Cognitive rehabilitation with immersive virtual reality in schizophrenia: A randomized waiting list-controlled study.

The pathway from successful clinical trial to implementation into care is lengthy and often unsuccessful. Given established evidence for a growing number of programs promoting long-term psychosocial adaptation in children with varying medical conditions, it is necessary to identify strategies to promote clinical implementation. Moving from diagnosis-specific to transdiagnostic approaches may mitigate barriers to implementation and support broader access to evidence-based practices. This transdiagnostic approach may be especially important in pediatric neurorehabilitation, where diagnosis-specific treatment protocols are limited to more common conditions (e.g., traumatic brain injury [TBI]) and awareness and expertise with less common conditions are lacking outside of large tertiary care treatment facilities. Across neurological conditions, executive function (EF) challenges and associated difficulties with emotion regulation and cognitive-communication skills contribute to problems with everyday functioning. EF is an important transdiagnostic psychological process that drives behavior and functioning in both clinical and nonclinical samples. It plays a central role in the development and maintenance of psychosocial symptoms across a range of neurological conditions. EF challenges link to poorer academic performance, adjustment (e.g., internalizing and externalizing problems), and/or health-related quality of life in adolescents with TBI, epilepsy, and brain tumors. Although transdiagnostic protocols targeting affective symptoms, such as depression and anxiety, have been developed and evaluated, no transdiagnostic treatment protocols currently exist for children with neurological conditions that disrupt EF and associated skills. Targeting EF could mitigate adverse psychosocial outcomes for these children. The Teen Online Problem Solving (TOPS) program was designed to equip adolescents and their families with skills to address common challenges associated with TBI in a problem-solving framework. Understanding and addressing EF challenges form the foundation of TOPS. Ten core sessions provide training in cognitive reframing, problem-solving, organization and planning, emotion regulation/anger management, and communication skills, with supplemental sessions addressing initiation and working memory. TOPS and related programs, such as Online Family Problem Solving and Counselor Assisted Problem Solving, have been shown to be effective in improving behavior and EF difficulties across five randomized controlled trials and an individual participant data meta-analysis. In joint profile analyses examining data from 359 participants with moderate to severe TBI across five randomized controlled trials, participants in the family problem-solving group had more favorable child (internalizing and externalizing behavior problems, executive function behaviors, social competence) and family outcomes (parental depression, psychological distress, family functioning, parent-child conflict) than participants in the control condition, with moderate effect sizes. Thus, recent evidence-based guidelines for acquired brain injuries (ABI) identified TOPS as a practice standard for treating behavioral and EF difficulties following TBI.