Assessing Social Cognition and Pragmatic Language in Adolescents with Traumatic Brain Injuries

Abstract

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.

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

“…13,15,16,62,80 Considering the interplay between both domains, the current findings support findings suggesting that communication impairments are associated with poor social outcomes. 16,46,56,57 The current results provide a preliminary insight into the very long-term outcomes in high-level language and social outcomes, as well as the interplay between these 2 domains for individuals who are several decades postinjury and provide an important extension of previous findings (up to 14 years post-childhood TBI 16,18,62,69 or only presented evidence based on 1 case 50 years postinjury 19 ). Hence, this present report on outcomes on average 31 years postinjury is filling an important gap in the previously available literature on long-term language and social outcomes post-childhood TBI.…”

“…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. 12,[46][47][48] These later emerging higher-order cognitive-linguistic skills are important for academic progress, development of peer relationships, socioemotional well-being, and vocational success. [49][50][51][52][53][54] Later developing high-level language skills depend on the maturity of linguistic skills as well as on the maturity of a range of cognitive skills that support language, such as executive function and working memory.…”

“…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.…”

Young people with an acquired brain injury: Development of a pilot program to support their transition to adulthood

“…It is well recognised that outcomes vary between people with ABI, but also that individuals may fluctuate in their capacity depending on the expectations and demands being placed upon them at any given time and environment. Within the wider literature, it has been suggested that the full realisation of a person's functional capacity does not become evident until early adulthood, when expectations for higher level executive functioning are increased (McDonald et al, 2013).…”

“…McDonald and colleagues (2013) reported that people with ABI often experience difficulty with pragmatic communication, whereby they have difficulty organising and maintaining topics of conversation. These difficulties can result in rejection by peers which further isolates them and limits their ability to practise and develop these skills (Bellon & Rees, 2006;McDonald et al, 2013). …”