Social Interaction in Young Children with Inflicted and Accidental Traumatic Brain Injury: Relations with Family Resources and Social Outcomes

Abstract

Core social interaction behaviors were examined in young children 0–36 months of age who were hospitalized for accidental (n = 61) or inflicted (n = 64) traumatic brain injury (TBI) in comparison to typically developing children (n = 60). Responding to and initiating gaze and joint attention (JA) were evaluated during a semi-structured sequence of social interactions between the child and an examiner at 2 and 12 months after injury. The accidental TBI group established gaze less often and had an initial deficit initiating JA that resolved by the follow-up. Contrary to expectation, children with inflicted TBI did not have lower rates of social engagement than other groups. Responding to JA was more strongly related than initiating JA to measures of injury severity and to later cognitive and social outcomes. Compared to complicated-mild/moderate TBI, severe TBI in young children was associated with less responsiveness in social interactions and less favorable caregiver ratings of communication and social behavior. JA response, family resources, and group interacted to predict outcomes. Children with inflicted TBI who were less socially responsive and had lower levels of family resources had the least favorable outcomes. Low social responsiveness after TBI may be an early marker for later cognitive and adaptive behavior difficulties.

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

“…Two main findings—that TBI was associated with subsequent adverse adulthood outcomes, and the dose-response relationship with injury severity—are consistent with previous research [17–20,44], although these studies have mostly focused on small and selected samples that rely extensively on self-reported data either from (severely) injured patients or their caregivers; an approach subject to substantial bias [45]. Similar results have been reported in studies examining global disability indices [10], such as the extended Glasgow Outcome Scale (GOSE) [21].…”

Social dysfunction after pediatric traumatic brain injury: A translational perspective

“…Following a TBI during childhood, family resources are considered to be a strong predictor of social and cognitive behaviors (Anderson et al, 2012; Ewing-Cobbs et al, 2013). A low socioeconomic status exerts a negative influence on cognitive and social outcomes for children with TBI, as does family stress (Anderson et al, 2001; Schmidt et al, 2010; Yeates et al, 2004; Yeates et al, 1997; Yeates et al, 2010).…”

“…In several studies, severe TBI in young children has been associated with poorer social interactions and social communication compared to complicated-mild or moderate TBI (Catroppa et al, 2008; Catroppa et al, 2015; Ewing-Cobbs et al, 2013). Supporting this concept, experimental studies in which the brain insult was considered mild or concussive typically failed to detect social deficits (Bajwa et al, 2016; Shultz et al, 2012; Shultz et al, 2011), although such an interpretation may be confounded by differing test conditions and measures with differing sensitivities.…”

Traumatic Brain Injury in Young Children: A Scoping Review

“…14 Eighteen studies reported on psychosocial and behavioral outcomes. 14,16,30,34,37,39,43,[45][46][47][48][49][50][51][52][53][54][55] Generally, social functioning was negatively impacted following early childhood TBI, independent of severity. Acutely, children who experienced a TBI before 6 years of age demonstrated decreased play engagement, including gaze initiation and joint attention.…”

“…Acutely, children who experienced a TBI before 6 years of age demonstrated decreased play engagement, including gaze initiation and joint attention. 16,48 Several studies reported that children then demonstrated significant recovery within the first year postinjury, although deficits were still ob-served. 48 Examined up to 18 months postinjury, children with mild TBI were found to have significantly poorer theory of mind skills when compared with children who were typically developing or with orthopaedic impairments.…”