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EBP Compendium: Summary of Systematic Review

Academy of Neurologic Communication Disorders and Sciences
Behavioural Interventions for Children and Adults with Behaviour Disorders After TBI: A Systematic Review of the Evidence

Ylvisaker, M., Turkstra, L., et al. (2007).
Brain Injury, 21(8), 769-805.

Indicators of Review Quality:

The review addresses a clearly focused question No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

Description: This is a review of experimental and non-experimental studies that examined the effects of behavioral treatments for children and adults with traumatic brain injury. Treatments were categorized by those using 1) contingency management procedures traditionally associated with applied behavior analysis (ABA), 2) proactive, antecedent-focused procedures associated with positive behavioral interventions and supports (PBIS) or 3) a combination of traditional ABA and PBIS treatments.

Question(s) Addressed:

Question not specifically stated.

Population: Children and adults with behavioral problems after traumatic brain injury.

Intervention/Assessment: Behavioral interventions using contingency management procedures, such as those associated with applied behavioral analysis; positive behavior interventions and supports; or a combination of the two procedures.

Number of Studies Included: 65

Years Included: Not stated



  • Treatment
    • Cognitive-Communication (Children)
      • Behavioral Interventions
        • “Both traditional contingency management procedures and positive behavior support procedures can be said to be evidence-based treatment options. However, a variety of methodological concerns block stronger conclusions” (p. 769).
        • “In the current review, the following contingency management procedures were used effectively in at least one study: positive reinforcement, negative reinforcement, extinction, and punishment” (p. 778).
        • The following PBIS procedures were found to be effective:
          • specifically planned environmental structuring
          • proactive adjustment of tasks and expectations to ensure success
          • provision of meaningful and well understood daily routines
          • assurance of adequate amount of choice and control
          • engagement in personally meaningful activities
          • engagement with desired people
          • planned development of positive behavioral momentum before difficult tasks
          • assurance of errorless learning with adequate antecedent supports/prompts
          • planned assurance of positive supportive communication from communication partners
          • proactive development of positive communication alternatives to negative behavior 
        • The authors indicated the following methodological concerns that weaken this body of evidence: inconsistent reporting of generalization and maintenance, unreported failures of behavioral interventions, inherently problematic behavioral interventions, inconsistent reporting of reliability of measurement, inconsistent reporting of validity of measurement, and the external validity issues associated with single-subject experiments.
    • Language (Adults)
      • Contingency Management Treatments
        • While the studies included in this review yielded positive findings for contingency management treatments, a number of methodological concerns were reported that weaken the body of evidence.
        • Areas of improved pragmatic and social skills after PBIS treatments included engagement with people and activities, use of positive communication alternatives to negative behavior and use of supportive communication from communication partners. 

Keywords: Brain Injury, Behavioral Treatments

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Added to Compendium: December 2011

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