LAUSR

n the article “Randomized Clinical Trial of Online Parent Training for Behavior Problems After Early Brain Injury” I by Wade et al., the authors have reported that brief online parent skills training via Skype showed a main effect in reducing parents’ report of how much their child’s behavioral symptoms were bothersome to them. In addition, manualized parent skills training as opposed to provision of Internet resources reduced behavioral symptoms best when pretreatment symptom levels were high. Furthermore, where pretreatment behavioral symptoms were higher, there was evidence that reduction in symptoms was mediated by improved parent skills. The study sample included young children (n 1⁄4 113) who had a history of hospitalization for mild to severe traumatic brain injury (TBI) between ages 3 and 8 years. The researchers studied the children a mean of 10.8 months (SD 1⁄4 16.7 months) after the TBI, and the children were a mean age of 5.4 years (SD 1⁄4 2.2 years) at the time of the clinical trial. Inclusion in the study did not require the presence of psychopathology, and this limited change in pretreatment to posttreatment levels of symptoms. The work is innovative in at least 3 respects. First, the children were selected because of their TBI; second, some measures of parenting involved direct observation and not merely self-report; and third, the treatment arms were all characterized by online provision of therapy or educational resources. The 3 specific arms of the treatment trial were Internet-based Interacting Together Everyday: Recovery After Childhood TBI (I-InTERACT) versus abbreviated parent training (Express) versus access to online resources (IRC). The effectiveness of the Express arm was especially encouraging, because of the hope that effective treatments for disruptive behavior problems in children with TBI can be treated with a relatively brief intervention and remotely via telemedicine. Furthermore, the parent-training arms are not particularly abstruse and are modifications of widely implemented and studied Parent Child Interaction Therapy (PCIT). In an age of limited resources, a creative approach such as this furthers the goal of providing needed relief to a large population of children and families who are the face of the major public health problem that is pediatric TBI. This is a wake-up call for child and adolescent psychiatrists and other pediatric mental health professionals that we need not feel uncomfortable working with children with a history of TBI; rather, we are among the professionals most well equipped to have a positive impact on children’s mental health, which is a highly relevant issue in children with a history of TBI. The high prevalence of preinjury lifetime psychiatric disorder (up to 50%) and the high risk of