Executive Functions and Theory of Mind as Predictors of Social Adjustment in Childhood Traumatic Brain Injury

Abstract

This study examined whether executive function and theory of mind mediate the effects of pediatric traumatic brain injury (TBI) on social adjustment, relative to children with orthopedic injury (OI). Participants included 19 children with severe TBI, 41 children with complicated mild/moderate TBI, and 57 children with OI. They completed measures of executive function, as well as cognitive, affective, and conative theory of mind. Parents provided ratings of children's social adjustment. Children with severe TBI performed more poorly than children with OI on executive function and theory of mind tasks and were rated by parents as having more behavioral symptoms and worse communication and social skills. Executive function and theory of mind were positively correlated with social skills and communication skills, and negatively correlated with behavioral symptoms. In multiple mediator models, theory of mind and executive function were not significant direct predictors of any measure of social adjustment, but mediated the association between injury and adjustment for children with severe TBI. Theory of mind was a significant independent mediator when predicting social skills, but executive function was not. TBI in children, particularly severe injury, is associated with poor social adjustment. The impact of TBI on children's social adjustment is likely mediated by its effects on executive function and theory of mind.

On the relation between theory of mind and executive functioning: A developmental cognitive neuroscience perspective

“…Studies of children with neurological disorders or acquired brain injury are also informative. For instance, children with traumatic brain injury (TBI) show both broad ToM and EF deficits (Robinson et al, 2014). Moreover, Dennis et al (2013) examined how injury to specific brain networks was associated with different aspects of ToM.…”

Long-Term Neuropsychological Profiles and Their Role as Mediators of Adaptive Functioning after Traumatic Brain Injury in Early Childhood

“…These analyses have identified mediation effects of verbal working memory on math performance, 50 of selfregulation skills on social and behavioral functioning, 51 and of theory of mind skills on social outcomes. 52 To our knowledge, no prior study has examined neuropsychological skills as mediators of the effect of childhood TBI on long-term adaptive functioning.…”

Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury

“…Children with moderate TBI have been found to have working memory deficits at least one year post-injury, 10 and children with mild–moderate TBI have been found to have theory of mind impairments one–five years post-injury. 11 Attention can also be affected; in one study, at one year post-injury, parents reported new moderate to severe attention difficulties for 5% of children with mild TBI and 15% of children with moderate TBI. 12 Children with TBI also have been observed to have lasting difficulties with response inhibition and inhibitory control.…”