Assessment of pragmatic communication skills in adolescents after traumatic brain injury

Development of a Social Communication Questionnaire (QSC-ID) for People With Intellectual Disability in a Deaf Sample: A Pilot and Feasibility Study

Background: Social communication (SC) includes the use and interpretation of verbal and non-verbal messages within a social context and thus requires more than knowledge of language. Social communication skills are essential for connecting and engaging with others, and SC deficits are often associated with emotional and behavioral problems. There is a lack of feasible instruments for assessing SC skills in individuals with intellectual disability (ID). Methods: A questionnaire on social communication in adults with ID (QSC-ID) comprising 20 Likert-scaled items was developed and completed on behalf of participants (n = 52) from three Austrian therapeutic living communities for people with ID and deafness by their living- and working-facility key caregivers. The sample of adults with hearing loss was considered ideal for the development of a measure of SC that is not restricted to a specific communication mode or overly related with language skills. Results: The preliminary results showed high construct validity. Correlations were high between SC and language, social skills, and severity of autism spectrum disorder (ASD), moderate between SC and adaptive skills, and non-verbal intelligence and, as expected, low between SC and motor skills. Interrater reliability was found to be good or at least acceptable for all items. Total raw scores were well-distributed over the whole range-Cut-offs based on the 10th and 20th percentile are suggested to identify atypical and borderline SC skills. Caregiver feedback and completeness of data suggest that the questionnaire is highly feasible. Conclusion: Questionnaire on social communication in adults with ID is an easy-to-use caregiver-reported questionnaire for use with individuals with mild to severe forms of ID. Initial testing of validity looks promising. Further validation in populations with typical hearing is required. Due to substantial correlations between SC and structural language skills the calculation of specific SC cut-offs for different levels of linguistic skills should be considered when sufficient data is available.

The Role of Gesture in Communication and Cognition: Implications for Understanding and Treating Neurogenic Communication Disorders

When people talk, they gesture. Gesture is a fundamental component of language that contributes meaningful and unique information to a spoken message and reflects the speaker's underlying knowledge and experiences. Theoretical perspectives of speech and gesture propose that they share a common conceptual origin and have a tightly integrated relationship, overlapping in time, meaning, and function to enrich the communicative context. We review a robust literature from the field of psychology documenting the benefits of gesture for communication for both speakers and listeners, as well as its important cognitive functions for organizing spoken language, and facilitating problem-solving, learning, and memory. Despite this evidence, gesture has been relatively understudied in populations with neurogenic communication disorders. While few studies have examined the rehabilitative potential of gesture in these populations, others have ignored gesture entirely or even discouraged its use. We review the literature characterizing gesture production and its role in intervention for people with aphasia, as well as describe the much sparser literature on gesture in cognitive communication disorders including right hemisphere damage, traumatic brain injury, and Alzheimer's disease. The neuroanatomical and behavioral profiles of these patient populations provide a unique opportunity to test theories of the relationship of speech and gesture and advance our understanding of their neural correlates. This review highlights several gaps in the field of communication disorders which may serve as a bridge for applying the psychological literature of gesture to the study of language disorders. Such future work would benefit from considering theoretical perspectives of gesture and using more rigorous and quantitative empirical methods in its approaches. We discuss implications for leveraging gesture to explore its untapped potential in understanding and rehabilitating neurogenic communication disorders.

Pragmatic Language Skills: A Comparison of Children With Cochlear Implants and Children Without Hearing Loss

Pragmatic language ability refers to the ability to use language in a social context. It has been found to be correlated with success in general education for deaf and hard of hearing children. It is therefore of great importance to study why deaf and hard of hearing children often perform more poorly than their hearing peers on tests measuring pragmatic language ability. In the current study the Pragmatics Profile questionnaire from the CELF-IV battery was used to measure pragmatic language ability in children using cochlear implants (N = 14) and children without a hearing loss (N = 34). No significant difference was found between the children with cochlear implants (CI) and the children without hearing loss (HL) for the sum score of the pragmatics language measure. However, 35.71% of the children with CI performed below age norm, while only 5.89% of the children without HL performed below age norm. In addition, when dividing the sum score into three sub-measures: Rituals and Conversational skills (RCS), Asking for, Giving, and Responding to Information (AGRI), and Nonverbal Communication skills (NCS), significant differences between the groups were found for the NCS measure and a tendency for a difference was found for the RCS measure. In addition, all three sub-measures (NCS, AGRI, RCS) were correlated to verbal fluency in the children with CI, but not the children without HL.

Performance and visual arts-based programs for children with disabilities: a scoping review focusing on psychosocial outcomes

Purpose: There is a growing movement in pediatric rehabilitation to understand how approaches addressing aspects beyond body function contribute to enhanced psychosocial well-being. Among such approaches is the use of creative arts. A scoping review was undertaken to synthesize the current literature on performance and visual arts-based programs and outcomes for children with disabilities.Methods: Data sources included CINAHL, MEDLINE, and PsycINFO. Eligible articles described programs involving performing or visual art activities in community and ambulatory care settings, delivered to children between 6 and 18 years with physical or developmental disabilities, and reported on at least one psychosocial outcome. Domains of interest included emotional, social, behavioral, physical, cognitive, and/or communicative functioning, which are known to impact well-being and participation. No limits were applied to study design.Results: Twelve articles using primarily case study and quasi-experimental designs were identified, encompassing an 11-year period. Most programs focused on theater as the central modality. A majority of papers addressed changes in physical, cognitive, and communicative function (n = 8), followed by social function (n = 6), emotional function (n = 5), and finally, behavioral function (n = 3). Across individual papers, diverse study designs, measures, and outcomes were examined with positive qualitative and/or quantitative findings noted across all domains.Conclusions: Within an emerging evidence base, arts-based programs show potential to positively impact psychosocial well-being and warrant further investigation with broader populations of children with physical and developmental disabilities. A greater emphasis on programmatic approaches and enhanced methodological rigor to establishing benefits is needed to advance understanding.Implications for rehabilitationPediatric therapists may wish to consider recommending arts-based programs for children with ASD, TBI, and other developmental disabilities given their potential in achieving psychosocial outcomesArts-based programs in rehabilitation provide creative ideas (e.g., drawing, painting) and techniques (e.g., modeling, role-play), which may be incorporated into individualized or group-based therapy to promote psychosocial well-beingProgram evaluators and researchers are encouraged to adopt a programmatic approach to further explore how art activities facilitate psychosocial outcomes.

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.

"Trying to Get a Grip": Language Competence and Self-Reported Satisfaction With Social Relationships Three Decades Post-Childhood Traumatic Brain Injury

OBJECTIVE

(1) To investigate outcomes in language competence and self-reported satisfaction with social relationships in long-term survivors of childhood traumatic brain injury (TBI); and (2) to establish whether language competence contributes to self-reported satisfaction with social relationships decades after sustaining childhood TBI.

PARTICIPANTS

Twelve females and 8 males aged 30 to 55 (mean = 39.80, standard deviation = 7.54) years who sustained a TBI during childhood and were on average 31 years postinjury (standard deviation = 9.69). An additional 20 participants matched for age, sex, handedness, years of education, and socioeconomic status constituted a control group.

MAIN MEASURES

Test of Language Competence-Expanded Edition and the Quality of Life in Brain Injury questionnaire.

RESULTS

Individuals with a history of childhood TBI performed significantly poorer than their non-injured peers on 2 (Ambiguous Sentences and Oral Expression: Recreating Sentences) out of the 4 Test of Language Competence-Expanded Edition subtests used and on the Quality of Life in Brain Injury subscale assessing satisfaction with social relationships. In the TBI group, scores obtained on the Ambiguous Sentences subtest were found to be a significant predictor of satisfaction with social relationships, explaining 25% of the variance observed.

CONCLUSIONS

The implication of high-level language skills to self-reported satisfaction with social relationships many decades post-childhood TBI suggests that ongoing monitoring of emerging language skills and support throughout the school years and into adulthood may be warranted if adult survivors of childhood TBI are to experience satisfying social relationships.

Pragmatic Ability Deficit in Schizophrenia and Associated Theory of Mind and Executive Function

Deficits in pragmatic abilities have frequently been observed in patients with schizophrenia. The objective of the study was to investigate the relationship between pragmatic deficits, ToM deficits and executive dysfunctions in schizophrenia. A group of 42 schizophrenic patients and 42 healthy controls were assessed on irony task (one type of pragmatic language), two subcomponents of ToM (cognitive and affective), and three subcomponents of EF (inhibition, updating, and switching). The clinical symptoms in schizophrenia were assessed using the positive and negative symptoms of schizophrenia. The schizophrenia group exhibited significant impairments in all above tasks compared to the control group. Correlation results found that irony scores were correlated with the two subcomponents of ToM and two of the three subcomponents of EF (inhibition and updating). The regression analysis revealed that the cognitive ToM and inhibition predicted 9.2% and 29.9% of the variance of irony comprehension in the patient group, and inhibition was the best predictor for performance on irony task. Irony understanding was related to positive symptoms, but not to negative symptoms. The results suggest that the ability to interpret pragmatic language depends on schizophrenic patients' ability to infer mental states and the ability of inhibition. It provides empirical evidence for a particular target of inhibition for rehabilitation and intervention programs developed for schizophrenic patients.

Labelling Facial Affect in Context in Adults with and without TBI

Recognition of facial affect has been studied extensively in adults with and without traumatic brain injury (TBI), mostly by asking examinees to match basic emotion words to isolated faces. This method may not capture affect labelling in everyday life when faces are in context and choices are open-ended. To examine effects of context and response format, we asked 148 undergraduate students to label emotions shown on faces either in isolation or in natural visual scenes. Responses were categorised as representing basic emotions, social emotions, cognitive state terms, or appraisals. We used students' responses to create a scoring system that was applied prospectively to five men with TBI. In both groups, over 50% of responses were neither basic emotion words nor synonyms, and there was no significant difference in response types between faces alone vs. in scenes. Adults with TBI used labels not seen in students' responses, talked more overall, and often gave multiple labels for one photo. Results suggest benefits of moving beyond forced-choice tests of faces in isolation to fully characterise affect recognition in adults with and without TBI.

Cognitive-communication disorders in children with traumatic brain injury

Children with moderate to severe traumatic brain injury (TBI) are at risk of developing cognitive-communication disorders that have devastating effects on their school life, family life, and social life. These problems can be difficult for families to describe and may be overlooked by community-based providers who are unfamiliar with TBI sequelae. To support the identification and management of cognitive-communication disorders, we review the common signs and symptoms of these disorders in children with TBI and discuss principles of assessment and intervention.

Social cognition in adolescent girls with fragile x syndrome

This study aimed to characterize social cognition, executive functions (EFs), and everyday social functioning in adolescent girls with fragile X syndrome, and identify relationships among these variables. Participants were 20 girls with FXS and 20 age-matched typically developing peers. Results showed significant between-groups differences in social cognition, accounted for by differences in IQ and language. Within the FXS group, IQ and language were related to social cognition; parent-reported social functioning was related to language and EFs; and self-reported social functioning was generally good and not related to cognitive or social cognition variables. Results suggest that intervention might focus on managing language and cognitive contributions to social functioning, rather than social cognition, and underscore the importance of considering parent and adolescent perspectives.

Arts-based social skills interventions for adolescents with acquired brain injuries: five case reports

OBJECTIVE

Previous research has demonstrated the value of arts-based programs for adolescents with childhood brain disorder to facilitate social skills and participation. The current study extends this work by examining the feasibility and effectiveness of an arts-based intervention for youth with acquired brain injuries (ABI).

METHODS

A case study approach was used with four adolescent participants and one case control. A battery of quantitative measures were administered four and one week pre-intervention, one week post-intervention, as well six to eight month post-intervention.

RESULTS

Improvements in pragmatic communication skills and social and participation goals were observed across intervention participants. Similar improvements were not seen with the case control participant.

CONCLUSION

Results support the use of an arts-based intervention for youth with ABI to facilitate social skills and participation. Findings also highlight the need for more sensitive measures of these skills for these youth. Suggested guidelines for program implementation are provided.

Assessing social cognition and pragmatic language in adolescents with traumatic brain injuries

Traumatic brain injuries (TBI) in children and adolescents can impair social cognition and communication skills but there are few assessment tools suitable for adolescents. The Awareness of Social Inference Test (TASIT) uses professionally enacted audiovisual vignettes of everyday conversational exchanges and is a valid measure of social perception disorders in adults. This study examined its utility for assessing impairments in social cognition in a group of 16 adolescents with TBI, compared to a group of 16 typically developing (TD) adolescents. Adolescents with TBI were, on average, no different to their TD peers on TASIT 1 (emotion recognition) and TASIT 3 (recognizing lies and sarcasm when provided with additional cues) but performed more poorly on TASIT 2 which required them to interpret sarcastic and sincere conversational exchanges with few cues other than the demeanor of the speakers. Within the TBI group, poor performance on TASIT correlated to both relative and self-reported communication difficulties at home. It also correlated with IQ, face recognition and severity of injury as indexed by duration of post-traumatic amnesia. Overall, this study suggests TASIT is a valid measure for adolescents although it raised questions as to how effective normative data is for comparing performance in social cognition during childhood and adolescence.

Impairments in social cognition following severe traumatic brain injury

Severe traumatic brain injury (TBI) leads to physical, neuropsychological, and emotional deficits that interfere with the individual’s capacity to return to his or her former lifestyle. This review focuses on social cognition, that is, the capacity to attend to, recognize and interpret interpersonal cues that guide social behavior. Social cognition entails ‘‘hot’’ processes, that is, emotion perception and emotional empathy and ‘‘cold’’ processes, that is, the ability to infer the beliefs, feelings, and intentions of others (theory of mind: ToM) to see their point of view (cognitive empathy) and what they mean when communicating (pragmatic inference). This review critically examines research attesting to deficits in each of these domains and also examines evidence for theorized mechanisms including specific neural networks, the role of simulation, and non-social cognition. Current research is hampered by small, heterogeneous samples and the inherent complexity of TBI pathology. Nevertheless, there is evidence that facets of social cognition are impaired in this population. New assessment tools to measure social cognition following TBI are required that predict everyday social functioning. In addition, research into remediation needs to be guided by the growing empirical base for understanding social cognition that may yet reveal how deficits dissociate following TBI.

Cognitive and psychopathological sequelae of pediatric traumatic brain injury

Childhood traumatic brain injury (TBI) is a frequent cause of acquired disability in childhood and can have a serious impact on development across the lifespan. The consequences of early TBI vary according to injury severity, with severe injuries usually resulting in more serious physical, cognitive and behavioral sequelae. Both clinical and research reports document residual deficits in a range of skills, including intellectual function, attention, memory, learning, and executive function. In addition, recent investigations suggest that early brain injury also affects psychological and social development and that problems in these domains may increase in the long term postinjury. Together, these deficits affect children's ability to function effectively at school, in the home, and in their social environment, resulting in impaired acquisition of knowledge, psychological and social problems, and overall reduced quality of life. Ultimately, recovery from childhood TBI depends on a range of complex biological, developmental, and psychosocial factors making prognosis difficult to predict. This chapter will detail the cognitive (intellectual, attentional, mnesic, executive, educational, and vocational) and psychopathological (behavioral, adaptive, psychological, social) sequelae of childhood TBI with a particular focus on postinjury recovery patterns in the acute, short-, and long-term phases, as well as into adulthood.

Two case study evaluations of an arts-based social skills intervention for adolescents with childhood brain disorder

OBJECTIVE

Arts-based programmes have been shown to be useful for individuals with disturbances in cognitive and behavioural functioning. The current case studies examined the feasibility and effectiveness of a theatre skills training programme to facilitate social skills and participation for adolescents with childhood brain disorder.

METHODS

A case study approach was used with two adolescent participants. Focus groups were conducted immediately post-intervention, while a battery of quantitative measures were administered pre- and post-treatment, as well as 8 months post-treatment.

RESULTS

Perceived and documented improvements in social skills and participation were observed from pre- to post-intervention and at follow-up.

CONCLUSION

Results support the use of an arts-based intervention for youth with brain injuries to facilitate social skills and participation. Findings also highlight the need for more sensitive measures of these skills for youth with childhood brain disorder, who may have impaired awareness of their abilities and/or impairments in memory and language comprehension.

Terminology and Methodology in the Assessment of Cognitive-Linguistic Disorders

The term ‘cognitive-linguistic’ has been widely adopted in descriptions of a variety of communication disorders of neurogenic origin. Despite this, clear agreement on the meaning of the term has yet to be reached, with the result that it is used both inconsistently and misleadingly. This lack of terminological clarity also undermines the assessment of complex communicative function. In this article the terminology associated with complex communication disorders is discussed and a simple framework for conceptualising cognitive-linguistic function is outlined. On the basis of this it is proposed that some currently available assessments that purport to measure cognitive-linguistic skills in fact have less explanatory power than other assessments that are often not specifically targeted at communication. Further, it is suggested that the framework offers an ecologically valid basis for the systematic assessment of cognitive-linguistic function.

The relationship of resting cerebral blood flow and brain activation during a social cognition task in adolescents with chronic moderate to severe traumatic brain injury: a preliminary investigation

Alterations in cerebrovascular function are evident acutely in moderate to severe traumatic brain injury (TBI), although less is known about their chronic effects. Adolescent and adult patients with moderate to severe TBI have been reported to demonstrate diffuse activation throughout the brain during functional magnetic resonance imaging (fMRI). Because fMRI is a measure related to blood flow, it is possible that any deficits in blood flow may alter activation. An arterial spin labeling (ASL) perfusion sequence was performed on seven adolescents with chronic moderate to severe TBI and seven typically developing (TD) adolescents during the same session in which they had performed a social cognition task during fMRI. In the TD group, prefrontal CBF was positively related to prefrontal activation and negatively related to non-prefrontal, posterior, brain activation. This relationship was not seen in the TBI group, who demonstrated a greater positive relationship between prefrontal CBF and non-prefrontal activation than the TD group. An analysis of CBF data independent of fMRI showed reduced CBF in the right non-prefrontal region (p<.055) in the TBI group. To understand any role reduced CBF may play in diffuse extra-activation, we then related the right non-prefrontal CBF to activation. CBF in the right non-prefrontal region in the TD group was positively associated with prefrontal activation, suggesting an interactive role of non-prefrontal and prefrontal blood flow throughout the right hemisphere in healthy brains. However, the TBI group demonstrated a positive association with activation constrained to the right non-prefrontal region. These data suggest a relationship between impaired non-prefrontal CBF and the presence of non-prefrontal extra-activation, where the region with more limited blood flow is associated with activation limited to that region. In a secondary analysis, pathology associated with hyperintensities on T2-weighted FLAIR imaging over the whole brain was related to whole brain activation, revealing a negative relationship between lesion volume and frontal activation, and a positive relationship between lesion volume and posterior activation. These preliminary data, albeit collected with small sample sizes, suggest that reduced non-prefrontal CBF, and possibly pathological tissue associated with T2-hyperintensities, may provide contributions to the diffuse, primarily posterior extra-activation observed in adolescents following moderate to severe TBI.

Measuring goodness of story narratives

PURPOSE

The purpose of this article was to evaluate a new measure of story narrative performance: story completeness. It was hypothesized that by combining organizational (story grammar) and completeness measures, story "goodness" could be quantified.

METHOD

Discourse samples from 46 typically developing adults were compared with those from 24 adults with acquired brain injuries. Story retellings were elicited and analyzed for episode structure (story grammar). Each story was also evaluated for the presence of 5 key components, yielding the story completeness score. Story goodness was quantified by combining the story grammar and completeness measures using a 2-coordinate grid system. A multivariate analysis of variance was performed as well as correlational analyses between the story grammar and story completeness scores.

RESULTS

There were significant group differences on both story grammar and story completeness. Moderate correlations were noted between the 2 measures, suggesting that the indices were not entirely measuring the same abilities. Plotting the 2 sets of scores into quadrants discriminated the comparison group and the group with brain injury into 4 distinct categories of story "goodness."

CONCLUSION

The combination of measures provided a more accurate depiction of discourse performance than either measure alone. Results suggest the measure is sensitive, is reliable, and has potential utility for investigating discourse deficits in clinical populations.

Community integration interventions for youth with acquired brain injuries: a review

OBJECTIVE

To identify and summarize published literature that examined the effectiveness of social and community integration interventions for children and adolescents with ABI in order to provide recommendations regarding future research on this topic.

METHODS

A literature review was conducted to identify studies that focused on social and community integration interventions for youth with ABI. Further manual searching of relevant journals with a paediatric rehabilitation focus was also carried out.

RESULTS

Currently, limited research has been published evaluating such interventions. The lack of research may stem largely from issues relating to how to measure community integration. Recommendations regarding intervention settings and structure are discussed.

CONCLUSION

Additional studies investigating social and community integration interventions are necessary, including those with measures tailored specifically to community integration, larger samples, as are better controls and recruitment of youth with varying severities of brain injuries.

The relation of cognitive control to social outcome after paediatric TBI: Implications for intervention

HYPOTHESIS

This study postulated cognitive control is related to social outcome in children with traumatic brain injury (TBI) and orthopaedic injury (OI). PROCEDURE AND DESIGN: This study analysed 12-month, post-injury, cross-sectional data from 52 children (7-17 years) with moderate-to-severe TBI and 41 children with OI. Cognitive control was measured with the Sternberg Task (memory) and the Flanker Task (resistance to interference). Relations to social outcome (Vineland Adaptive Behavioural Scales-Socialization and Communications domains) were measured.

RESULTS

Reaction time (RT) on the Sternberg task was related to social outcome, with stronger relations in children of lower SES. Flanker baseline and interference RTs were related to social outcome, with the relation for interference RT more robust in children with lower SES.

CONCLUSIONS

Cognitive control is related to social outcome. Further, it is suggested that cognitive training may have positive effects on social function through improved efficiency of social information processing.

Paediatric traumatic brain injury: A review of pertinent issues

Children with traumatic brain injury (TBI), regardless of the severity of the injury, often face challenges when living in home, school and community. Their needs are often overlooked and recognition of the long-term consequences is not always central to the management of the child in the school or community. This article provides references to pertinent literature and suggestions for intervention from the clinical experiences of four individuals with extensive experience of the family stresses, educational, cognitive-communicative and behavioural challenges that occur after TBI in children. It provides information regarding these issues, particularly educational situations, and suggests methods that may be useful for service providers and family members.

Reliability and validity of The Awareness of Social Inference Test (TASIT): A clinical test of social perception

PURPOSE

The Awareness of Social Inference Test (TASIT) is an audiovisual tool designed for the clinical assessment of social perception with alternate forms for re-testing. Part 1 assesses emotion recognition, Parts 2 and 3 assess the ability to interpret conversational remarks meant literally (i.e., sincere remarks and lies) or non-literally (i.e., sarcasm) as well as the ability to make judgments about the thoughts, intentions and feelings of speakers. This paper aims to examine TASIT's reliability and validity.

METHOD

Some 32 adults with severe, chronic brain injuries were administered Form A twice, one week apart. 38 adults with brain injuries were readministered alternate forms over a period of 5 - 26 weeks. Construct validity was examined in subsets of a sample of 116 adults with brain injuries by relating TASIT performance to standard tests of neuropsychological function and specific social perception measures.

RESULTS

Test-retest reliability ranged from 0.74 - 0.88. Alternate forms reliability ranged from 0.62 - 0.83. TASIT performance was associated with face perception, information processing speed and working memory. Socially relevant new learning and executive tasks were significantly associated with TASIT performance whereas non-social tasks showed little association. Social perception tasks such as Ekman photos and theory of mind stories were also associated.

CONCLUSIONS

TASIT has adequate psychometric properties as a clinical test of social perception. It is not overly prone to practice effects and is reliable for repeat administrations. Performance on TASIT is affected by information processing speed, working memory, new learning and executive functioning, but the uniquely social material that comprises the stimuli for TASIT will provide useful insights into the particular difficulties people with clinical conditions experience when interpreting complex social phenomena.

Adolescent Brain and Cognitive Developments: Implications for Clinical Assessment in Traumatic Brain Injury

Adolescence is a time of significant physical, social, and emotional developments, accompanied by changes in cognitive and language skills. Underlying these are significant developments in brain structures and functions including changes in cortical and subcortical gray matter and white matter tracts. Among the brain regions that develop during adolescence are areas that are commonly damaged as a result of a traumatic brain injury (TBI). This paper summarizes major brain changes during adolescence and evidence linking maturation of these cognitive and language functions to brain development, placing consideration of both areas of development in the context of rehabilitation for adolescents with TBI.

Pragmatic language interpretation after closed head injury: relationship to executive functioning

INTRODUCTION

Closed head injury is associated with impairment in a range of executive skills, and with everyday difficulties in social interactions. Comprehension of pragmatic language plays an important role in social interactions. The present study was designed to examine performance on a task involving pragmatic judgement in people who had suffered closed head injury (CHI), and the relationship between this and any impairments in executive skills.

METHODS

Participants with CHI were compared to a matched healthy control group on a pragmatic inference task consisting of a series of brief vignettes. Participants made judgements about alternative responses in relation to social appropriateness/skill, and carried out several nonsocial executive tasks thought to play a role in pragmatic judgement.

RESULTS

The CHI group was poorer than the control group on the pragmatic measure, showing less discrimination than the control group between direct, literal interpretations and correct, indirect interpretations. They also performed more poorly on the nonsocial executive measures. Regression analysis showed an association between pragmatic performance and one of the executive tasks, a measure of inhibition.

CONCLUSIONS

More work is needed to explore further the nature of any relationship between pragmatic judgement and executive skills.

Weak coherence, no theory of mind, or executive dysfunction? Solving the puzzle of pragmatic language disorders

Deficits in pragmatic language ability are common to a number of clinical populations, for example, right-hemisphere damage (RHD), Autism and traumatic brain injury (TBI). In these individuals the basic structural components of language may be intact, but the ability to use language to engage socially is impaired. Despite the nature of these difficulties being well documented, exactly what causes these difficulties is less clear. Furthermore, the current status of causal explanations for pragmatic difficulties across these populations is divergent and sometimes contradictory. This paper explores the empirical validity of three theories that attempt to explain pragmatic language impairment. It is recommended that a new, more convergent approach to investigating the causes of pragmatic language disability be adopted.

Delayed predictive accuracy of narrative recall after traumatic brain injury: salience and explicitness

Fifteen adults with traumatic brain injury (TBI) and 15 adults without brain injury listened to narratives, made delayed predictions of recall, and took a delayed recall test. Narrative questions differed by salience (main ideas, details) and explicitness (implied, stated) (R. H. Brookshire & L. E. Nicholas, 1993). TBI survivors recalled less than control participants regardless of question type. All participants recalled main ideas and implied information with greater accuracy than details and stated information. Predictive accuracy for recalling stated information was strong regardless of group. Participants were unable to predict recall for implied information. The materials-appropriate-processing (MAP) hypothesis proposes that predictive accuracy is biased by text type (i.e., predictive accuracy for recalling main ideas should be higher than for details when learning narratives). However, there were no differences in predictive accuracy for recalling main ideas and details, with both groups predicting recall modestly well. Controlling for explicitness appears to be an important variable for future metamemory text studies.

Brain injury and violent crime

PRIMARY OBJECTIVE

To test the hypothesis that TBI is associated with violent crime, the prevalence and characteristics of traumatic brain injury (TBI) were compared between men convicted of domestic violence and a matched comparison group.

METHODS AND PROCEDURES

Participants were 20 African American men convicted of domestic violence and 20 African American men without criminal convictions matched for age and socioeconomic status. Participants completed a questionnaire regarding health and behaviour history.

MAIN OUTCOMES AND RESULTS

More than half of the participants in both groups had sustained a TBI, although injuries in the offender group were significantly more severe. There were significantly more reports of problems with anger management in the offender group.

CONCLUSIONS

Published epidemiological data regarding TBI may underestimate the prevalence in urban populations, which may have confounded earlier studies of TBI and domestic violence. The reported prevalence in this sample of defendants suggests implications for the justice system.

Social information processing in adolescents: data from normally developing adolescents and preliminary data from their peers with traumatic brain injury

OBJECTIVE

To assess aspects of social information processing in naturalistic conversations, using online videotape tasks.

DESIGN AND PARTICIPANTS

The tasks were administered to 60 normally developing (ND) subjects ages 13 to 21, and 10 adolescents with traumatic brain injury (TBI).

SETTING

University.

MAIN OUTCOME MEASURE

Task accuracy scores and measures of reliability and validity.

RESULTS AND CONCLUSIONS

ND group scores were generally high, without significant differences by race, sex or age. TBI group scores were significantly lower than ND group scores for both emotion recognition and detection of conversation skills. The results are discussed in light of the evaluation of pragmatic competence in adolescents with TBI.

Assessment of syntax after adolescent brain injury: effects of memory on test performance

In this study, we investigated the influence of working memory load on performance of a task designed to measure receptive syntax ability. Subjects were 6 brain-injured adolescents and 6 hospitalized control subjects matched for age, sex, and general ability. Each subject was administered the Listening/Grammar subtest of the Test of Adolescent Language (TOAL-3) and a modified version of this subtest with identical syntax and fewer response choices (i.e., a reduced working memory processing and storage load). The syntactic structures tested on these tasks also were measured in spontaneous narratives. The brain-injured subjects' performance was significantly worse than that of controls on both versions of the syntax comprehension subtest. There was a significant group-by-task interaction, as brain-injured subjects' performance was significantly worse on the Listening/Grammar subtest than the modified subtest, whereas Control subjects'performance did not differ across the two tasks. In their spontaneous narratives, subjects in both groups produced the syntactic structures tested on the receptive syntax tasks, with no between-groups difference in syntax production. The results are discussed in terms of test validity and the impact of measurement methods on test performance in disordered groups.