Social Function in Children and Adolescents after Traumatic Brain Injury: A Systematic Review 1989–2011

Abstract

Clinical reports and case studies suggest that traumatic brain injury (TBI) can have significant social consequences, with social dysfunction reported to be the most debilitating problem for child and adolescent survivors. From a social neuroscience perspective, evidence suggests that social skills are not localized to a specific brain region, but are mediated by an integrated neural network. Many components of this network are susceptible to disruption in the context of TBI. In early development, a brain injury can disrupt this neural network while it is in the process of being established, resulting in social dysfunction. In order to clarify the prevalence and nature of social dysfunction after child TBI, studies of social outcomes in children and adolescents after TBI over the last 23 years have been reviewed. Despite casting a wide net initially, only 28 articles met review criteria. These studies were characterized by methodological weaknesses, including variations in definitions of TBI, limited assessment tools, reliance on parent reports, small sample sizes, and absent control groups. Despite these limitations, the weight of evidence confirmed an elevated risk of social impairment in the context of moderate and severe injury. While rarely examined, younger age at insult, pathology to frontal regions and the corpus callosum, and social disadvantage and family dysfunction may also increase the likelihood of social difficulties. More research is needed to obtain an accurate picture of social outcomes post-brain injury.

Community-based interventions for adolescents following traumatic brain injury: A systematic review

“…However, despite this review identifying seventeen different studies, covering eleven distinct community-based interventions for adolescents following TBI, the quality and applicability of the evidence is limited and highly variable. This finding is consistent with the conclusions of other paediatric TBI rehabilitation systematic reviews and meta-analyses, suggesting limited development of the research area despite repeated calls for higher quality evidence (Rosema, Crowe, & Anderson, 2012;Lindsay et al, 2015;Ross, Dorris, & McMillan, 2011;Laatsch et al, 2007).…”

Predictors of longitudinal outcome and recovery of pragmatic language and its relation to externalizing behaviour after pediatric traumatic brain injury

“…Perhaps surprisingly, relative to TD controls children with mild TBI showed reduced pragmatic communication skills at 6-months post-TBI. Although social dysfunction is documented in individuals with moderatesevere TBI (Rosema et al, 2012) we provide evidence that pragmatic language skills may also be vulnerable to the effects of milder generalized injuries.…”

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

“…This is consistent with previous analyses from the full sample from this study using individual measures of theory of mind, 10 as well as research clearly documenting that children with TBI, especially those with more severe injuries, are at risk for such deficits. 6 Children with STBI also demonstrated deficits on several parentrated measures of social adjustment. Children with STBI were reported to have significant overall behavioral symptoms on the BASC-2, as well as problematic social skills and communication on FIG.…”

“…5 Disruption of the normal development of SIP as a result of TBI may place children at risk for social isolation, difficulties with peer and family relationships, and decreased quality of life. 6 Although previous research has documented specific deficits in executive function, SIP, and social adjustment after TBI, few studies have addressed the associations among these domains. Dennis and colleagues 7 concluded that early-onset TBI is associated with deficits in multiple regulatory and adaptive skills (i.e., vigilance, selective attention, response manipulation), but did not examine how these predictors interact in accounting for social adjustment.…”