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

Abstract

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.

Social Functioning and Autistic Behaviors in Youth Following Acquired Brain Injury

“…This skill, as described above, is a more developmentally advanced task than basic emotion recognition; therefore, it follows that those abilities might be preferentially impacted while emotion recognition skills are spared in patients with more mild-to-moderate injuries. Further, social-pragmatic language is also often disrupted in children following TBI, and has been shown to mediate the relationship between early-childhood TBI and social and conceptual adaptive functioning in middle childhood relative to children with orthopedic injuries alone [ 61 ]. Middle childhood TBI has also been associated with sustained pragmatic language difficulties 24-months postinjury and was associated with increased externalizing behaviors [ 62 ].…”