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  • Article: Response inhibition in children with and without ADHD after traumatic brain injury.
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    ABSTRACT: Children with attention-deficit hyperactivity disorder (ADHD) and traumatic brain injury (TBI) show deficient response inhibition. ADHD itself is a common consequence of TBI, known as secondary ADHD (S-ADHD). Similarity in inhibitory control in children with TBI, S-ADHD, and ADHD would implicate impaired frontal-striatal systems; however, it is first necessary to delineate similarities and differences in inhibitory control in these conditions. We compared performance of children with ADHD and those with TBI without pre-injury ADHD on a stop signal, response inhibition task. Participants were 274 children aged 6-14 years. There were 92 children with ADHD, 103 children with TBI, and 79 typically developing children who served as controls. Among the TBI participants, injury severity ranged from mild to severe. Children with ADHD and TBI showed deficient inhibition. The deficit in children with ADHD was as great as or greater than that in children with TBI, regardless of degree of TBI severity or the presence of S-ADHD. The finding indicates that TBI results in deficient inhibition regardless of the development of S-ADHD.
    Journal of Neuropsychology 03/2013; 7(1):1-11. · 1.74 Impact Factor
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    Article: Peer Relationships of Children with Traumatic Brain Injury.
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    ABSTRACT: This study examined peer relationships in children with traumatic brain injury (TBI) relative to children with orthopedic injuries (OI), and explored whether differences in peer relationships correlated with white matter volumes. Classroom procedures were used to elicit peer perceptions of social behavior, acceptance, and friendships for eighty-seven 8- to 13-year-old children, 15 with severe TBI, 40 with complicated mild/moderate TBI, and 32 with OI. Magnetic resonance imaging (MRI) and voxel-based morphometry (VBM) were used to investigate volumetric correlates of peer relationship measures. Children with severe TBI were rated higher in rejection-victimization than children with OI, and were less likely than children with OI to have a mutual friendship in their classroom (47% vs. 88%). Children with TBI without a mutual friend were rated lower than those with a mutual friend on sociability-popularity and prosocial behavior and higher on rejection-victimization, and had lower peer acceptance ratings. Mutual friendship ratings were related to white matter volumes in several posterior brain regions, but not to overall brain atrophy. Severe TBI in children is associated with detrimental peer relationships that are related to focal volumetric reductions in white matter within regions of the brain involved in social information-processing. (JINS, 2013, 19, 1-10).
    Journal of the International Neuropsychological Society 01/2013; 19:518–527. · 2.76 Impact Factor
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    Article: Irony and Empathy in Children With Traumatic Brain Injury.
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    ABSTRACT: Social communication involves influencing what other people think and feel about themselves. We use the term conative theory of mind (ToM) to refer to communicative interactions involving one person trying to influence the mental and emotional state of another, paradigmatic examples of which are irony and empathy. This study reports how children with traumatic brain injury (TBI) understand ironic criticism and empathic praise, on a task requiring them to identify speaker belief and intention for direct conative speech acts involving literal truth, and indirect speech acts involving either ironic criticism or empathic praise. Participants were 71 children in the chronic state of a single TBI and 57 age- and gender-matched children with orthopedic injuries (OI). Group differences emerged on indirect speech acts involving conation (i.e., irony and empathy), but not on structurally and linguistically identical direct speech acts, suggesting specific deficits in this aspect of social cognition in school-age children with TBI. Deficits in children with mild-moderate TBI were less widespread and more selective than those of children with more severe injuries. Deficits in understanding the social, conative function of indirect speech acts like irony and empathy have widespread and deep implications for social function in children with TBI. (JINS, 2013, 19, 1-11).
    Journal of the International Neuropsychological Society 01/2013; · 2.76 Impact Factor
  • Article: Cognitive, affective, and conative theory of mind (ToM) in children with traumatic brain injury.
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    ABSTRACT: We studied three forms of dyadic communication involving theory of mind (ToM) in 82 children with traumatic brain injury (TBI) and 61 children with orthopedic injury (OI): Cognitive (concerned with false belief), Affective (concerned with expressing socially deceptive facial expressions), and Conative (concerned with influencing another's thoughts or feelings). We analyzed the pattern of brain lesions in the TBI group and conducted voxel-based morphometry for all participants in five large-scale functional brain networks, and related lesion and volumetric data to ToM outcomes. Children with TBI exhibited difficulty with Cognitive, Affective, and Conative ToM. The perturbation threshold for Cognitive ToM is higher than that for Affective and Conative ToM, in that Severe TBI disturbs Cognitive ToM but even Mild-Moderate TBI disrupt Affective and Conative ToM. Childhood TBI was associated with damage to all five large-scale brain networks. Lesions in the Mirror Neuron Empathy network predicted lower Conative ToM involving ironic criticism and empathic praise. Conative ToM was significantly and positively related to the package of Default Mode, Central Executive, and Mirror Neuron Empathy networks and, more specifically, to two hubs of the Default Mode Network, the posterior cingulate/retrosplenial cortex and the hippocampal formation, including entorhinal cortex and parahippocampal cortex.
    Developmental cognitive neuroscience. 11/2012; 5C:25-39.
  • Article: Emotional Expression and Socially Modulated Emotive Communication in Children with Traumatic Brain Injury.
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    ABSTRACT: Facial emotion expresses feelings, but is also a vehicle for social communication. Using five basic emotions (happiness, sadness, fear, disgust, and anger) in a comprehension paradigm, we studied how facial expression reflects inner feelings (emotional expression) but may be socially modulated to communicate a different emotion from the inner feeling (emotive communication, a form of affective theory of mind). Participants were 8- to 12-year-old children with TBI (n = 78) and peers with orthopedic injuries (n = 56). Children with mild-moderate or severe TBI performed more poorly than the OI group, and chose less cognitively sophisticated strategies for emotive communication. Compared to the OI and mild-moderate TBI groups, children with severe TBI had more deficits in anger, fear, and sadness; neutralized emotions less often; produced socially inappropriate responses; and failed to differentiate the core emotional dimension of arousal. Children with TBI have difficulty understanding the dual role of facial emotions in expressing feelings and communicating socially relevant but deceptive emotions, and these difficulties likely contribute to their social problems. (JINS, 2013, 18, 1-10).
    Journal of the International Neuropsychological Society 11/2012; · 2.76 Impact Factor

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