Social Cognition in Paediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis

Abstract

Background: Recent evidence suggests social cognitive deficits may be among the most profound and disabling consequences of childhood traumatic brain injury (TBI); however, it is only over the last decade that this area has received increasing research attention.Aim: This study aims to systematically review all studies reporting on the effects of childhood TBI on social cognition. Meta-analytic techniques were employed to determine the magnitude of social cognitive deficits in childhood TBI.Methods: Literature searches were conducted in electronic databases (Medline/PubMed, Scopus, Cochrane, EMBASE, PsycINFO and CINAHL) to retrieve relevant articles on social cognitive outcomes of paediatric TBI published from 2007 -2019. The systematic review identified fourteen eligible studies, which examined the effect of paediatric TBI on five dimensions of social cognition, including emotion recognition/perception, theory of Mind (ToM), pragmatic language, moral reasoning, and social problem solving. Of these studies, eleven articles were included in subsequent meta-analyses, which included 482 children with TBI.Results: Meta-analysis using a random-effects model revealed non-significant differences between TBI and typically developing (TD) control groups on measures of emotion perception/ recognition. In contrast, children and adolescents with TBI performed significantly worse than control groups on ToM and pragmatic language tasks, with small and moderate effect sizes, respectively (Hedge's g = -0.46; -0.73). Meta-regression indicated that post-injury social cognitive deficits were not moderated by child age. While the effect of time since injury was not statistically significant, poorer social cognitive outcomes are documented soon after injury.Conclusions: Despite relatively intact basic social cognitive skills (i.e. emotion perception/ recognition) children and adolescents with TBI are vulnerable to deficits in higher-order aspects of social cognition, including ToM and pragmatic language. These findings underscore the importance of further research, using well-validated, standardised outcome instruments, in larger paediatric TBI samples. Furthermore, longitudinal prospective studies are needed to evaluate the respective contribution of injury and non-injury factors to individual variation in outcome and recovery of social cognition after paediatric TBI.

What predicts persisting social impairment following pediatric traumatic brain injury: contribution of a biopsychosocial approach

“…It comprises numerous brain regions vulnerable to the diffuse axonal injury characteristic of TBI, for example, aspects of the prefrontal cortex, temporo-parietal junction, insula, and amygdala (Adolphs, 2001 , 2003 ). TBI during childhood has the potential to derail the maturation of this network resulting in social dysfunction (Anderson, Spencer-Smith, & Wood, 2011 ; Zhi, Ryan, Konjarski, Catroppa, & Stargatt, 2021 ).…”

Mediating effects of impulsivity and alexithymia in the association between traumatic brain injury and aggression in incarcerated males

“…This does not fit well with a previous study implication emotion recognition as possible mechanism for problematic behavior in TBI patients (Jorna et al, 2021) nor with a recent meta‐analysis which showed higher levels of alexithymia (measured with the TAS‐20) in TBI patients (Fynn et al, 2021). Nevertheless, another recent review and meta‐analysis indicates that basic social skills (including emotion recognition) are generally intact in children and adolescents with TBI, but more complicated processes (including theory of mind and pragmatic language) were significantly impaired (On et al, 2022). This would indicate that future studies on the association between TBI and aggression should also assess higher order aspects of social cognition.…”

Social Functioning and Autistic Behaviors in Youth Following Acquired Brain Injury

“…Of our identified studies, all were conducted since [ 26 ] initially completed their systematic review on the social functioning of children and adolescents following TBI that spanned studies from 1989 to 2011. More recently, a systematic review and meta-analysis surrounding social cognitive outcomes in a pediatric TBI sample was conducted by On and colleagues [ 27 ]. The following results aim to build on those works and expand those findings to include acquired brain injury more broadly, as well as other social constructs beyond social cognition alone.…”

“…Social cognitive impairments have frequently been documented in youth following TBI [ 44 ], and to a lesser extent in children with ABI, such as stroke or neurological infection; however, this has been observed clinically. A recent systematic review and meta-analysis regarding social cognitive functioning in pediatric TBI patients [ 27 ] found that many youths who experience TBI are vulnerable to declines in higher-order social cognitive abilities such as pragmatic language, social problem solving, and ToM. Social information processing also involves leveraging broader executive functioning skills that are often impacted by ABI.…”

“…It is hypothesized that the interaction between age at injury and social outcomes is not necessarily linear in nature. Rather, due to increased neural plasticity in early development serving as a protective factor, a critical period model in which the specific timing of an injury variably impacts outcomes [ 27 , 78 ] is most appropriate. For example, Crowe and colleagues [ 79 ] identified TBIs occurring in middle childhood (7–9 years old), as opposed to infancy, preschool, and late childhood, as being associated with the poorest cognitive performance.…”