Social Outcomes in Pediatric Traumatic Brain Injury: Toward an Integrative, Multi-level Model
Objective: To describe and illustrate an integrative, multi-level model of the social outcomes of childhood traumatic brain injury (TBI). The model is grounded in concepts and methods drawn from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. It specifies anticipated relations between social adjustment, peer interaction, social information processing, and the brain substrates for social cognition.
Method: The research application of the model will be illustrated using data collected during a prospective, longitudinal study of childhood TBI that included 53 children with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not accompanied by brain insult. Participants were from 6 to 12 years of age when injured. The children’s social information-processing (SIP) and social adjustment were measured at an extended follow-up a mean of 4 years post injury. SIP was assessed using measures of language pragmatics, executive functions, and social reasoning. Social adjustment was measured using parent ratings on three standardized rating scales.
Results: Hierarchical multiple regression analyses were used to examine the contributions of SIP to the social outcome measures at 4 years post-injury. Analyses controlled for demographic factors and injury severity. Each of the SIP measures explained a significant amount of variance in the measures of social outcomes.
Conclusions: The results indicate that an integrative, multi-level model is likely to provide a richer picture of the social outcomes of childhood TBI. Future research guided by the model should result in a major expansion of knowledge, which will prove valuable in designing interventions to promote better social outcomes following childhood TBI.