Social dysfunction after pediatric traumatic brain injury: A translational perspective

Abstract

Social dysfunction is common after traumatic brain injury (TBI), contributing to reduced quality of life for survivors. Factors which influence the emergence, development or persistence of social deficits after injury remain poorly understood, particularly in the context of ongoing brain maturation during childhood. Aberrant social interactions have recently been modeled in adult and juvenile rodents after experimental TBI, providing an opportunity to gain new insights into the underlying neurobiology of these behaviors. Here, we review our current understanding of social dysfunction in both humans and rodent models of TBI, with a focus on brain injuries acquired during early development. Modulators of social outcomes are discussed, including injury-related and environmental risk and resilience factors. Disruption of social brain network connectivity and aberrant neuroendocrine function are identified as potential mechanisms of social impairments after pediatric TBI. Throughout, we highlight the overlap and disparities between outcome measures and findings from clinical and experimental approaches, and explore the translational potential of future research to prevent or ameliorate social dysfunction after childhood TBI.

Developmental trajectories of adaptive functioning following early mild traumatic brain injury

“…Social competence depends on both individual (i.e., child behavior and social cognitive functioning) and family environmental factors (i.e., parental responsiveness, adjustment, and resources) which may be affected after TBI regardless of severity (Beauchamp & Anderson, 2010;Ryan et al, 2016;Yeates et al, 2007). Consistent with this, the complementary analyses suggest that an increase in child behavior problems and a decrease in family functioning after mTBI may be associated with poorer development of social adaptive functioning following early mTBI.…”

“…Previous studies using linear mixed‐models reported long‐term consequences of moderate to severe TBI on the development of social abilities, including social adaptive functioning (Taylor et al, ; Yeates et al, ); however, the present results are the first to identify such an effect after milder injuries. Social competence depends on both individual (i.e., child behavior and social cognitive functioning) and family environmental factors (i.e., parental responsiveness, adjustment, and resources) which may be affected after TBI regardless of severity (Beauchamp & Anderson, ; Ryan et al, ; Yeates et al, ). Consistent with this, the complementary analyses suggest that an increase in child behavior problems and a decrease in family functioning after mTBI may be associated with poorer development of social adaptive functioning following early mTBI.…”

Altered resting‐state functional connectivity within the developing social brain after pediatric traumatic brain injury

“…The following ROIs were selected: Bilateral left posterior STS, fusiform gyrus, temporal pole, inferior frontal gyrus, TPJ, amygdala, as well as the dorsomedial PFC (dmPFC), the ventromedial PFC (vmPFC), the rostral ACC and the medial frontal pole. These brain regions have consistently been related to morphological abnormalities and to social difficulties following TBI (Ryan, Catroppa, Beare, et al, , ; Ryan et al, ; Ryan, Catroppa, Cooper, Beare, Ditchfield, Coleman, Silk, Crossley, Rogers, et al, ; Ryan, Catroppa, Godfrey, et al, ; Ryan et al, ; see Table for details on ROIs and MNI coordinates).…”

“…The following ROIs were selected: Bilateral left posterior STS, fusiform gyrus, temporal pole, inferior frontal gyrus, TPJ, amygdala, as well as the dorsomedial PFC (dmPFC), the ventromedial PFC (vmPFC), the rostral ACC and the medial frontal pole. These brain regions have consistently been related to morphological abnormalities and to social difficulties following TBI Ryan et al, 2017;Ryan, Catroppa, Cooper, Beare, Ditchfield, Coleman, Silk, Crossley, Rogers, et al, 2015;Ryan, Catroppa, Godfrey, et al, 2016;Ryan et al, 2018; see Table 1 for details on ROIs and MNI coordinates). At the second-level analysis, two-sample t-tests were performed to assess between-group differences in ROI-to-ROI functional connectivity for each ROI, controlling for age at rsfMRI acquisition, sex, SES, and total GM volume to account for the global presence of structural lesions.…”

Under-Identification of Students with Long Term Disability from Moderate to Severe TBI:

“…Challenges with memory, executive function, attention, concentration, and processing speed can negatively affect a child's ability to learn and perform in school (Ewing-Cobbs, Prasad, & Kramer, 2006;Prasad, Swank, & Ewing-Cobbs, 2017;Gerrard-Morris, Taylor, Yeates, 2010;Hawley, 2004;Moser, Schatz, & Jordan, 2005). Behavioral challenges, impulsivity, and emotional issues are also common after TBI (Barlow et al, 2010;Li, & Liu, 2013;Limond, Dorris, & McMillan, 2009;Ryan et al, 2016) and can negatively affect school performance, perhaps as long as ten years post-injury (Beauchamp et al, 2011). Following TBI, children experience persistent lower life satisfaction, reduced adaptive functioning, and lower rates of participation in a variety of activities compared with children who have orthopedic injuries, and those differences can persist throughout their formal schooling (Rivara, Koepsell, & Wang, 2012a;Rivara, Vavilala, & Durbin, 2012b).…”