Electrophysiological correlates of emotional face processing after mild traumatic brain injury in preschool children

Evidence suggests that social skills are affected by childhood mild traumatic brain injury (mTBI), but the neural and affective substrates of these difficulties are still underexplored. In particular, nothing is known about consequences on the perception of emotional facial expressions, despite its critical role in social interactions and the importance of the preschool period in the development of this ability. This study thus aimed to investigate the electrophysiological correlates of emotional facial expressions processing after early mTBI. To this end, 18 preschool children (mean age 53 ± 8 months) who sustained mTBI and 15 matched healthy controls (mean age 55 ± 11 months) were presented with pictures of faces expressing anger, happiness, or no emotion (neutral) while event-related potentials (ERP) were recorded. The main results revealed that P1 amplitude was higher for happy faces than for angry faces, and that N170 latency was shorter for emotional faces than for neutral faces in the control group only. These findings suggest that preschool children who sustain mTBI do not present the early emotional effects that are observed in healthy preschool children at visuospatial and visual expertise stages. This study provides new evidence regarding the consequences of childhood mTBI on socioemotional processing, by showing alterations of emotional facial expressions processing, an ability known to underlie social competence and appropriate social interactions.     

Socio‐economic,socio‐political and socio‐emotional variables explaining school bullying: a country‐wide multilevel analysis

Why do some countries, regions and schools have more bullying than others? What socio‐economic, socio‐political and other larger contextual factors predict school bullying? These open questions inspired this study with 53.316 5th‐ and 9th‐grade students (5% of the national student population in these grades), from 1,000 schools in Colombia. Students completed a national test of citizenship competencies, which included questions about bullying and about families, neighborhoods and their own socio‐emotional competencies. We combined these data with community violence and socio‐economic conditions of all Colombian municipalities, which allowed us to conduct multilevel analyses to identify municipality‐ and school‐level variables predicting school bullying. Most variance was found at the school level. Higher levels of school bullying were related to more males in the schools, lower levels of empathy, more authoritarian and violent families, higher levels of community violence, better socio‐economic conditions, hostile attributional biases and more beliefs supporting aggression. These results might reflect student, classroom and school contributions because student‐level variables were aggregated at the school level. Although in small portions, violence from the decades‐old‐armed conflict among guerrillas, paramilitaries and governmental forces predicted school bullying at the municipal level for 5th graders. For 9th graders, inequality in land ownership predicted school bullying. Neither poverty, nor population density or homicide rates contributed to explaining bullying. These results may help us advance toward understanding how the larger context relates to school bullying, and what socio‐emotional competencies may help us prevent the negative effects of a violent and unequal environment. Aggr. Behav. 35:520–529, 2009. © 2009 Wiley‐Liss, Inc.     

Counter‐intuitive moral judgement following traumatic brain injury

Several neurological patient populations, including traumatic brain injury (TBI), appear to produce an abnormally ‘utilitarian’ pattern of judgements to moral dilemmas; they tend to make judgements that maximize the welfare of the majority, rather than deontological judgements based on the following of moral rules (e.g., do not harm others). However, this patient research has always used extreme dilemmas with highly valued moral rules (e.g., do not kill). Data from healthy participants, however, suggest that when a wider range of dilemmas are employed, involving less valued moral rules (e.g., do not lie), moral judgements demonstrate sensitivity to the psychological intuitiveness of the judgements, rather than their deontological or utilitarian content (Kahane et al., Social Cognitive and Affective Neuroscience, 7, 2011, 393). We sought the moral judgements of 30 TBI participants and 30 controls on moral dilemmas where content (utilitarian/deontological) and intuition (intuitive/counter‐intuitive) were measured concurrently. Overall TBI participants made utilitarian judgements in equal proportions to controls; disproportionately favouring utilitarian judgements only when they were counter‐intuitive, and deontological judgements only when they were counter‐intuitive. These results speak against the view that TBI causes a specific utilitarian bias, suggesting instead that moral intuition is broadly disrupted following TBI.     

Exploring the relationships between trait emotional intelligence and objective socio‐emotional outcomes in childhood

Background Trait emotional intelligence (trait EI or trait emotional self‐efficacy) is a constellation of emotion‐related self‐perceptions and dispositions located at the lower levels of personality hierarchies. This paper examines the validity of this construct, as operationalized by the Trait Emotional Intelligence Questionnaire‐Child Form (TEIQue‐CF), in primary schoolchildren. Aims The main aim was to examine the construct validity of trait EI in middle and late childhood by exploring its relationships with cognitive ability, emotion perception, and social behaviour. Sample The sample comprised 140 children aged between 8 and 12 years (M = 9.26 years, SD = 1.00 year; 63 girls) from two English state primary schools. Method Pupils completed the TEIQue‐CF, the standard progressive matrices (SPM), the guess who peer assessment, the social skills training (SST) test, and the assessment of children's emotion skills (ACES) during formal class periods. The procedure took approximately two hours with a short break between assessments. Results Trait EI scores were positively related both to peer‐rated prosocial behaviour and to overall peer competence. They also predicted emotion perception accuracy beyond overall peer competence. As hypothesized in trait EI theory, the construct was unrelated to IQ (Raven's matrices) and academic performance. Conclusions Trait EI is successfully operationalized through the TEIQue‐CF and has important and multifaceted implications for the socialization of primary schoolchildren.     

Effects of cultural background on WAIS‐III and WMS‐III performances after moderate‐severe traumatic brain injury

The assessment of cognitive function in individuals of culturally and linguistically diverse background poses considerable challenges for the psychologist, particularly when English proficiency is limited. This study explored the effects of diverse cultural background and non‐Western educational background on Wechsler Adult Intelligence Scale‐Third edition (WAIS‐III) and Wechsler Memory Scale‐Third Edition (WMS‐III) performances in moderate‐severe traumatic brain injury within an outpatient rehabilitation setting. Participants were aged 16–65 years and met careful selection criteria. IQ, index and age‐scaled subtest scores were compared across three groups: (a) English‐speaking background (n = 130), (b) culturally and linguistically diverse background and education completed in English (n = 33), and (c) culturally and linguistically diverse background and non‐English education (n = 33). Cultural backgrounds included people of Asian, European, Middle Eastern, African and Oceania origin. Results were that the English‐educated culturally and linguistically diverse group performed lower than the English‐speaking background group on some verbal WAIS‐III measures; effect sizes were small‐moderate. The non‐English‐educated culturally and linguistically diverse group performed lower than both groups on several WAIS‐III and one WMS‐III measure, with large effect sizes. Clinical implications included the need for caution in interpreting test scores to avoid diagnostic errors and the need for further development of valid assessment tools.     

Hyperactivity,shyness, and sex: Development and socio‐emotional functioning

Based on formulations about the possible consequences for adaptation of gender non‐normative behaviour, we investigated predictive and concurrent relations of hyperactivity and shyness to various aspects of adaptation focusing on possible effects of sex. At ages 5–6, parents and preschool teachers rated hyperactivity and shyness for 151 children (50% boys). At age 9, we obtained teacher ratings of hyperactivity, internalizing and externalizing problems, self‐ratings of trait anxiety, and peer nominations of shyness, social preference, and aggression. Several effects of sex were found. Hyperactivity ratings were more strongly related across time and raters for boys than for girls. In the predictive analyses, boys' hyperactivity was more strongly related to aggression than was girls' hyperactivity, and in concurrent analyses, girls' hyperactivity was more strongly associated with low social preference than was boys' hyperactivity. There was a protective effect of shyness with regard to aggression that applied only to boys, that is, at high hyperactivity levels, boys with high shyness levels were less aggressive than boys with low shyness levels. There were also main effects of hyperactivity and shyness. In predictive and concurrent analyses, hyperactivity was associated with low social preference, high levels of externalizing problems and with aggression, whereas shyness was associated with high levels of internalizing problems. Finally, there was an interactive effect of hyperactivity and shyness. In the concurrent analyses, an exacerbating effect was demonstrated insofar as high shyness was associated with low social preference at high, but not at low levels of hyperactivity. The different developmental risks of hyperactivity and shyness were discussed.     

Neuropathological determinants of acquired attention disorders in traumatic brain injury

Attentional disorders are frequently mentioned neuropsychological sequalae following traumatic brain injury (TBI). However, little is known about the recovery of attention, or the determinants of variability of attentional functioning following TBI. The present study was undertaken to examine (1) the extent to which attentional disorders are present among patients at various chronicity stages following TBI, (2) differences in performance on a number of measures of attention as a function of different clinical-neuropathological syndromes. A sample of 70 TBI subjects were rated according to different clinical-neuropathological syndromes and neuropsychologically evaluated. The results suggest that TBI patients of different chronicity stages, with significantly different lengths of coma, did not significantly differ in terms of the type or severity of attentional disorders. However, when the same patients were classified according to clinical-neuropathological syndromes, significant differences in the severity and type of attentional disorders were evident. The findings were interpreted to suggest that typical indices of severity of TBI do not correlate with the severity and type of attentional disorders and that qualitative aspects of the subjects' pathology may be more important in determining the nature of the attentional disorders.     

Executive function outcomes of children with traumatic brain injury sustained before three years

Traumatic brain injury (TBI) is a common cause of disability in childhood. While the outcomes of TBI sustained in school years has been heavily researched, very little is known about the impact of TBI in infants and young children. The aim of this study was to investigate the impact of TBI on executive function (EF) in children who sustained a TBI before 3 years of age. A group of 55 children, 19 with a mild TBI, 16 children with a moderate-severe TBI, and 20 uninjured comparison children participated. The EF of children aged 3 to 6 years were compared using child-based measures of attentional control and information processing. Parents completed questionnaires rating their child's EF. Severity groups differed on the child-based EF measure of attentional control with children with TBI performing below the control group. There were no significant group differences for information processing or parent-rated EF. It appears that children who sustain a TBI before the age of 3 years display impairments in some areas of attentional control 3–4 years postinjury. The findings fit with the existing EF literature for older children.     

Reciprocal and complementary sibling interactions,relationship quality and socio‐emotional problem solving

Associations between reciprocal and complementary sibling interactions, sibling relationship quality, and children's socio‐emotional problem solving were examined in 40 grade 5–6 children (M age = 11.5 years) from middle class, Caucasian, Canadian families using a multi‐method approach (i.e. interviews, self‐report questionnaires, daily diary checklist, narrative task). Findings demonstrated that reciprocal sibling interactions were positively associated with warmth, mutual esteem, happy daily exchanges, and negatively related to rivalry and dominance, whereas complementary interactions were positively related to upsetting daily exchanges. Further, reciprocal and complementary interactions differed significantly in relation to several relationship qualities, with reciprocal interactions emerging as a significantly stronger correlate of happy exchanges. Only reciprocal interactions were positively correlated with socio‐emotional problem solving. Finally, birth order moderated the negative association of reciprocal interactions with rivalry and dominance and the positive association with socio‐emotional problem solving. In each case, the effect was stronger for younger members of the sibling dyad. Findings are discussed in light of recent theory on the sibling relationship and children's development. Copyright © 2007 John Wiley & Sons, Ltd.     

Family satisfaction with medical care after traumatic brain injury

Ratings during acute and follow-up care by 35 families having members with traumatic brain injury showed none of the medical facilities met families' needs though some aspects of patients' care were rated higher in hospitals. Findings suggest comprehensive surveys are needed.     

WAIS-III factor index score patterns after traumatic brain injury

Profile subtypes, based on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) factor index scores, were examined in a sample of 166 patients with traumatic brain injury (TBI) by means of a two-stage clustering procedure. Three reliable subtypes were found that were differentiated primarily by level of performance across all factor index scores, although each of them demonstrated a relative weakness on the Processing Speed index. These subtypes were then validated on the basis of demographic variables, injury parameters, and additional psychometric measures that had not been included in the clustering procedures. The results indicated that performance on the WAIS-III after TBI was affected by both injury severity and level of education. It is concluded that there is no unique "signature" profile on the WAIS-III after TBI, except that a relative strength on the Processing Speed index is uncommon with this condition.     

A review of social disinhibition after traumatic brain injury

Acquired social disinhibition refers to a debilitating behavioural syndrome commonly reported after a severe traumatic brain injury (TBI) and is characterized by inappropriate social behaviour, often described as immaturity and insensitivity towards others. These behaviours can have enduring effects on the social capability of the individual and their relationships with others. However, research into socially disinhibited behaviour after TBI has been thwarted by a lack of consensus in the literature on definition and measurement. This review provides an overview of our current understanding of the definition, measurement, prevalence, associated outcomes, neuropathology, and underlying mechanisms of social disinhibition after TBI. In addition, suggestions are made for future research to further our understanding of this syndrome with the eventual aim of rehabilitating problematic behaviours. It is concluded that an improved understanding of what causes disinhibited behaviour after TBI will be necessary for the development of effective treatment strategies aimed at the rehabilitation of underlying impairments.     

Assessing executive functions in traumatic brain injury: an exploratory study of the Executive Interview

Executive dysfunction is a frequent sequela of traumatic brain injury. Two correlational studies using samples of inpatients and outpatients diagnosed with traumatic brain injury were undertaken to evaluate the validity of a bedside screening test of executive functioning, the 1992 Executive Interview EXIT 25 by Royall, Mahurin, and Gray. In the first study of 23 inpatients receiving rehabilitation, the EXIT 25 was strongly related to both the Mini-Mental State Examination and the Modified Mini-Mental State Examination. In the second study of 20 outpatients, the EXIT 25 correlated with other executive function measures and with ratings of functional disability at discharge, although a ceiling effect raised questions about its utility for patients with mild to moderate disability. Further study of the EXIT 25 is justified with a larger sample of inpatients, although caution should be exercised when using the EXIT 25 in mildly impaired outpatients.     

Clients' perspectives on problems many years after traumatic brain injury

This study investigated the types of self-reported main problems that persons report many years following a traumatic brain injury. This preliminary study is part of a large ongoing study of disability and handicap in adults following traumatic brain injury. As part of an extensive interview, subjects were asked an open-ended question regarding their current main problems which they thought resulted from their traumatic brain injury. Responses were obtained from 166 adult subjects (119 men and 47 women) whose time postinjury ranged from 9 to 24 years. Categories for responses were subsequently developed. The most commonly reported categories of problems were those relating to movement (39%), cognition (36%), and sensory impairment (31%). Findings suggest that subjects' long-term concerns were related to specific impairments more than to psychosocial, emotional, or behavioral issues. Methodological issues concerning this research are discussed in relation to findings.     

Predictors of neuropsychological test performance after pediatric traumatic brain injury

The influence of neurological and demographic variables on neuropsychological test performance was examined in 100 9-to 16-year-old children with traumatic brain injury (TBI). Regression analyses were conducted to determine the relative contributions of coma, neuroimaging findings, ethnicity, socioeconomic status, and gender to variance in performance on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), California Verbal Learning Test--Children's Version (CVLT-C), and the Children's Category Test. Both neurological and demographic variables contributed to performance on various WISC-III factor index scores as well as the CVLT-C. No evidence for a moderating effect of demographic variables was found, but speed of information processing mediated the effect of neurological and demographic variables on CLVT-C performance. It is concluded that demographic variables have an incremental effect on the neuropsychological test performance of children with TBI above and beyond the influence of injury severity.     

Age at injury and long-term behavior problems after traumatic brain injury in young children

Objective: This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI). Method: A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems. Results: At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury. Conclusions: Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Sexual offenses and traumatic brain injury

A sample of 476 male sexual offenders, seen at a university psychiatric hospital for forensic assessment, was examined for the incidence of traumatic head injuries. A total of 49.3% had sustained head injuries that led to unconsciousness and of these 22.5% sustained significant neurological insults. A major causative factor was motor vehicle accidents, but lifestyle variables including alcohol and drug abuse and history of violence also contributed. The brain-injured group was convicted for a wide range of sexual offenses and was comparable to the non-injured group in this respect, but tended more often to offend against adults than against children and to show somewhat more exhibiting and polymorphous sexual behavior. In spite of the serious legal implications for these men and the additional distress to their families, psychologists, psychiatrists, and the professional literature have been relatively silent on the subject which calls for more attention to sexual behavior as part of assessments and treatment planning.