Psychological interventions for externalising behaviours following paediatric traumatic brain injury: a systematic review and clinical practice recommendations.

Abstract

Objective 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. Methods 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. Results 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. Conclusions 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.