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Although the adverse consequences of changes in social behavior following traumatic brain injury (TBI) are well documented, relatively little is known about possible underlying neuropsychological deficits. Following a model originally developed for social behavior deficits in schizophrenia, we investigated whether impairments in emotion recognition, understanding of other people's intentions ("theory of mind"), and cognitive flexibility soon after first TBI or 1 year later were associated with self and proxy ratings of behavior following TBI. Each of the three functions was assessed with two separate tests, and ratings of behavior were collected on three questionnaires. Patients with TBI (n 5 33) were impaired in emotion recognition, "theory of mind," and cognitive flexibility compared with matched orthopedic controls (n 5 34). Proxy ratings showed increases in behavioral problems 1 year following injury in the TBI group but not in the control group. However, test performance was not associated with questionnaire data. Severity of the impairments in emotion recognition, understanding intention, and flexibility were unrelated to the severity of behavioral problems following TBI. These findings failed to confirm the used model for social behavior deficits and may cast doubt on the alleged link between deficits in emotion recognition or theory of mind and social functioning. (JINS, 2008, 14, 318-326.)

Most studies into acquired theory of mind (ToM) deficits assessed patients once, long after the onset of brain injury. As a result, the time course of acquired ToM impairments is largely unknown. The present study examined whether ToM impairments following traumatic brain injury (TBI) recover, remain stable, or worsen over time. Because of the alleged association between ToM and social communication, ToM impairments may deteriorate because of changes in patients' social environment following injury. ToM ability and executive functioning were assessed shortly after injury and at 1-year follow-up. Compared with the orthopedic control group, the TBI group was impaired on ToM and executive functioning tasks at both assessments. Furthermore, the ToM impairments in the TBI group remained stable over time.