Impairments in social cognition following severe traumatic brain injury

Joint Video Self-Modeling for Persons With Traumatic Brain Injury and Their Partners: A Case Series

Purpose Individuals with traumatic brain injury (TBI) experience impairments to self-regulation and social communication that strain relationships. Video self-modeling (VSM) provides visible and audible, tangible evidence of what they do well and what could improve. Conducting such training in the context of authentic exchanges with their everyday partners may support positive change in social communication. The present investigation sought to evaluate indices of improved social communication. Method A mixed-methods design was employed for this case series investigation. Quantitative measures include pre- and postoutcomes on goal attainment scales (GASs) and measures of conversational effectiveness. Qualitative measures include responsiveness to video-supported prompts, conversational behaviors, and metacognitive statements. Results Participants perceived gains on GAS of 3-4 SDs, as well as perceived improvements on the La Trobe Communication Questionnaire. Those gains were validated by gains on the adapted Measure of Participation in Conversation and Measure of Skill in Supported Conversation. Individuals with TBI and their partners reached consensus on most goals and postintervention La Trobe Communication Questionnaire ratings. Participants made accurate judgments about their behaviors at a high rate, given video review. Conversational behaviors and use of metacognitive statements varied across participants and conversational contexts. Field notes and session transcripts provide evidence that both dyads increased internalization of VSM goals and purpose. Conclusions Joint VSM shows promise as a method for eliciting accurate self-assessments among individuals with TBI and their close partners. Both dyads perceived positive gains in interactions within and outside their dyads. Furthermore, joint VSM and GAS appear to improve self-awareness and internalization of VSM goals and purpose.

Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research

Purpose In both basic science and intervention research in traumatic brain injury (TBI), heterogeneity in the patient population is frequently cited as a limitation and is often interpreted as a factor reducing certainty in the generalizability of research findings and as a source of conflicting findings across studies. Historically, much of TBI research in rehabilitation and cognition has relied upon case-control studies, with small to modest sample sizes. In this context, heterogeneity is indeed a significant limitation. Here, however, we argue that heterogeneity in patient profiles is a hallmark characteristic of TBI and therefore cannot be avoided or ignored. We argue that this inherent heterogeneity must be acknowledged and accounted for prior to study design. Fortunately, advances in statistical methods and computing power allow researchers to leverage heterogeneity, rather than be constrained by it. Method In this article, we review sources of heterogeneity that contribute to challenges in TBI research, highlight methodological advances in statistical analysis and in other fields with high degrees of heterogeneity (e.g., psychiatry) that may be fruitfully applied to decomposing heterogeneity in TBI, and offer an example from our research group incorporating this approach. Conclusion Only by adopting new methodological approaches can we advance the science of rehabilitation following TBI in ways that will impact clinical practice and inform decision making, allowing us to understand and respond to the range of individual differences that are a hallmark in this population.

Theory of Mind after Pediatric Traumatic Brain Injury: A Scoping Review

This scoping review aims to synthesize existing literature regarding theory of mind (ToM) outcomes, the neuropathology associated with ToM outcomes, and the relationship between ToM outcomes and social functioning in children and adolescents with traumatic brain injury (TBI). We searched MEDLINE^® and PsycINFO databases to identify all literature that examined ToM following pediatric TBI until July 2019. A total of 29 articles met inclusion and exclusion criteria and were included in the results. These articles examined a variety of aspects of ToM, which could be broadly grouped into those focused on cognitive, cognitive-affective, and pragmatic factors. The existing literature suggests that children and adolescents with TBI, compared with their typically developing peers and peers with orthopedic injuries, are more likely to have deficits in ToM. The evidence further shows that the age at which brain injury occurs contributes to ToM disruption. Neuroimaging techniques have offered crucial insights into how TBI may impact ToM performance in children and adolescents. Finally, this review provides evidence that disruption in ToM plays a role in the difficulties in social functioning demonstrated by children and adolescents with TBI. Limitations and gaps in the existing literature warrant future research in this field.

Parenting practices, aggressive response evaluation and decision, and social difficulties in kindergarten children: The role of fathers

The association between fathers' parenting characteristics and their preschool children's social information processing (SIP) patterns is an understudied research topic. Hence, the current study aims to bridge this gap by examining whether there are differences between mothers' and fathers' parenting characteristics and their children's SIP patterns as well as their social functioning in school, with a specific focus on children's aggressive response evaluation and decision (RED) and social difficulties in kindergarten. Using a multimethod (self-reports and direct assessments) multi-informant (mother, father, child, and teacher) design, we collected data from 115 kindergarten children, their mothers, and their fathers, tapping the parents' perceptions of the relationships with the child and parenting style; the child's aggressively biased RED, and the child's social difficulties in kindergarten. We found that fathers' parenting capacities are associated with children's aggressively biased RED, whereas no such associations were found for mothers. In addition, aggressively biased RED mediated the association between fathers' authoritative parenting style and the child's maladaptive behavior in kindergarten. There were no differences between fathers and mothers in relation to social difficulties in kindergarten, with both parents' authoritative parenting style associated with less social difficulties. However, sex moderated this association in mothers as their authoritative style was associated with social difficulties in boys but not in girls. This difference was not found in fathers. On the other hand, fathers' authoritarian parenting style was associated with aggressive RED in boys but not in girls. The tentative nature of these findings and the need for replications are discussed.

Social Media and People With Traumatic Brain Injury: A Metasynthesis of Research Informing a Framework for Rehabilitation Clinical Practice, Policy, and Training

Purpose The aim of the study was to investigate the experiences of people with traumatic brain injury (TBI) and rehabilitation professionals in use of social media after TBI. Design Metasynthesis of a multilevel mixed-methods research design was used in the study. Method A qualitative metasynthesis of (a) evidence in the literature regarding the use of communication technologies and social media after TBI, (b) Twitter data and network analysis, (c) interviews with people with TBI (n = 13), (d) focus groups with TBI rehabilitation professionals (n = 11), and (e) a review of current guidance on safe use of social media was conducted. Results People with TBI adopt a trial-and-error approach to using social media. Their meaningful use and a sense of connection enable them to develop social media mastery. TBI rehabilitation professionals' concerns regarding potential risks associated with using social media might lead them to restrict social media use during rehabilitation. Conclusions Access to proactive training in social media use and a supportive network of rehabilitation professionals, family, and friends can enable people with TBI to develop social media mastery through working collaboratively on social media goals. This metasynthesis of research culminates in an evidence-based protocol for assessing and supporting a person with TBI's social media goals to guide clinical practice and future research in the field.

Anosognosia for theory of mind deficits: A single case study and a review of the literature

Being aware of one's own ability to interact socially is crucial to everyday life. After a brain injury, patients may lose their capacity to understand others' intentions and beliefs, that is, the Theory of Mind (ToM). To date, the debate on the association between ToM and other cognitive deficits (in particular executive functions and behavioural disorders) remains open and data regarding awareness of ToM deficits are meagre. By means of an ad-hoc neuropsychological battery of tests, we report on a patient who suffers from ToM deficits and is not aware of these disorders, although aware of his other symptoms. The study is accompanied by a review of the literature (PRISMA guidelines) demonstrating that ToM deficits are independent of executive functions. Furthermore, an advanced lesion analysis including tractography was executed. The results indicate that: i) ToM deficits can be specific and independent of other cognitive symptoms; ii) unawareness may be specific for ToM impairment and not involve other disorders and iii) the medial structures of the limbic, monitoring and attentional systems may be involved in anosognosia for ToM impairment.

Early Brain Injury and Adaptive Functioning in Middle Childhood: The Mediating Role of Pragmatic Language

OBJECTIVE

Traumatic brain injuries (TBIs) often adversely affect adaptive functioning (AF). However, the cognitive mechanisms by which AF is disrupted are not well understood in young children who sustain TBI. This study examined pragmatic language (PL) and executive functioning (EF) as potential mechanisms for AF disruption in children with early, predominantly mild-complicated, TBI.

METHOD

The sample consisted of 76 children between the ages of 6 and 10 years old who sustained a TBI (n = 36) or orthopedic injury (OI; n = 40) before 6 years of age and at least 1 year prior to testing (M = 4.86 years, SD = 1.59). Children's performance on a PL and an expressive vocabulary task (which served as a control task), and parent report of child's EF and AF were examined at two time points 1 year apart (i.e., at age 8 and at age 9 years).

RESULTS

Injury type (TBI vs. OI) significantly predicted child's social and conceptual, but not practical, AF. Results indicated that PL, and not expressive vocabulary or EF at time 1, mediated the relationship between injury type and both social and conceptual AF at time 2.

CONCLUSIONS

A TBI during early childhood appears to subtly, but uniquely, disrupt complex language skills (i.e., PL), which in turn may disrupt subsequent social and conceptual AF in middle childhood. Additional longitudinal research that examines different aspects of PL and adaptive outcomes into adolescence is warranted.

Evolutionary-adaptive and nonadaptive causes of infant attack/desertion in mammals: Toward a systematic classification of child maltreatment

Behaviors comparable to human child maltreatment are observed widely among mammals, in which parental care is mandatory for offspring survival. This article first reviews the recent findings on the neurobiological mechanisms for nurturing (infant caregiving) behaviors in mammals. Then the major causes of attack/desertion toward infants (conspecific young) in nonhuman mammals are classified into five categories. Three of the categories are 'adaptive' in terms of reproductive fitness: (i) attack/desertion toward non-offspring; (ii) attack/desertion toward biological offspring with low reproductive value; and (iii) attack/desertion toward biological offspring under unfavorable environments. The other two are nonadaptive failures of nurturing motivation, induced by: (iv) caregivers' inexperience; or (v) dysfunction in caregivers' brain mechanisms required for nurturing behavior. The proposed framework covering both adaptive and nonadaptive factors comprehensively classifies the varieties of mammalian infant maltreatment cases and will support the future development of tailored preventive measures for each human case. Also included are remarks that are relevant to interpretation of available animal data to humans: (1) any kind of child abuse/neglect is not justified in modern human societies, even if it is widely observed and regarded as adaptive in nonhuman animals from the viewpoint of evolutionary biology; (2) group-level characteristics cannot be generalized to individuals; and (3) risk factors are neither deterministic nor irreversible.

Social Communication Following Adult Traumatic Brain Injury: A Scoping Review of Theoretical Models

Purpose Social communication is the set of abilities that allows individuals to achieve relevant social goals across contexts. Speech-language pathology evaluation and treatment of traumatic brain injury (TBI)-related social communication problems should be informed by evidence-supported theories of social communication. The primary purpose of this article is to summarize the results of a scoping review of theoretical models that speech-language pathologists may apply to the evaluation and treatment of social communication problems of adults with TBI. Method A scoping review was conducted of PubMed, PsycINFO, and Embase for sources published in English between 1989 and 2020 that described human social communication and participation. Resulting sources were systematically examined for social communication models. Results Nine theoretical models were identified that speech-language pathologists may apply to their assessment and treatment of social communication abilities of adults with TBI. Identified models were categorized thematically into one of three classes: cognitive models, social competence models, and pragmatic models. Using a framework developed for the purposes of this article, each identified model was evaluated, and one exemplar model in each class is described in depth. Conclusions Social communication problems in adults post-TBI are common. The existence of multiple models empowers speech-language pathologists to select individual-focused assessment and treatment approaches to maximize intervention outcomes.

The role of alexithymia in social cognition: Evidence from a non-clinical population

BACKGROUND

Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment.

METHODS

We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills.

RESULTS

Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states.

LIMITATIONS

The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships.

CONCLUSIONS

These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

An Emotional Agent for Moral Impairment Rehabilitation in TBI Patients

The ability to identify the emotions of others is a key component of what is known as social cognition. Narratives exploit this mechanism to create an emotional bond with the characters and to maintain the engagement of the audience throughout the story. In this paper, we illustrate a case study in emotion understanding in stories that exploits a computational agent to explore emotion impairment in a group of traumatic brain injured people. The study focuses on moral emotions, aiming to investigate the differences in moral functioning that characterize traumatic brain injured patients. After comparing the understanding of the moral and emotional facets of the agent's behavior in traumatic brain injured patients and in neurologically intact controls, slight-yet meaningful-differences were observed between the two groups. We describe the test methodology and results, highlighting their implications for the design of rehabilitation applications based on virtual agents.

Understanding the role of social cognition in neurodegenerative Disease: A scoping review on an overlooked problem

Social cognition (SC) is the set of socio-cognitive processes that guide automatic and voluntary behaviors by modulating behavioral responses, it includes both cognitive (Theory of the mind - ToM) and affective aspects (Empathy). SC also includes representations of internal somatic states, self-knowledge, perception of others, communication with others and interpersonal motivations. SC is relevant in daily life and reflects the neural complexity of social processing. The purpose of this scoping review is to evaluate the role of SC in neurological disorders, also considering the pathophysiological mechanisms underlying SC and potential assessment tools. The included studies were carried out between 2010 and 2019 and were found on PubMed, Scopus, Cochrane, and Web of Sciences databases, using the combined terms "social cognition"; "dementia"; "multiple sclerosis"; "parkinson", "amyotrophic lateral sclerosis", "neurodegenerative disease". Our review has shown that different SC domains are affected by several neurological conditions, with regards to dementia and amyotrophic lateral sclerosis. Further studies are needed to investigate the association between cognitive and social deficits, for a better management of patients with neurological disorders.

Trait Mindfulness as a Mediator of Anxiety and Psychosocial Functioning in Young People with Acquired Brain Injury

Objective: Following acquired brain injury (ABI), young people may experience increased anxiety as well as difficulties with their psychosocial functioning. This study examined trait mindfulness as a mediator of the relationship between anxiety and psychosocial domains of School and Leisure Activities (SLA), Interpersonal Relationships (IR) and Daily Living Skills (DLS).Method: Participants were adolescents with ABI (aged 12-19 years, N = 38). Standardised measures were used to assess anxiety, trait mindfulness, and psychosocial functioning.Results: Higher levels of anxiety were found to be associated with reduced IR (p < .05) and DLS (p < .05). Increased trait mindfulness was found to be associated with lowered anxiety (p < .01), as well as with better IR (p < .05) and DLS (p <.01). Mediation analyses found a significant indirect effect for the relationship between anxiety and DLS through trait mindfulness.Conclusion: Findings highlight the contribution of trait mindfulness as a mediator between anxiety and psychosocial functioning, such that increased mindfulness and lower levels of anxiety are related to better DLS.

Independent contributions of social cognition and depression to functional status after moderate or severe traumatic brain injury

Impairments in cognitive processing related to social understanding and communication (i.e., "social cognition") are well documented after moderate or severe traumatic brain injury (TBI) and can contribute to negative functional outcome. Depression is also a common feature of TBI with detrimental functional consequences. We evaluated relationships between social cognition, depression symptom severity, and functional status in individuals with chronic TBI (>1 year post injury; n = 25) and healthy controls (n = 30) using objective tests of social cognition as well as self-reported depression (Beck Depression Inventory-II) and functional status (Functional Behavior Profile). Results revealed significant relationships between depression and functional status across the sample, and relationships between social cognition and functional status specific to TBI. In the TBI group only, social cognition significantly predicted both overall and social functional status above and beyond depression. Group differences in functional status were independently mediated by social cognition and, especially, depression. Our findings suggest that social cognitive impairments and depression are distinct, functionally relevant TBI sequelae. Interventions to improve social functioning in this population may be most effective when contextualized within treatments for emotional disturbances.

A novel combined visual scanning and verbal cuing intervention improves facial affect recognition after chronic severe traumatic brain injury: A single case design

A single case design (AB with follow up) was used to determine the effect of a combined visual scanning and verbal cuing intervention technique in improving facial affect recognition after traumatic brain injury (TBI). A 35-year-old male (BR) with impaired ability to recognize facial emotions as a result of severe TBI participated in the study over a 3-month duration. BR's mean accuracy across six universal static facial expressions of emotion improved significantly during intervention and was maintained at follow up. BR was most impaired in labelling negative (sad, angry, disgusted, anxious) versus positive facial expressions (surprised, happy). BR's accuracy to negative facial affect significantly improved during intervention. No further improvement was possible for positive expressions because a ceiling effect was observed at baseline. Overall BR's mean response times across emotions was reduced at baseline but increased significantly during intervention. This was also recorded for both positive and negative expressions, respectively. This novel combined intervention has potential to improve facial affect recognition after TBI. Further evaluation using a multiple-baseline design is recommended. Additional research is needed to determine whether improved facial affect recognition following training translates to improvements in social function and communication in people with TBI.

Empathy Mediates the Relations between Working Memory and Perpetration of Intimate Partner Violence and Aggression

Deficits in executive functioning have been associated with aggressive and violent behavior toward intimate partners. However, it is unclear what specific mechanisms are being affected by cognitive deficits that increase an individual's tendency to become aggressive. The current study examined empathy as a mediating factor between deficits in working memory and perpetration of intimate partner aggression and violence. Men in heterosexual relationships (N = 49) were administered a measure of visual-spatial working memory, and questionnaire measures of head injury and empathy. During a second session, men participated in a conflict discussion with their female partner that was coded for aggressive behavior. Female partners also reported on men's physical and psychological abuse. Working memory was positively related to cognitive and affective empathy, and negatively related to men's physical abuse perpetration and observed aggression during the conflict discussion. The effects of working memory on observed aggression during the conflict were fully mediated by cognitive and affective empathy. Additionally, the effects of working memory on reported physical IPV frequency were fully mediated by affective empathy. Deficits in working memory may decrease men's ability to use empathetic processes, resulting in increased aggression and violence toward their intimate partners. Clinically, incorporating empathy training in battering intervention programs may be helpful, especially among men with deficits in cognitive functioning.

Visual Behavior, Pupil Dilation, and Ability to Identify Emotions From Facial Expressions After Stroke

Social cognition is the innate human ability to interpret the emotional state of others from contextual verbal and non-verbal information, and to self-regulate accordingly. Facial expressions are one of the most relevant sources of non-verbal communication, and their interpretation has been extensively investigated in the literature, using both behavioral and physiological measures, such as those derived from visual activity and visual responses. The decoding of facial expressions of emotion is performed by conscious and unconscious cognitive processes that involve a complex brain network that can be damaged after cerebrovascular accidents. A diminished ability to identify facial expressions of emotion has been reported after stroke, which has traditionally been attributed to impaired emotional processing. While this can be true, an alteration in visual behavior after brain injury could also negatively contribute to this ability. This study investigated the accuracy, distribution of responses, visual behavior, and pupil dilation of individuals with stroke while identifying emotional facial expressions. Our results corroborated impaired performance after stroke and exhibited decreased attention to the eyes, evidenced by a diminished time and number of fixations made in this area in comparison to healthy subjects and comparable pupil dilation. The differences in visual behavior reached statistical significance in some emotions when comparing individuals with stroke with impaired performance with healthy subjects, but not when individuals post-stroke with comparable performance were considered. The performance dependence of visual behavior, although not determinant, might indicate that altered visual behavior could be a negatively contributing factor for emotion recognition from facial expressions.

The Psychosocial Impact of Neurobehavioral Disability

Neurobehavioral disability (NBD) comprises elements of executive and attentional dysfunction, poor insight, problems of awareness and social judgement, labile mood, altered emotional expression, and poor impulse control, any or all of which can have a serious impact upon a person's decision-making and capacity for social independence. The aim of this narrative review is to explore some of the more intrusive forms of NBD that act as obstacles to psychosocial outcome to act as a frame of reference for developing effective rehabilitation interventions. Special consideration is given to the psychosocial impact of three core forms of NBD: a failure of social cognition, aggressive behavior, and problems of drive/motivation. Consideration is also given to the developmental implications of sustaining a brain injury in childhood or adolescence, including its impact on maturational and social development and subsequent effects on long-term psychosocial behavior.

Theory of Mind Impairments Highlighted With an Ecological Performance-Based Test Indicate Behavioral Executive Deficits in Traumatic Brain Injury

Background: In view of the recent literature, the negative impact of traumatic brain injury (TBI) on social cognition remains a debated issue. On one hand, a considerable number of studies reported significant impairments in emotion recognition, empathy, moral reasoning, social problem solving, and mentalizing or theory of mind (ToM) abilities in patients with TBI. On the other hand, the ecological validity of social cognition tasks is still a matter of concern and debate for clinicians and researchers.

Objectives: The objectives of the present study were 2-fold: (1) to assess social cognition in TBI with an ecological performance-based test which focuses on ToM ability, and (2) to study the relationship between performances on this task and behavioral disorders. To this end, 47 patients with moderate to severe TBI in the chronic stage were assessed with a ToM task, the Movie for the Assessment of Social Cognition (MASC), a film displaying social interactions in natural settings and asking for an evaluation of the emotions, thoughts, and intentions of the characters. Behavioral disorders were assessed with the Behavioral Dysexecutive Syndrome Inventory (BDSI), a structured interview of an informant in assessing changes compared with previous behavior in 12 domains.

Results: Patients were significantly less accurate in mental state attribution than a demographically matched group of 38 healthy control subjects. Significant others of patients also reported more behavioral executive problems than controls' relatives on most of the domains of the BDSI. In addition, social cognition performance in the MASC was significantly correlated with behavioral dysexecutive problems rated by proxies on the BDSI.

Conclusions: This study is the first to find association between impairments in mentalizing abilities in the MASC and behavioral impairments in patients with TBI, confirming the added value of this ecological task and that the recognition of social signals is a key element for adequate behavioral functioning.

Systematic Review and Inventory of Theory of Mind Measures for Young Children

Theory of mind (TOM), the ability to infer mental states to self and others, has been a pervasive research theme across many disciplines including developmental, educational, neuro-, and social psychology, social neuroscience and speech therapy. TOM abilities have been consistently linked to markers of social adaptation and have been shown to be affected in a broad range of clinical conditions. Despite the wealth and breadth of research dedicated to TOM, identifying appropriate assessment tools for young children remains challenging. This systematic review presents an inventory of TOM measures for children aged 0-5 years and provides details on their content and characteristics. Electronic databases (1983-2019) and 9 test publisher catalogs were systematically reviewed. In total, 220 measures, identified within 830 studies, were found to assess the understanding of seven categories of mental states and social situations: emotions, desires, intentions, percepts, knowledge, beliefs and mentalistic understanding of non-literal communication, and pertained to 39 types of TOM sub-abilities. Information on the measures' mode of presentation, number of items, scoring options, and target populations were extracted, and psychometric details are listed in summary tables. The results of the systematic review are summarized in a visual framework "Abilities in Theory of Mind Space" (ATOMS) which provides a new taxonomy of TOM sub-domains. This review highlights the remarkable variety of measures that have been created to assess TOM, but also the numerous methodological and psychometric challenges associated with developing and choosing appropriate measures, including issues related to the limited range of sub-abilities targeted, lack of standardization across studies and paucity of psychometric information provided.

Association between the Mother's Social Cognition and the Child's Social Functioning in Kindergarten: The Mediating Role of the Child's Social Cognition

Children’s ability to adjust to the social rules and expectations in the educational environment is of major concern to researchers and practitioners alike. Accordingly, the main purpose of the present study was to examine predictors of children’s social functioning in kindergarten with a specific focus on (a) maternal factors and (b) children’s social cognition. Using a multi-method (self-reports and direct assessments), multi-informant (child, mother, teacher) design, we collected data from 301 kindergarten children and their mothers tapping the mother’s social cognition (general and child-related) and parenting style, and children’s social cognition (social information processing) and functioning in kindergarten. We found direct associations between the mother and child’s social cognition, between the mother’s authoritarian parenting style and her child’s less competent social cognition and behavior, and between the child’s social cognition and social functioning. Finally, as hypothesized, we found a number of interesting mediated effects. Most notably, we found that the association between the mother’s social cognition (her tendency to attribute hostile intent to unknown others) and the child’s social cognition (his/her tendency to generate less competent responses) is fully mediated by the mother’s higher levels of authoritarian parenting style. The important theoretical and clinical implications of our findings are discussed.

Social cognition

Social cognition refers to a complex set of mental abilities underlying social stimulus perception, processing, interpretation, and response. Together, these abilities support the development of adequate social competence and adaptation. Social cognition has a protracted development through infancy to adulthood. Given the preponderance of social dysfunctions across neurologic conditions, social cognition is now recognized as a core domain of functioning that warrants clinical attention. This chapter provides an overview of the construct of social cognition, defines some of the most clinically significant sociocognitive abilities (face processing, facial expression processing, joint attention, theory of mind, empathy, and moral processing), and introduces the neural networks and frameworks associated with these abilities. Broad principles for understanding the development of social cognition are presented, and a summary of normative developmental milestones of clinically relevant sociocognitive abilities is proposed. General guidelines for sound social cognition assessment in children and adolescents are summarized.

Impairment of sociocognitive functions in patients with brain tumours

The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.

Providing on-line support to families of people with brain injury and challenging behaviour: A feasibility study

Challenging behaviour following traumatic brain injury (TBI) is a major source of stress for families. Providing support can be limited by availability of clinicians and geographic location. A solution is to provide support on-line. This study aimed to evaluate the feasibility of an on-line treatment programme "Carer's Way Ahead" that provides families and carers with psychoeducation about TBI and challenging behaviours, specific approaches to managing apathy, irritability/aggression, acting without thinking and social difficulties and also self-care for the family member. Each module was supplemented with detailed notes and summaries of the sessions. Six family carers, five caring for a person with TBI and one caring for a person with stroke, worked through the programme, providing feedback on wording, content, structure and useability. They also completed measures of family functioning, social problem solving, carer strain, mood and the nature and severity of challenging behaviours. In general, the families were positive about the programme with most finding it useful, practical and logically structured although not all believed it was helpful. There was little change in self-reported challenging behaviour, mood, carer strain and family function over the few months of the programme. Longer-term effects were not examined but this requires further research.

Altered resting-state functional connectivity within the developing social brain after pediatric traumatic brain injury

Traumatic brain injury (TBI) in childhood and adolescence can interrupt expected development, compromise the integrity of the social brain network (SBN) and impact social skills. Yet, no study has investigated functional alterations of the SBN following pediatric TBI. This study explored functional connectivity within the SBN following TBI in two independent adolescent samples. First, 14 adolescents with mild complex, moderate or severe TBI and 16 typically developing controls (TDC) underwent resting‐state functional magnetic resonance imaging 12–24 months post‐injury. Region of interest analyses were conducted to compare the groups' functional connectivity using selected SBN seeds. Then, replicative analysis was performed in an independent sample of adolescents with similar characteristics (9 TBI, 9 TDC). Results were adjusted for age, sex, socioeconomic status and total gray matter volume, and corrected for multiple comparisons. Significant between‐group differences were detected for functional connectivity in the dorsomedial prefrontal cortex and left fusiform gyrus, and between the left fusiform gyrus and left superior frontal gyrus, indicating positive functional connectivity for the TBI group (negative for TDC). The replication study revealed group differences in the same direction between the left superior frontal gyrus and right fusiform gyrus. This study indicates that pediatric TBI may alter functional connectivity of the social brain. Frontal‐fusiform connectivity has previously been shown to support affect recognition and changes in the function of this network could relate to more effortful processing and broad social impairments.

Experimental social training methods

Impairments of social behavior constitute common symptoms of frontal lobe dysfunction and are frequent consequences of damage to the frontal lobe. In this chapter we define and describe social behavioral deficits that include mentalizing (e.g., theory of mind, empathy), social self-regulation, social self-awareness, and social problem solving, and discuss how intervention research might address these deficits. Three stages of neurologic illness are emphasized: the early recovery stage after frontal lobe damage, chronic recovery phases of recovery from frontal lobe damage, and progressive decline from frontal neurodegenerative disease. Each of these stages presents unique challenges in identifying and remediating social impairments that constitute vital areas of adjustment for patients and their families within home and community settings.

Are emotion recognition abilities intact in pediatric ADHD?

Extant studies suggest that children with attention-deficit/hyperactivity disorder (ADHD) may make more errors and respond more slowly on tasks that require them to identify emotions based on facial affect. It is unclear, however, whether these findings reflect a unique deficit in emotion recognition, or more general difficulty with choice-response tasks (i.e., tasks that require participants to select among a set of competing options). In addition, ADHD is associated with executive dysfunction, but there is inconsistent evidence regarding the extent to which top-down cognitive control is involved in emotion recognition. The current study used a series of four counterbalanced tasks to systematically manipulate emotional content and working memory demands to determine (a) whether children with ADHD exhibit a unique facial affect recognition deficit and (b) the extent to which facial affect recognition is an automatic versus controlled process that depends in part on working memory. Bayesian results from a carefully phenotyped sample of 64 children ages 8 to 13 (M = 10.42, SD = 1.56; 26 girls; 67% Caucasian/non-Hispanic) with ADHD (n = 35) and without ADHD (n = 29) indicated that working memory is involved in children's ability to efficiently infer emotional state from facial affect (BF₁₀= 4.59 × 10¹⁴). Importantly, there was significant evidence against deficits in emotion recognition for children with ADHD. The ADHD/non-ADHD groups were statistically equivalent in terms of recognition accuracy (BF₀₁ = 1.32 × 10⁵⁴, d = -0.18), and the ADHD group's slower recognition speed was parsimoniously explained by difficulty with choice-response tasks rather than unique to emotional stimuli (BF₁₀ = 3.23, d = 0.31). These findings suggest that emotion recognition abilities are intact in children with ADHD, and highlight the need to control for impaired bottom-up (choice-response) and top-down abilities (working memory) when investigating emotional functioning in ADHD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reaction time and cognitive-linguistic performance in adults with mild traumatic brain injury

Objective: The purpose of this study was to characterize cognitive-linguistic performance in adults with mild traumatic brain injury (mTBI) to advance assessment and treatment practices. We hypothesized that individuals with mTBI would demonstrate longer reaction times (RTs) and greater error rates when compared to an orthopedic injury (OI) group on a category-naming task. Method: Participants were age and education-matched adults with mTBI (n = 20; 12 females) and adults with OI (n = 21; 5 females) who were discharged to home after an Emergency Department visit. Our primary task was a category-naming task shown to be sensitive to language deficits after mTBI. The task was adapted and administered under speeded and unspeeded conditions. Results: There was a significant main effect of condition on RT (speeded faster than unspeeded) and accuracy (more errors in the speeded condition). There was a marginally significant effect of group on errors, with more errors in the mTBI group than the OI group. Naming RT and accuracy in both conditions were moderately correlated with injury variables and symptom burden. Conclusions: Our data showed a marginal effect of group on accuracy of performance. Correlations found between naming and neurobehavioural symptoms, including sleep quality, suggest that the latter should be considered in future research.

Measuring conversations after acquired brain injury in 30 minutes or less: a comparison of two pragmatic rating scales

Primary objective: This study compared the reliability, validity and feasibility of the Pragmatics Rating Scale (PRS) to the Profile of Pragmatic Impairment in Communication (PPIC). It was hypothesized that the PRS would have equivalent reliability and validity and superior feasibility. Research design: A correlational pilot study design was implemented. Methods and procedures: Participants were 15 adults with a history of ABI, who provided two conversation samples each, and 15 adults with no history of ABI, who provided one conversation sample each. Two clinicians used the PRS and PPIC to rate each conversation sample. Main outcomes and results: The results of the PRS showed good discriminative validity between the ABI and non-ABI group, adequate construct validity with the PPIC and the La Trobe Communication Questionnaire, superior interrater reliability to the PPIC, and good test-retest reliability. Also, the PRS demonstrated higher clinical feasibility than the PPIC as measured by mean completion time per sample and ratings on a clinical feasibility survey. Conclusions: These results supported our hypotheses that the PRS is sensitive to aspects of social communication often impaired by ABI, without the feasibility drawbacks of a more complex rating scale.

Detection of text-based social cues in adults with traumatic brain injury

OBJECTIVES

Written text contains verbal immediacy cues-word form or grammatical cues that indicate positive attitude or liking towards an object, action, or person. We asked if adults with moderate-severe traumatic brain injury (TBI) would respond to these cues, given evidence of TBI-related social communication impairments.

METHODS

Sixty-nine adults with TBI and 74 healthy comparison (HC) peers read pairs of sentences containing different types of immediacy cues (e.g., speaker A said "these Canadians" vs. B said "those Canadians.") and identified which speaker (A or B) had a more positive attitude towards the underlined entity (Task 1); and pairs of sentences comprised of a context sentence (e.g., Fred is asked, "Did you visit Joan and Sue?") and a statement sentence (Fred says, "I visited Sue and Joan.") and were asked to indicate how much Fred liked or disliked the underlined words (Task 2).

RESULTS

HC group scores were significantly higher on Task 1, indicating more sensitivity to cues. On Task 2, TBI and HC group ratings differed across cue types and immediacy types, and the TBI group appeared to have less sensitivity to these cues.

CONCLUSIONS

Findings suggest that TBI-related impairments may reduce sensitivity to subtle social cues in text.

Interpretation of non-verbal cues by people with and without TBI: understanding relationship intentions

BACKGROUND

Although long-term social challenges following traumatic brain injury (TBI) are well documented, the challenges of establishing new relationships following TBI are less understood.

AIMS

To examine how the type of non-verbal cues produced by an unfamiliar communication partner impacts feelings of relationship closeness by people with and without TBI.

METHODS & PROCEDURES

In this quasi-experimental comparative mixed-group design, participants included 12 male heterosexual adults with moderate/severe TBI and 10 typical comparison peers. An adaptation of the Relationship Closeness Induction Task (RCIT), a 29-item questionnaire, was completed by all participants to induce relationship closeness through reciprocal self-disclosure during conversation. Participants completed the RCIT three separate times in counterbalanced order. Conversational partners for the RCIT were three female actors trained to convey similar verbal answers to the RCIT questions, but to produce different non-verbal cues: solicitation (i.e., flirting), neutral and rejecting. Following each conversation, the participants completed a 10-item Likert-type questionnaire about the experience.

OUTCOMES & RESULTS

Between- and within-group non-parametric statistical analysis of Likert questions showed non-significant differences between the two participant groups such that both groups consistently rated the female actor who used flirting non-verbal cues higher than the actor who used rejecting non-verbal cues.

CONCLUSIONS & IMPLICATIONS

These results suggest a small sample of heterosexual males with TBI interpret non-verbal relationship cues in real-time conversations with unfamiliar partners as well as comparison peers. Clinical implications include the need to consider real-time conversation in assessment and treatment planning for social communication goals related to cognitive-communication impairment.

Predictors of working alliance in cognitive behaviour therapy adapted for traumatic brain injury

Cognitive Behaviour Therapy (CBT) has the strongest preliminary support for treatment of depression and anxiety following traumatic brain injury (TBI). TBI associated cognitive impairments may pose an obstacle to development of a strong working alliance, on which therapeutic gains depend. The current study examined the association of demographic (i.e., gender, age at study entry, years of education and premorbid IQ) and injury-related (i.e., years since injury, post-trauma amnesia duration, memory and executive functioning test performance) variables with alliance in CBT adapted for TBI (CBT-ABI). The audio-recordings of 177 CBT-ABI sessions from 31 participants were assessed with an observer version of the Working Alliance Inventory at nine time-points. Multi-level mixed model regressions showed that participants and therapists maintained a relatively strong alliance across all sessions. Pre-intervention symptom severity was considered as a confounder variable and was found to have no statistically significant influence on the models. None of the demographic variables were significantly associated with alliance scores. More years since injury was associated with a stronger alliance. These findings demonstrate that TBI associated cognitive impairments do not necessarily pose an obstacle to development and maintenance of a strong working alliance, which is more likely to develop with more time post-brain injury.

N-Acetyl Serotonin Protects Neural Progenitor Cells Against Oxidative Stress-Induced Apoptosis and Improves Neurogenesis in Adult Mouse Hippocampus Following Traumatic Brain Injury

In this study, with primary mouse neural progenitor cells (NPCs), we investigated the neuroprotective effect of a tropomyosin-related kinase receptor B (TrkB) agonist, N-acetyl serotonin (NAS), against hydrogen peroxide (H₂O₂)-induced toxicity. We found that pre-incubation with NAS not only ameliorates H₂O₂-induced cell viability loss, lactate dehydrogenase (LDH) release, and proliferative and migratory capacity impairments, but counteracts H₂O₂-triggered production of nitric oxide (NO), reactive oxygen species (ROS), malondialdehyde (MDA), and 8-hydroxy-deoxyguanosine (8-OHdG) in a dose-dependent manner. Additionally, pre-treatment with NAS was able to attenuate H₂O₂-induced apoptosis in NPCs, evidenced by the decreased percentage of apoptotic cells and altered expression of apoptosis-related factors. Furthermore, in differentiated NPCs, NAS improves H₂O₂-induced reduction in neurite growth. Mechanistic studies revealed that the protective effects of NAS in NPCs may be mediated by the TrkB/PI3K/Akt/ cAMP response element binding protein (CREB) signaling cascades. In a mouse traumatic brain injury (TBI) model, we found that systemic administration of 30 mg/kg NAS could improve hippocampal neurogenesis, manifested by the increased number of SOX-2-positive cells and increased expression of phosphorylated CREB in the dentate gyrus (DG) area. Treatment with NAS also ameliorates cognitive impairments caused by TBI, as assessed by Y-maze and contextual and cued fear conditioning tests. Taken together, these results provide valuable insights into the neuroprotective and neuroregenerative effects of NAS, suggesting it may have therapeutic potential for the treatment of TBI.

Treatment of social cognition impairments in patients with traumatic brain injury: a critical review

Objective: The aim of this study is to review published research on treatment of social cognition impairments in patients with traumatic brain injury (TBI).Methods: Following the PRISMA guidelines, a PubMed literature search was conducted, followed by a manual search in recently published papers. Main criteria for selection were that patients had sustained a TBI, and that social cognition was the main target of treatment. A total of 16 papers and three reviews were selected and included in the present review.Results: Five studies (including three randomized controlled trials (RCT)) addressed facial affect recognition, one study specifically addressed emotional prosody, two RCTs used a combination of treatment strategies addressing social perception deficits. Six studies, including two RCTs, addressed social communication skills or theory of mind. Finally, two RCTs reported the effectiveness of a more global approach, addressing multiple domains of social cognition, such as emotion perception, social skills training, and theory of mind.Discussion/conclusion: Although there has been much less research on treatment of social cognition in patients with TBI as compared with psychiatric conditions, the findings reported in the present review are encouraging. Further multicenter large-scale RCTs are needed, with special emphasis on the generalization of treatment effects to social skills in everyday life.

Response to text-based social cues in the formation of causal attributions in adults with traumatic brain injury

BACKGROUND

Adults with traumatic brain injury (TBI) may have deficits recognizing spoken social cues, with major negative social consequences. We do not know if these deficits extend to written social cues. Written cues, such as letterhead, provide information we use to make critical inferences about an author's perspective, and interpret subsequent text considering that perspective, and thus are critical for social communication. This study examined response to written social cues in adults with and without TBI.

METHODS AND PROCEDURES

We asked adults with TBI (n = 38) and uninjured adults (n = 20) to read an article describing actions of a mass murderer and give reasons for the those actions. Materials were presented on letterhead from either a social or a personality institute, to bias responses to either situational or dispositional factors. We hypothesized persons with TBI would be less likely to show bias consistent with the letterhead.

MAIN OUTCOMES AND RESULTS

Significantly more comparison-group responses (72%) than TBI-group responses (52%) were biased (p = 0.01) to match the institute in the letterhead.

CONCLUSIONS

Results indicated reduced sensitivity to written social cues in adults with TBI. Our findings add to evidence of impaired social cue response after TBI, and extend this to written text.

Relationship between social cognition and social behaviour following traumatic brain injury

Objective: To present an overview of studies that investigated associations between social cognition functions (social cue perception, empathy, understanding intentions) and social behaviour or social outcome following traumatic brain injury (TBI).Methods: The literature search was conducted in the Medline, PsycInfo, Cochrane Library and Web of Science databases. Main criteria for selection were that the participants were adult persons with TBI, social cognition as well as social behaviour or social outcome post-TBI was assessed and correlations between social cognition and social behaviour or outcome were reported. Average correlations were calculated based on weighted summation of the correlations from the individual studies.Results: Of the 511 publications identified in the search, 13 were selected. Ten of these assessed emotion recognition, six assessed understanding of intentions and two assessed empathy. Average correlations between social cognition performance and post-injury social behaviour or outcome were significant for each of the three social cognition functions; poorer performance was associated with poorer outcome. Effect sizes varied from small to moderate (understanding intentions) to moderate (emotion recognition) to large (empathy).Conclusions: The associations were in line with models of social cognition and proposals that impairments in social cognition may underlie social behaviour difficulties and poor social outcome following TBI.

Are Moral and Socio-conventional Knowledge Impaired in Severe Traumatic Brain Injury?

Objective

The aim of this study was to investigate explicit moral and socio-conventional knowledge in Traumatic Brain Injury (TBI) patients.

Method

A group of 28 TBI patients was tested on a new set of moral and socio-conventional items. Responses of TBI patients were compared with those of 28 matched controls. Participants had to report how hard would be to perform specific moral or socio-conventional transgressions, using a 10-point Likert scale. We analyzed our data through mixed-effects models, to jointly assess by-participants and by-items variance. The factors considered were Type of Item (Moral vs. Socio-conventional) and Group (TBI vs. Controls).

Results

Results revealed a significant interaction between Type of Item and Group (χ2[1] = 25.5, p < .001). Simple-effects analyses showed that TBI, as Controls, were able to differentiate moral and socio-conventional transgressions (χ2[1] = 72.3, p < .001), as they deemed the former as more difficult to enact. TBI patients, however, evaluated moral transgressions as easier to fulfill (χ2[1] = 12.2, p = .001).

Conclusions

TBI patients can clearly differentiate moral and socio-conventional transgressions, suggesting that the explicit knowledge of these two dimensions is spared. TBI patients, however, considered moral transgressions as easier to fulfill with respect to Controls. This finding may suggest a tendency in TBI patients to underestimate the weight of moral transgressions.

Sex differences in response to emotion recognition training after traumatic brain injury

OBJECTIVE

To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI).

SETTING

Post-acute rehabilitation facilities.

PARTICIPANTS

203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men).

DESIGN

Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist.

MEASURES

Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST).

RESULTS

A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention.

CONCLUSION

This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.

Theory of Mind after Severe Acquired Brain Injury: Clues for Interpretation

Background. Recently, increased interest has been shown in Theory of Mind (ToM) abilities of individuals with severe acquired brain injury (sABI). ToM impairment following sABI can be associated with altered executive functioning and/or with difficulty in decoding and elaborating emotions. Two main theoretical models have been proposed to explain the mechanisms underlying ToM in the general population: Theory Theory and Simulation Theory. This review presents and discusses the literature on ToM abilities in individuals with sABI by examining whether they sustain the applicability of the Theory Theory and/or Simulation Theory to account for ToM deficits in this clinical population. We found 32 papers that are directly aimed at investigating ToM in sABI. Results did not show the univocal predominance of one model with respect to the other in explaining ToM deficits in sABI. We hypothesised that ToM processes could be explained by coinvolvement of the two models, i.e., according to personal experience, cognitive features, or the emotional resources of the persons with sABI.

Toward a Two-Dimensional Model of Social Cognition in Clinical Neuropsychology: A Systematic Review of Factor Structure Studies

OBJECTIVE

Social cognition has received growing interest in many conditions in recent years. However, this construct still suffers from a considerable lack of consensus, especially regarding the dimensions to be studied and the resulting methodology of clinical assessment. Our review aims to clarify the distinctiveness of the dimensions of social cognition.

METHOD

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, a systematic review was conducted to explore the factor structure of social cognition in the adult general and clinical populations.

RESULTS

The initial search provided 441 articles published between January 1982 and March 2017. Eleven studies were included, all conducted in psychiatric populations and/or healthy participants. Most studies were in favor of a two-factor solution. Four studies drew a distinction between low-level (e.g., facial emotion/prosody recognition) and high-level (e.g., theory of mind) information processing. Four others reported a distinction between affective (e.g., facial emotion/prosody recognition) and cognitive (e.g., false beliefs) information processing. Interestingly, attributional style was frequently reported as an additional separate factor of social cognition.

CONCLUSIONS

Results of factor analyses add further support for the relevance of models differentiating level of information processing (low- vs. high-level) from nature of processed information (affective vs. cognitive). These results add to a significant body of empirical evidence from developmental, clinical research and neuroimaging studies. We argue the relevance of integrating low- versus high-level processing with affective and cognitive processing in a two-dimensional model of social cognition that would be useful for future research and clinical practice. (JINS, 2018, 24, 391-404).

Reliability of two social cognition tests: The combined stories test and the social knowledge test

Deficits in social cognition are common in psychiatric disorders. Validated social cognition measures with good psychometric properties are necessary to assess and target social cognitive deficits. Two recent social cognition tests, the Combined Stories Test (COST) and the Social Knowledge Test (SKT), respectively assess theory of mind and social knowledge. Previous studies have shown good psychometric properties for these tests, but the test-retest reliability has never been documented. The aim of this study was to evaluate the test-retest reliability and the inter-rater reliability of the COST and the SKT. The COST and the SKT were administered twice to a group of forty-two healthy adults, with a delay of approximately four weeks between the assessments. Excellent test-retest reliability was observed for the COST, and a good test-retest reliability was observed for the SKT. There was no evidence of practice effect. Furthermore, an excellent inter-rater reliability was observed for both tests. This study shows a good reliability of the COST and the SKT that adds to the good validity previously reported for these two tests. These good psychometrics properties thus support that the COST and the SKT are adequate measures for the assessment of social cognition.