Social functioning after pTBI: Efficient assessment

As public awareness of pediatric traumatic brain injury (pTBI) increases, you might be finding more of these kids on your caseload before you know exactly what to do with them. (Never fear! That’s why TISLP is here!) SLPs and other professionals (school psychologists, teachers, and physicians) are often prepared to address issues such as fatigue, impulsiveness, and attentional deficits, but are you on the lookout for social communication deficits as well? For pTBI, these might show up in areas such as topic maintenance, figurative language, discourse organization, and non-verbal cues. (Check out this systematic review to get an even deeper understanding of how much pTBI can impact social communication.)

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Many parent-report measures for social communication are impractical (either because they are very lengthy or very age-specific), so Genova et al. tested out a tool you might already be using for autistic kids: Social Communication Disorder Checklist (SCDC). The SCDC is an efficient 12 item parent report tool, where parents rate how often various social, communication, and behavioral difficulties occur. The researchers paired the SCDC with two lengthier but valid assessments for pTBI: the Behavioral Assessment System for Children (BASC-2) and a Theory of Mind task that assesses a child’s ability to recognize a speaker’s beliefs (what does the speaker think about this situation?) and intentions (what does the speaker want the listener to think?).

And great news: the results were promising!

  • As expected, parents of kids with TBI reported significantly higher social communication issues than the parents of healthy controls on the SCDC. (Not to mention more difficulty with the BASC-2 and Theory of Mind task, as expected.)

  • The SCDC was correlated with the BASC-2 measures and all but one of the Theory of Mind measures, giving researchers more confidence that the SCDC carries over well to children with TBI!

Admittedly, this is the first study examining the use of the SCDC in the pTBI population and, as such, should be considered with caution. AND a (valid) 12-item parent report measure does not a full formal assessment make…but it sure makes it a heck of a lot easier!

Genova, H. M., Haight, A., Natsheh, J. Y., Deluca, J., & Lengenfelder, J. (2019). The Relationship Between Social Communication and Social Functioning in Pediatric TBI: A Pilot Study. Frontiers in Neurology. doi:10.3389/fneur.2019.00850

Pediatric brain injury referrals to SLPs very low

Pediatric brain injury isn’t just a temporary medical problem, but something that can cause cognitive–communication issues that last well past the acute phase and have a significant academic and social impact. The authors of this study emphasize that SLPs are ideal professionals to address these issues, and have “…a unique set of knowledge and skills that is needed in pediatric brain injury management…”
So the primary question in this article was—are these kids with pediatric brain injury being referred to SLPs (as they should be) while in the hospital? The medical records of 200 children*, from two hospitals, with intake between 2012–2014, were carefully examined. The authors found that at Hospital 1, 36% of children with pediatric brain injury were referred to an SLP, and at Hospital 2, only 2% were. Surprisingly, these were “specialty children’s hospitals affiliated with academic medical centers."
The authors describe their sample: the top three diagnoses were concussion, skull fracture, and hemorrhage, and the most frequent mechanisms were falls, motor vehicle collisions, and sports. Referral patterns were predicted most strongly by injury severity (more severe injuries get SLP referral) and age (older children more likely to get SLP referral). Now—the 36% an 2% stats are sad enough, but the fact that younger kids are less likely to get SLP referral is just painful. The authors propose several possible reasons for this (though the current data set can’t confirm it), with one of them being that perhaps young children’s behavioral repertoire (e.g. communication skills) aren’t as advanced, so deficits are simply more likely to go unnoticed. The authors indicate additional research in progress to help address the questions of why referral rates are so low and exhibit age and severity trends.
 
Ciccia, A.H., Lundine, J.P., Coreno, A. (2016) Referral Patterns as a Contextual Variable in Pediatric Brain Injury: A Retrospective Analysis. American Journal of Speech-Language Pathology. Advance online publication.  doi: 10.1044/2016_AJSLP-15-0087

*There were more cases of pediatric brain injury than this, but many records had to be excluded from analyses because they were incomplete or inconsistent in some way.