Social Problem-Solving Skills in Children with Traumatic Brain Injury: Long-Term Outcomes and Prediction of Social Competence

The effects of childhood traumatic brain injury (TBI) on social problem-solving were examined in 35 children with severe TBI, 40 children with moderate TBI, and 46 children with orthopedic injuries (OI). The children were recruited prospectively following injuries that occurred between 6 and 12 years of age. They were followed longitudinally, and ranged from 9 to 18 years of age at the time of the current study, which occurred on average 4 years post injury. They were administered a semi-structured interview used in previous research on social problem-solving to assess the developmental level of their responses to hypothetical dilemmas involving social conflict. Children in the severe TBI group defined the social dilemmas and generated alternative strategies to solve those dilemmas at the same developmental level as did children in the OI group. However, they articulated lower-level strategies as the best way to solve the dilemmas and used lower-level reasoning to evaluate the effectiveness of the strategies. After controlling for group membership, race, socioeconomic status, IQ, and age, children's social problem-solving, and particularly the developmental level of their preferred strategies for resolving conflicts, predicted parents ratings of children's social skills, peer relationships, aggressive behavior, and academic performance. The findings indicate that children with severe TBI demonstrate selective, long-term deficits in their social problem-solving skills that may help to account for their poor social and academic outcomes.     

Theory of mind skills 1 year after traumatic brain injury in 6- to 8-year-old children

This study examined the longer-term effects of traumatic brain injury (TBI) on theory of mind (ToM) skills of children who were between the ages of 5 and 7 years at the time of injury. Fifty-two children with orthopaedic injury, 30 children with moderate TBI, and 12 children with severe TBI were evaluated approximately 1 year post-injury (mean age=6.98 years, SD=0.59, range=6.02–8.26). Children with severe TBI did not engage in representation of first- and second-order mental states at a developmental level comparable to their peers, suggesting stagnation or lack of development, as well as regression of putatively existing ToM skills. Age, task-specific cognitive demands, and verbal abilities were strong predictors of ToM performance. However, even after taking those factors into account, children with severe TBI had poorer ToM performance than children with orthopaedic injuries.     

Social competence and conduct problems in young children: issues in assessment

Examined the differences in various facets of social competence in 2 groups of young children (ages 4-7 years)--a clinic-referred group of aggressive children (N = 60) diagnosed with oppositional defiant disorder or conduct problems and a matched comparison group of typically developing children (N = 60). Four aspects of social competence were assessed: social information processing, actual observations of conflict management skills and social play interactions during peer interactions, positive social interactions with mothers and fathers at home, and teacher reports of social competence. The social information processing assessed included problem-solving skills (hypothetical skills as demonstrated on a social problem-solving test), self-perceptions (child's awareness of his or her own social self and feelings of loneliness), perceptions of others (attributions), and perceptions of others' attitudes toward oneself. To determine the construct validity of various means of assessing child social competence, we correlated children's social information processing measures with parent and teacher reports of social adjustment and with actual observations of interactions during peer play and at home with parents. Results comparing the 2 groups suggest that young children with conduct problems have deficits in their social information processing awareness or interpretation of social cues--they overestimate their own social competence and misattribute hostile intent to others. Tests of cognitive problem solving and observations of peer play interactions indicated that the children with conduct problems had significantly fewer positive problem-solving strategies and positive social skills, more negative conflict management strategies, and delayed play skills with peers than the comparison children. Correlation analyses indicated significant correlations between children's negative attributions and the ratio of positive to negative problem-solving strategies with observations of peer play interactions.     

Emerging narrative discourse skills 18 months after traumatic brain injury in early childhood

This study examined the longer term effect of traumatic brain injury (TBI), approximately 18 months post-injury, on emerging narrative discourse skills of 85 children with orthopaedic injury (OI), 43 children with moderate TBI, and 19 children with severe TBI who were between 3 years and 6 years 11 months at injury. Children with TBI performed worse than children with OI on most discourse indices. Children with severe TBI were less proficient than children with moderate TBI at identifying unimportant story information. Age and pragmatic skills were predictors of discourse performance.     

Prevalence and correlates of depressive symptoms following traumatic brain injuries in children.

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.     

Social problem‐solving skills following childhood traumatic brain injury and its association with self‐regulation and social and behavioural functioning

This study examines social problem‐solving skills following childhood traumatic brain injury (TBI) and its association with self‐regulation, and social and behavioural functioning. Participants included 65 children with moderate to severe TBI and 65 children without TBI, all between 6 and 11 years of age. Social problem‐solving, self‐regulation, and social and behavioural functioning were assessed 2–5 years following injury. Children were administered a newly developed semi‐structured task to assess their solutions to hypothetical situations involving social problems or dilemmas. When compared with uninjured children, those with TBI suggested avoidant and aggressive solutions more often and assertive solutions less often in response to the hypothetical situations. Children's self‐regulatory skills, as measured by the Matching Familiar Figures Test (MFFT), Test of Everyday Attention for Children (TEA‐Ch) and the Delay of Gratification Task (DGT), collectively accounted for significant variance in their solutions to social problems, such that better self‐regulation predicted more assertive solutions and fewer aggressive solutions. Assertive solutions were positively related to parent‐ and teacher‐rated social and behavioural outcomes, whereas aggressive solutions were negatively related to the outcomes. The difficulties in social problem‐solving skills demonstrated by children with TBI may help account for their poor social and behavioural functioning.     

Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury.

Examined posttraumatic stress (PTS) symptoms in children following pediatric traumatic brain injury (TBI). Children (ages 6-12) with TBI (n = 81) and orthopedic injury (OI; n = 59) were assessed 6 and 12 months postinjury. Parents of children with severe TBI reported higher levels of child PTS symptoms than did parents of children with moderate TBI or OI at the 6- and 12-month follow-ups. Group differences in child-reported PTS symptoms emerged at the 12-month follow-up with higher symptom levels reported by children with severe TBI than by those with moderate TBI or OI. At both follow-ups, rates of clinically significant symptom levels were higher in the severe TBI group than in the moderate TBI or OI groups. The group differences in parent and child reports were significant even after taking ethnicity, social disadvantage, and age at injury into account. Parent and child reports of child PTS symptoms were related to family socioeconomic status. Implications for clinical intervention with children and families following pediatric TBI are discussed.     

Gender influences on preschool children's social problem-solving strategies

The authors investigated gender influences on the nature and competency of preschool children's social problem-solving strategies. Preschool-age children (N = 179; 91 boys, 88 girls) responded to hypothetical social situations designed to assess their social problem-solving skills in the areas of provocation, peer group entry, and sharing or taking turns. Results indicated that, overall, girls' responses were more competent (i.e., reflective of successful functioning with peers) than those of boys, and girls' strategies were less likely to involve retaliation or verbal or physical aggression. The competency of the children's responses also varied with the gender of the target child. Findings are discussed in terms of the influence of gender-related social experiences on the types of strategies and behaviors that may be viewed as competent for boys and girls of preschool age.     

Evaluation of a short-term group therapy program for children with behavior problems and their parents.

The current study investigated the effectiveness of a short-term, cognitive behavioral program for 106 primary school-aged children referred with externalizing behavior problems and their parents, compared with 39 children and their parents on a waiting-list to be treated. Exploring Together' comprised a children's group (anger management, problem-solving and social skills training), a parents' group (parenting skills training and dealing with parents' own issues), and a combined children's and parents' group (to target parent-child interactions). The program reduced children's behavior problems and improved their social skills at home. Changes in children's behaviors and social skills at home were generally maintained at 6- and 12-month follow-up. Implications of the findings for improving interventions for childhood externalizing behavior problems are discussed.     

3~5岁幼儿自我延迟满足的发展特点及其中澳跨文化比较

采用实验室实验和情境观察相结合的方法,考察了我国3~5岁幼儿自我延迟满足发展的特点及中澳幼儿自我延迟满足的跨文化差异。研究结果表明：(1) 3~5岁幼儿自我延迟满足平均延迟时间随年龄增长而延长;3岁幼儿使用延迟策略少,4岁幼儿主要使用寻求策略,5岁幼儿主要使用寻求策略和自我分心、问题解决策略,自我言语控制策略在整个幼儿期始终不具有显著优势性。(2) 澳大利亚幼儿自我延迟满足发展水平高于我国同龄幼儿;在延迟策略选择上中澳幼儿既具有差异性,又具有一定的相似性;文化价值观通过教育影响着幼儿自我延迟满足的发展。     

Social problem solving and mother-child interactions of educable mentally retarded children

Mothers of retarded children and nonretarded children were observed and videotaped as they interacted with their own child in a seminaturalistic situation, requiring teaching, cooperation, and free play. The child's social problem-solving abilities were assessed independently. The Vineland scale was employed to provide some convergent evidence of social problem-solving as a component of social competence. Twelve educable mentally retarded and 19 nonretarded 10-year-old children and their mothers comprised the sample. For the mentally retarded group, it was found that the higher maternal directiveness, the lower the child's social problem-solving skills. Mothers who often gave the child opportunity for decision-making and social influence had children with higher problem-solving skills. The retarded children produced significantly fewer different strategies for solving social problems, but gave a wider range of strategies than has been found in previous research. There was some support that social problem-solving skills are related to social maturity.     

Long-term executive function deficits in children with traumatic brain injuries: assessment using the Behavior Rating Inventory of Executive Function (BRIEF).

Long-term deficits in executive functions following childhood traumatic brain injuries (TBI) were examined using the Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF approximately 5 years postinjury as part of a prospective study of children injured between the ages of 6 and 12. The children were between 10 and 19 years of age at the time of the assessment, and included 33 with severe TBI, 31 with moderate TBI, and 34 with orthopedic injuries. Parents also rated children's adaptive functioning and completed several other measures of parent and family functioning. Children were administered a neuropsychological test battery that included several measures of executive functions. The groups displayed a significant linear trend in BRIEF scores, with the largest deficits in executive functions reported in children with severe TBI. BRIEF scores were related consistently across groups to a test of working memory, but not to other neuropsychological measures. BRIEF scores also predicted children's adaptive functioning and behavioral adjustment, as well as parent psychological distress, perceived family burden, and general family functioning. The findings indicate that TBI results in long-term deficits in executive functions that are related to children's psychosocial outcomes, as well as to parent and family functioning.     

Treating boys with low school achievement and behavior problems: comparison of two kinds of intervention

Children with low school achievement frequently have behavior problems and interpersonal difficulties that pose a risk for psychosocial maladjustment. 39 boys were assessed and randomly assigned to one of two group treatment conditions: (a) interpersonal cognitive problem-solving for whom training was provided through oral and written language activities that met children's social and academic needs and (b) a language workshop, during which only academic difficulties were treated. Parents of children in both groups received group attention. Posttreatment assessments indicated that boys in both conditions showed significant improvements on school achievement and behavior problems, as they were measured by behavior scales reported by mothers and by an academic achievement test. Children in the problem-solving group improved significantly more than the other group on most measures. These results suggest that work with interpersonal cognitive problem-solving skills combined with reading and writing activities is a useful means to produce improvements in child behavior and school achievement.     

Prevalence and Correlates of Depressive Symptoms Following Traumatic Brain Injuries in Children

The prevalence and correlates of depressive symptoms following childhood traumatic brain injuries (TBI) were examined using data drawn from a prospective longitudinal study. Participants included 38 children with severe TBI, 51 with moderate TBI, and 55 with orthopedic injuries (OI). Assessments occurred shortly after injury (baseline) and at 6- and 12-month follow-ups. Children completed the Child Depression Inventory (CDI). Parents rated depressive symptoms using the Child Behavior Checklist (CBC), with baseline ratings reflecting premorbid status. Assessments also included measures of children's neurocognitive functioning and the family environment. The three groups did not differ overall in self-reported symptoms on the CDI, but did display different trends over time. The three groups did not differ on parent ratings of premorbid depressive symptoms on the CBC, but parents reported more depressive symptoms in the TBI groups than in the OI group at 6- and 12-month follow-ups. Child and parent reports were correlated for children in the TBI groups, but not for those in the OI group. Depressive symptoms were related to socioeconomic status in all groups. Socioeconomic status also was a significant moderator of group differences, such that the effects of TBI were exacerbated in children from more disadvantaged homes. Although self-reports of depressive symptoms were related inconsistently to children's verbal memory, parent reports of depressive symptoms were unrelated to IQ or verbal memory. The findings suggest that TBI increases the risk of depressive symptoms, especially among more socially disadvantaged children, and that depressive symptoms are not strongly related to post-injury neurocognitive deficits.     

Recovery and predictors of language skills two years following pediatric traumatic brain injury

Subtle language processing difficulties may adversely affect scholastic performance, as well as communication and social skills. It is therefore crucial that language skills are monitored following traumatic brain injury (TBI) in childhood. The present study examined language skills in a group of 68 children who had sustained a mild, moderate or severe TBI. Results indicated that during the acute stage a dose-response relationship was evident, where severe TBI was associated with poorest performance and mild TBI with least deficits. By 24 months post-TBI, it was clear that for some language functions, the severe TBI group showed substantial recovery, and at times performed better than the moderate TBI group. Predictors of language and literacy skills at 24 months post TBI included pre-injury communication skills, socio-economic status, age at injury, and Vocabulary, as measured by the Wechsler Intelligence Scale for Children (WISC-111).     

Natural sequence of recovery from child post-traumatic amnesia: A retrospective cohort study

The aim of this study was to determine the sequence of skills recovery during post-traumatic amnesia (PTA) in children with moderate to severe traumatic brain injuries (TBIs). Setting: Fifty children aged 8 to 15 years consecutively admitted to a children’s hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.     

Interpersonal problem solving in preschool and first grade: developmental change and ecological validity

Examined problem-solving strategies, their correlation with multiple-informant ratings of behavior problems and social competence, and developmental change over a 2-year period. Shure's (1999) model targets children's production of alternative solutions to interpersonal problems. Others have found that solution quality correlates more highly with adjustment. Children (N = 208, M age = 60 months) completed the Preschool Interpersonal Problem Solving (PIPS) task in Head Start and again 2 years later. Many children achieved substantial gains in problem-solving skill as measured by PIPS. The prosocial or forceful quality of children's responses correlated with observational, caregiver, and teacher ratings of behavior problems and social competence. Quality of response appeared more important than solution quantity in predicting ecologically valid behaviors, implying that interventions should concentrate on response content more than quantity.     

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).     

Preschool teachers' ratings of behavioral problems: Observational,sociometric, and social-cognitive correlates

Behar and Stringfield (1974) have suggested that the Preschool Behavior Questionnaire (PBQ) is a reliable index of young children's social competence. However, there are few extant data in which teacher ratings of children on the PBQ have been correlated with independent assessments of social competence. In this study PBQ ratings of 123 preschoolers were correlated with observations of in-class social and cognitive play behaviors, sociometric status, and social problem-solving skills. Analyses indicated that children rated highly on the PBQ's Anxious-Fearful, Hostile-Aggressive, and Hyperactive-Distractible factors (a) displayed less mature and more aggressive in-class behaviors, (b) were less popular among their peers, and (c) were more likely to suggest negative affect strategies on the social problem-solving measure. Thus, the PBQ appears to be a useful instrument for identifying children with social problems.