Social skills and theory of mind in children with Traumatic Brain Injury

This thesis investigated the social competencies of children with traumatic brain injury (TBI) by investigating the predictors of social functioning and developing a measure of affective theory of mind (ToM). Study 1 examined the biopsychosocial predictors of social functioning in 56 children (7 - 16 years) with TBI. Using Beauchamp and Anderson’s (2010) socio-cognitive integration of abilities (SOCIAL) model, the study investigated the predictive abilities of family functioning, socio-economic status, children’s internal behaviours, executive functions, communication and social-cognitive abilities. A series of hierarchical multiple regression analyses showed that family functioning, internal behaviours, ecological executive functions and ToM made significant unique and collective contributions to the prediction of children’s socialisation skills and social behaviours. In light of the importance ToM has on children’s social functioning, Study 2 developed a measure of affective ToM and trialled its use on 17 children with TBI and a control group of 59 typically developing children (4 – 6.5 years). A visual and verbal version of a story book was developed to ask children a series of factual and emotional questions which were designed to assess their understanding of others’ feelings during social interactions. A series of analyses of variance were run, controlling for children’s receptive language skills. Although there was no significant difference between children with TBI and typically developing children on the factual and emotional questions, the results showed that children correctly answered significantly more emotional questions when the story was conveyed verbally as opposed to visually. There was no significant difference between book types on the fact questions. Furthermore, the results showed that affective ToM is a skill that develops with age, particularly during the preschool years. Both Study 1 and 2 have implications for the development of social rehabilitation techniques in children with TBI. In particular, Study 1 highlights the importance of family therapy and rehabilitation that targets children’s mood and understanding of others’ beliefs. Study 2 built on the concept of addressing ToM, and the findings have implications for teaching children about emotions and highlight the importance of language.