Pragmatic Language Comprehension After Pediatric Traumatic Brain Injury: A Scoping Review

Abstract

Objective: This scoping review aims to examine the literature pertaining to pragmatic language comprehension in pediatric traumatic brain injury (TBI), in order to summarize the current evidence and to identify areas for further research. Methods: We searched MEDLINE Ovid and PsycINFO Ovid using search terms to identify all articles that examined pragmatic language comprehension in children and adolescents with TBI published until November 2017. Results: A total of 13 articles met our inclusion criteria. The studies included examined a number of pragmatic domains including knowledge-based and pragmatic inferences, detection and judgment of ambiguous sentences, comprehension of humor, understanding of figurative language (eg, metaphors and idioms), and comprehension of irony and deceptive praise. Conclusion: The research suggests that children and adolescents with TBI, as compared with healthy or orthopedically injured controls, display deficits in comprehension of pragmatic language. Children with severe TBI demonstrate more widespread deficits in pragmatic comprehension abilities, whereas children with mild TBI show relatively intact pragmatic comprehension. Limitations and gaps identified in the literature warrant further research in this area.

A Conceptual Framework of Social Communication: Clinical Applications to Pediatric Traumatic Brain Injury

“…68 The paralinguistic cues include aspects such as vocal prosody, speech rate or rhythm, facial expression, intonation, and eye contact to express one's intentions and goals, as well as considering the perspective of the listener. 15,52,69 Pragmatic impairments are likewise well documented in children and adolescents with TBI. 16,24,53 Cognitive flexibility is a component of executive functions and is the mental ability to switch between thinking about two different concepts, and to think about multiple concepts simultaneously.…”

“…13 Moreover, while researchers have studied social communication deficits following pediatric TBI, the methods of assessment as well as the assessment measures in these studies are highly variable, suggesting there is no consistent benchmark in evaluating social communication. 15 However, as social communication is dependent on the social context and thus varies accordingly, one could argue that observational checklists and self-report measures are perhaps more appropriate than assessments that rely on "normative" data. This view is also in keeping with the views of Ylvisaker and Feeney who espoused that assessments should be individualized, collaborative, ongoing, and embedded in everyday routines, with hypothesis testing used to inform and alter intervention plans.…”

“…However, as norm-referenced measures are also an important part of the assessment process, current practices often require professionals to evaluate these skills via informal administration of assessment tools that were normed on adults or normed on children with neurodevelopment disorders where social communication deficits are often seen (i.e., autism spectrum disorder). 15,78 Currently, there is a lack of ecologically valid tools that meet the proposed guidelines for social assessment design and development. Tools are needed, for example, that incorporate stimuli that closely approximate the complexity of real-world social environments and that are also dynamic and engaging.…”

“…Parent/Caregiver/Teacher and Self-Report Rating Scales and Questionnaires Rating scales and questionnaires that are completed by significant communication confidants, such as parents/caregivers and teachers, in a child's natural, everyday environment are frequently used by speech-language pathologists to gather information about social communication skills. 15,79 Douglas 83 proposed that this approach allows for behavioral description and measurement of the problems perceived by individuals with TBI or their family members as they negotiate day-to-day interactions across a variety of situations. Moreover, family members have knowledge of the individual's premorbid functioning that clinicians lack, and thus they are well placed to evaluate postinjury change in social communication ability and to do so from within the same sociodemographic context.…”

“…1,[4][5][6] These challenges may endure throughout childhood 7 and well into adulthood, particularly for those children with moderate-severe injuries. [8][9][10] Impairments in social processes are increasingly recognized as a common sequelae following pediatric TBI 4,[11][12][13][14][15] and include more general social cognitive problems, such as deficits in social problem solving, 16,17 emotion recognition, 16,18,19 perspective taking/theory of mind (ToM), 5,20,21 intent attribution, 17 empathy, and moral reasoning. 22,23 Alterations in social communication 13 have also been widely identified and described.…”