Melbourne School of Psychological Sciences - Theses

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    Reconceptualising paediatric traumatic brain injury as a disorder of the ‘social brain’: a longitudinal prospective study of brain-behaviour relationships
    RYAN, NICHOLAS PETER ( 2017)
    Background: Childhood and adolescence coincide with rapid maturation of distributed neural systems implicated in complex socio-emotional behaviours; however, little is known about the impact of early traumatic brain injury on the acquisition and establishment of these skills. This longitudinal prospective study evaluates the influence of paediatric traumatic brain injury (TBI) on social cognitive and sociobehavioural functioning, and examines factors associated with long-term outcome and recovery of these skills. Method: High resolution T1, susceptibility-weighted and diffusion-weighted MRI sequences were acquired sub-acutely in 112 children and adolescents with mild-severe TBI. For comparison, 43 typically developing children of similar age and sex were scanned. Formal child outcome assessments and parent ratings of social behaviour were completed at both 6- and 24-months post-injury. Results: Findings reveal that social cognitive and sociobehavioural skills are vulnerable to long-term disruption from TBI, with evidence for a time-dependent emergence of social cognitive impairment in younger children for whom skills were emerging or not yet established at the time of injury. Poorer long-term social outcomes were documented in association with diffuse cerebral microbleeds, lower family affective responsiveness, poorer parent mental health, and grey and white matter neuroanatomical differences in large-scale neural systems implicated in social behaviour. Poorer post-acute social cognition mediated the prospective impact of sub-acute neuroanatomical abnormalities on chronic sociobehavioural problems. Conclusions: Evidence for robust brain-behaviour relationships accord with a network paradigm of sociocognitive disturbance, and should prompt clinicians to consider structural connectivity when interpreting impairments in children with TBI, especially in the domain of social cognition. Results suggest that, although high resolution MRI has potential to unlock prognostic markers associated with poorer social outcomes, neuroanatomical differences in large scale neural systems represent one of several factors that contribute to the emergence and persistence of social difficulties after child TBI. Clinicians should monitor the presence of broad range of injury, child-related, and modifiable family environmental risk factors, and incorporate these indicators into clinical management and rehabilitation planning.