Cognitive–communication disorders in children with traumatic brain injury

Abstract

ABBREVIATION TBI Traumatic brain injuryChildren 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.Traumatic brain injury (TBI) is common among children and adolescents. 1 Current incidence and prevalence statistics are thought to underestimate the true incidence of TBI in these age groups, as most injuries are mild and many are not reported.1 Emerging international standards for evaluation and management of mild TBI 2 and growing awareness of potential long-term morbidity after mild TBI 3 mean that it is likely that the accuracy of incidence and prevalence estimates will be improved in the coming years.After discharge from hospital, it is likely that children with TBI will be cared for by community-based care providers who have little specialized knowledge of TBI and its sequelae. Thus, children and adolescents with TBI may lack a long-term 'medical home' 4 because they lack a physician or other care providers who understand the implications of TBI as a chronic disease. Community-based care providers play a critical role in this long-term stage not only by managing chronic postinjury health, social, and educational problems, but also as a source of referral to appropriate therapies and other services. The aim of this paper is to provide a resource for community care providers in both of these roles.In this paper, we review one aspect of outcome from paediatric TBI: long-term impairments in what is referred to as cognitive-communication ability.5 While language disorders such as aphasia can result from paediatric TBI, the more common clinical finding is a communication disorder due to underlying impairments in cognitive functions, such as attention, working memory, declarative learning, executive functions, and social cognition.6,7 Cognitive impairments can affect any communication modality (listening, speaking, gesturing, reading, or writing); and any language domain (phonology, morphology, syntax, semantics, or pragmatics). 5 We chose to focus on cognitive-communication disorders in this paper because they can be less obvious than gross sensory or motor impairments, and thus might be missed in a clinical examination. It can also be difficult for families to describe signs of a cognitive-communication disorder clearly to a care provider. Communication impairments in general are a major source of stress and burden for families, 8 and may affect long-term outcomes in school life 7 and social life. 9 Thus, it is important to recognize cognitive-communication challenges in children and adolescents with TBI and refer t...

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

“…The finding was indicative of a reciprocal relationship where reduced competence in resolving ambiguous sentences was associated with lower self-reported social satisfaction in the TBI group and, vice versa, increased ability to resolve ambiguous sentences was associated with greater satisfaction with social relationships. The current findings of residual high-level language impairments in the TBI group are consistent with previous studies reporting impairments in high-level language skills as a common consequence of childhood TBI, 5,12,19,[42][43][44][45]56 among them deficits in the explanation of ambiguous content. 12,56 In addition, individuals with a history of childhood TBI reported lower satisfaction with their social relationships, which is congruent with adverse social outcomes reported in previous studies investigating social functioning following childhood TBI.…”

“…[39][40][41] A commonly observed pattern in studies examining language outcomes following childhood TBI is that early acquired basic language skills, such as picture naming, are frequently spared from disruption. 42 In children, TBIs typically disrupt later emerging, complex language skills, such as the interpretation of ambiguous or figurative expressions and inferences, 12,43 as well as the comprehension of humor and sarcasm. 44,45 Relying on frontal lobe input to relay neural processes, these complex language functions are required for deciphering nonliteral meanings, which allow social messages to be enriched by inferential and humorous expressions.…”

“…Indicating frontal lobe dysfunction, 56 problems in reflecting on the social use of language, 43,48 using language in context, 55 and using language to achieve a specific goal 57 are the most commonly reported communication problems in childhood TBI. 42 These high-level language problems are typically referred to as deficits in social pragmatic language skills and deficits in metalinguistic awareness or the ability to reflect on the use of language. Both are important for the analysis, reflection, and interpretation of conversations beyond the literal meaning of words.…”

“…Both are important for the analysis, reflection, and interpretation of conversations beyond the literal meaning of words. 42,58 McDonald and colleagues 46 found that pragmatic skills are complex and reliant upon cognitive function, which may only be evident in late childhood when metalinguistic demands for abstract thoughts increase, and "real-world" language experiences accumulate and develop. 42,59 Hence, survivors of a childhood TBI can be faced with the dual disadvantage of poor language competence combined with a reduced ability to interpret and act on social cues 60 due to the frontal lobe being implicated both in language and social impairments following childhood TBI.…”

“…42,58 McDonald and colleagues 46 found that pragmatic skills are complex and reliant upon cognitive function, which may only be evident in late childhood when metalinguistic demands for abstract thoughts increase, and "real-world" language experiences accumulate and develop. 42,59 Hence, survivors of a childhood TBI can be faced with the dual disadvantage of poor language competence combined with a reduced ability to interpret and act on social cues 60 due to the frontal lobe being implicated both in language and social impairments following childhood TBI. 39,61 Of particular importance for this dual disadvantage is the recently proposed notion that postinjury language ability might contribute to social outcomes in children.…”