Social and emotional competence in traumatic brain injury: New and established assessment tools

Abstract

Chronic social/emotional deficits are common in moderate to severe traumatic brain injury (TBI), leading to significant functional difficulties. Objective, quantitative tools for assessing social/emotional competence are an important adjunct to cognitive assessments. We review existing social/emotional measures, conclude that theory of mind tests are not adequate for clinical assessments of social competence, and explain the development and piloting of novel measures in a small group of moderate to severe TBI patients (N = 16) and non-brain-damaged controls (N = 16). The novel measures are the Global Interpersonal Skills Test (GIST), a questionnaire measuring informant-rated social skills; the Assessment of Social Context (ASC), a video-based task examining understanding of others' emotions, attitudes, and intentions; the Social Interpretations Test, a social framing task based on Heider and Simmel ( 1944 ); and Awareness of Interoception, a heartbeat-detection paradigm related to physiological self-awareness. In a MANOVA, other-rated social skills (GIST), ASC, and Awareness of Interoception scores were significantly lower for TBI patients than controls. ASC, r(31) = .655, and Social Interpretations, r(31) = .460, scores were significantly correlated with informant-rated social skills (GIST). We encourage clinicians to add social/emotional measures to assessments of TBI patients.

Theory of Mind in Adults with Traumatic Brain Injury

“…These questions are used to make sure that responding to these questions requires general comprehension of tasks apart from mental state understanding (48). In the examined studies, 17 ToM tasks had the control questions.…”

Brain activation during a social attribution task in adolescents with moderate to severe traumatic brain injury

“…Performance on ToM tasks is related to deficits in social behavior following TBI (Hynes, Stone, & Kelso, 2011 this issue). However, in the present study, the prescan training allowed both groups to complete the social interaction condition of the SAT with \hbox{accuracy} that exceeded 70%.…”

Development and psychometric properties of an informant assessment scale of theory of mind for adults with traumatic brain injury

“…Members of the research team extensively reviewed the existing ToM literature (Baron-Cohen et al, 1985;Call & Tomasello, 2008), the literature on ToM assessment (Hynes et al, 2011;McDonald et al, 2003), and the literature on the development of an informant assessment scale (Alexander & Liljequist, 2013;Teng, Tassniyom, & Lu, 2012), with a focus on the definition of ToM, the construct of ToM, and informant assessment methods. This review resulted in the generation of the structural design of the scale.…”

“…During the caretaking process, they observe the patient's ToM ability across a range of real-world circumstances and obtain rich information regarding the patient's abilities. Despite the encouraging results from Hynes's work (Hynes et al, 2011), there has not been an informant ToM scale developed with larger samples of adults with TBI. In the present study, we collected items from existing ToM literature, modified items according the opinions of caretakers of individuals with TBI, and tested the scale's reliability and validity in large samples of individuals with TBI and normal controls and their informants.…”

“…Hynes, Stone, and Kelso (2011) developed the Global Interpersonal Skills Test (GIST), which is a questionnaire with both self-rated and informant-rated versions to measure social skills, and tested its application in a small sample of adults with TBI (n ¼ 16) and normal controls (n ¼ 16). The test is sensitive to the presence of TBI compared with traditional ToM measures, and informants provided more accurate scores for the patients compared with the patients themselves; i.e., informants of patients gave lower GIST scores for patients than the informants of normal controls, whereas there were no differences between patients and normal controls on the self-rated version of the GIST (Hynes et al, 2011). This phenomenon can be explained by the fact that individuals with TBI typically display low levels of self-awareness (Bach & David, 2006).…”