK), Social Care Institute for Excellence (UK) (2013). Antisocial Behaviour and Conduct Disorders in Children and Young People: Recognition, Intervention and Management. (British Psychological Society). Available at http://www.ncbi.nlm.nih.gov/books/NBK299074/
Pastore V, Colombo K, Liscio M, Galbiati S, Adduci A, Villa F, Strazzer S (2011) Efficacy of cognitive behavioural therapy for children and adolescents with traumatic brain injury. Disability and Rehabilitation 33(8), 675-683.
| Crossref | Google Scholar | PubMed |
Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S (2006). ‘Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme.’ (Lancaster University). 10.13140/2.1.1018.4643
Riise EN, Wergeland GJH, Njardvik U, Öst L-G (2021) Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical Psychology Review 83, 101954.
| Crossref | Google Scholar | PubMed |
Raj SP, Zhang N, Kirkwood MW, Taylor HG, Stancin T, Brown TM, Wade SL (2018) Online Family Problem Solving for Pediatric Traumatic Brain Injury: Influences of Parental Marital Status and Participation on Adolescent Outcomes. Journal of Head Trauma Rehabilitation 33(3), 158-166.
| Crossref | Google Scholar |
Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, Britten N, Popay J (2009) Testing Methodological Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: Effectiveness of Interventions to Promote Smoke Alarm Ownership and Function. Evaluation 15(1), 49-73.
| Crossref | Google Scholar |
Sagar R, Patra B, Patil V (2019) Clinical practice guidelines for the management of conduct disorder. Indian Journal of Psychiatry 61(8), 270-276.
| Crossref | Google Scholar | PubMed |
Schofield PW, Malacova E, Preen DB, D’Este C, Tate R, Reekie J, Wand H, Butler T (2015) Does Traumatic Brain Injury Lead to Criminality? A Whole-Population Retrospective Cohort Study Using Linked Data. PLoS One 10(7), e0132558.
| Crossref | Google Scholar | PubMed |
Schwartz D, Mayeux L, Harper J (2011) Bully/Victim Problems during Adolescence. In ‘Encyclopedia of Adolescence’. (Eds B Bradford Brown, MJ Prinstein) pp. 25–34. (Elsevier). 10.1016/B978-0-12-373951-3.00045-4
Simmons-Mackie N, Raymer A, Armstrong E, Holland A, Cherney LR (2010) Communication Partner Training in Aphasia: A Systematic Review. Archives of Physical Medicine and Rehabilitation 91(12), 1814-1837.
| Crossref | Google Scholar | PubMed |
Slavin RE (1995) Best evidence synthesis: An intelligent alternative to meta-analysis. Journal of Clinical Epidemiology 48(1), 9-18.
| Crossref | Google Scholar | PubMed |
Slifer KJ, Amari A (2009) Behavior management for children and adolescents with acquired brain injury. Developmental Disabilities Research Reviews 15(2), 144-151.
| Crossref | Google Scholar | PubMed |
Steiner H (1997) Practice Parameters for the Assessment and Treatment of Children and Adolescents With Conduct Disorder. Journal of the American Academy of Child & Adolescent Psychiatry 36(10), 122S-139S.
| Crossref | Google Scholar | PubMed |
Steiner H, Remsing L (2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder. Journal of the American Academy of Child & Adolescent Psychiatry 46(1), 126-141.
| Crossref | Google Scholar | PubMed |
Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, et al. (2016) ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355, i4919.
| Crossref | Google Scholar | PubMed |
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, et al. (2019) RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 366, l4898.
| Crossref | Google Scholar | PubMed |
Timonen M, Miettunen J, Hakko H, Zitting P, Veijola J, von Wendt L, Räsänen P (2002) The association of preceding traumatic brain injury with mental disorders, alcoholism and criminality: The Northern Finland 1966 Birth Cohort Study. Psychiatry Research 113(3), 217-226.
| Crossref | Google Scholar | PubMed |
Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ (1997) Impact of covert duplicate publication on meta-analysis: A case study. BMJ 315(7109), 635-640.
| Crossref | Google Scholar | PubMed |
Wade SL, Carey J, Wolfe CR (2006) The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury. Rehabilitation Psychology 51(3), 179-189.
| Crossref | Google Scholar |
Wade SL, Walz NC, Carey J, McMullen KM, Cass J, Mark E, Yeates KO (2011) Effect on Behavior Problems of Teen Online Problem-Solving for Adolescent Traumatic Brain Injury. Pediatrics 128(4), e947-e953.
| Crossref | Google Scholar |
Wade SL, Stancin T, Kirkwood M, Brown TM, McMullen KM, Taylor HG (2014) Counselor-Assisted Problem Solving (CAPS) Improves Behavioral Outcomes in Older Adolescents With Complicated Mild to Severe TBI. Journal of Head Trauma Rehabilitation 29(3), 198-207.
| Crossref | Google Scholar | PubMed |
Wade SL, Kurowski BG, Kirkwood MW, Zhang N, Cassedy A, Brown TM, Nielsen B, Stancin T, Taylor HG (2015a) Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial. Pediatrics 135(2), e487-e495.
| Crossref | Google Scholar | PubMed |
Wade SL, Taylor HG, Cassedy A, Zhang N, Kirkwood MW, Brown TM, Stancin T (2015b) Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury. Journal of Neurotrauma 32(13), 967-975.
| Crossref | Google Scholar | PubMed |
Wade SL, Cassedy AE, Shultz EL, Zang H, Zhang N, Kirkwood MW, Stancin T, Yeates KO, Taylor HG (2017) Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury. Journal of the American Academy of Child & Adolescent Psychiatry 56(11), 930-939.e2.
| Crossref | Google Scholar | PubMed |
Wade SL, Taylor HG, Yeates KO, Kirkwood M, Zang H, McNally K, Stacin T, Zhang N (2018) Online Problem Solving for Adolescent Brain Injury: A Randomized Trial of 2 Approaches. Journal of Developmental & Behavioral Pediatrics 39(2), 154-162.
| Crossref | Google Scholar | PubMed |
Williams WH, Chitsabesan P, Fazel S, McMillan T, Hughes N, Parsonage M, Tonks J (2018) Traumatic brain injury: A potential cause of violent crime? The Lancet Psychiatry 5(10), 836-844.
| Crossref | Google Scholar | PubMed |
Wohlin C (2014) Guidelines for snowballing in systematic literature studies and a replication in software engineering. In ‘ACM International Conference Proceeding Series’. (Association for Computing Machinery) 10.1145/2601248.2601268
Ylvisaker M, Turkstra L, Coehlo C, Yorkston K, Kennedy M, Sohlberg MM, Avery J (2007) Behavioural interventions for children and adults with behaviour disorders after TBI: A systematic review of the evidence. Brain Injury 21(8), 769-805.
| Crossref | Google Scholar | PubMed |
