following childhood traumatic following childhood traumatic brain injury and its brain injury and its association with self- association with self- regulation and social and regulation and social and behavioral functioning behavioral functioning Kalaichelvi Ganesalingam, Keith Owen Kalaichelvi Ganesalingam, Keith Owen Yeates, Ann Sanson, and Vicki Anderson Yeates, Ann Sanson, and Vicki Anderson Presented by: Edward Harris, Jordan McNeely, & Keith Pelstring
Transcript
Social problem solving skills following Social problem solving skills following childhood traumatic brain injury and its childhood traumatic brain injury and its
association with self-regulation and association with self-regulation and
social and behavioral functioningsocial and behavioral functioning Kalaichelvi Ganesalingam, Keith Owen Yeates, Ann Kalaichelvi Ganesalingam, Keith Owen Yeates, Ann
Sanson, and Vicki AndersonSanson, and Vicki Anderson
Presented by:
Edward Harris, Jordan McNeely, & Keith Pelstring
IntroductionIntroduction
Childhood Traumatic Brain Injury (TBI)Childhood Traumatic Brain Injury (TBI) Results in a variety of adverse outcomesResults in a variety of adverse outcomes
Magnitude closely related to severity of injury Magnitude closely related to severity of injury (Yeates, 2000)(Yeates, 2000)
Moderate to severe TBI results in significant Moderate to severe TBI results in significant deficits in NP functioningdeficits in NP functioning
Poor regulatory skills, e.g. hyperactivity, inattention Poor regulatory skills, e.g. hyperactivity, inattention (Max, et al. 2004)(Max, et al. 2004)
Poor adaptive behaviors, interpersonal relations Poor adaptive behaviors, interpersonal relations (Yeates, et al. 2004)(Yeates, et al. 2004)
Lower social competency, higher levels of loneliness Lower social competency, higher levels of loneliness (Andrews, Rose & Johnson, 1998)(Andrews, Rose & Johnson, 1998)
Introduction cont.Introduction cont.
Research pays little attention to underlying Research pays little attention to underlying factorsfactors
Previous studies propose various NP deficits Previous studies propose various NP deficits as predictors (e.g. McGann, Werven & as predictors (e.g. McGann, Werven & Douglas, 1997)Douglas, 1997) Scores on traditional tests rarely strongly Scores on traditional tests rarely strongly
predictive among children with TBI predictive among children with TBI (Papero, et al. 1993)(Papero, et al. 1993)
Studies need to examine contribution of Studies need to examine contribution of social cognitive skills, NP factors, and social cognitive skills, NP factors, and interpersonal thinking skills to social interpersonal thinking skills to social behavioral functioning.behavioral functioning.
Introduction cont.Introduction cont.
Available studies suggest children with TBI Available studies suggest children with TBI demonstrate poorer social problem solving demonstrate poorer social problem solving skills.skills. Generate fewer solutions to hypothetical situationsGenerate fewer solutions to hypothetical situations Solutions provided are indirect, less positive, less Solutions provided are indirect, less positive, less
assertive (Warschausky, et al. 1997)assertive (Warschausky, et al. 1997) Children with severe TBI often respond with Children with severe TBI often respond with
immature strategies to solve social problemsimmature strategies to solve social problems Use less advanced reasoning to evaluate the Use less advanced reasoning to evaluate the
effectiveness of chosen strategies (Janusz, et al. effectiveness of chosen strategies (Janusz, et al. 2002)2002)
Social Information Social Information Processing ModelProcessing Model
Six steps:Six steps:– Encoding situational and Encoding situational and
internal cues.internal cues.– Interpretation of cuesInterpretation of cues– Selecting or clarifying goalSelecting or clarifying goal– Generating or accessing Generating or accessing
possible responsespossible responses– Choosing a responseChoosing a response– Behavioral enactmentBehavioral enactment
Hypothesized that negative Hypothesized that negative behavior results from deficits behavior results from deficits in one or more stage (Dodge, in one or more stage (Dodge, 1986).1986).
Interpersonal Negotiation Interpersonal Negotiation Strategies ModelStrategies Model
Four Steps:Four Steps: Defining the problemDefining the problem Generating alternative Generating alternative
strategiesstrategies Selecting and implementing Selecting and implementing
a specific strategya specific strategy Evaluating the strategy’s Evaluating the strategy’s
outcomeoutcome Each skill can be implemented Each skill can be implemented
at four developmental levelsat four developmental levels Reflects children’s social Reflects children’s social
Current study uses newly developed, semi-structured task Similar to SIP and INS models, but attends
specifically to step 5 of SIP and step 3 of INS Less time consuming to administer and easier to
score Overall Goal: “…to examine the impact of
childhood TBI on social problem solving skills… and to determine whether social problem solving is predicted by measures of self regulation.”
HypothesisHypothesis Children with moderate to severe TBI Children with moderate to severe TBI
would display poorer social problem would display poorer social problem solving skills.solving skills.
Regardless of group, self regulation Regardless of group, self regulation would account for significant would account for significant variance in social problem solving.variance in social problem solving.
Social problem solving would account Social problem solving would account for significant variance in social and for significant variance in social and behavioral functioning.behavioral functioning.
MethodMethod
SubjectsSubjects Experimental GroupExperimental Group
60 children with TBI’s were recruited from 3 60 children with TBI’s were recruited from 3 hospitals around Australiahospitals around Australia
5 more children with TBI’s were recruited 5 more children with TBI’s were recruited form primary schools in New Zealandform primary schools in New Zealand
Control groupControl group 5 children from Australia and 60 children 5 children from Australia and 60 children
from New Zealand without TBI’s were from New Zealand without TBI’s were recruited the control subject matched the recruited the control subject matched the experimental group for age and genderexperimental group for age and gender
All subjects were ages 6-11All subjects were ages 6-11 All subjects were attending a mainstream primary schoolAll subjects were attending a mainstream primary school 95% of subjects were Caucasian 95% of subjects were Caucasian Remaining 5% were of Asian, Polynesian, or Middle-Remaining 5% were of Asian, Polynesian, or Middle-
Eastern decentEastern decent All subjects wrote and spoke English as their first All subjects wrote and spoke English as their first
languagelanguage All subjects with severe TBI’s (n=32) had intracranial All subjects with severe TBI’s (n=32) had intracranial
abnormalities on CT and/or MRI scans abnormalities on CT and/or MRI scans Of the subjects with moderate TBI’s (n=33) 73% had Of the subjects with moderate TBI’s (n=33) 73% had
intracranial abnormalities on CT and/or MRI scansintracranial abnormalities on CT and/or MRI scans Socio-economic status varied widely based on maternal Socio-economic status varied widely based on maternal
Diagnosis criteria Diagnosis criteria TBI’s had to be documented and accidentalTBI’s had to be documented and accidental It had been 2-5 years from TBI incident It had been 2-5 years from TBI incident Severe TBI was defined as a score of 8 or less on the Severe TBI was defined as a score of 8 or less on the
Glasgow Coma Scale (GCS)Glasgow Coma Scale (GCS) Moderate TBI was defined as a GCS score of 9-12Moderate TBI was defined as a GCS score of 9-12 Also, a TBI with a GCS score of 13-15 was defined as Also, a TBI with a GCS score of 13-15 was defined as
moderate if it was accompanied by:moderate if it was accompanied by: Skull fractureSkull fracture Intracranial lesionIntracranial lesion diffuse cerebral swelling on routine clinical imagingdiffuse cerebral swelling on routine clinical imaging Post-traumatic neurological abnormality Post-traumatic neurological abnormality Loss of consciousness for longer that 15 minutesLoss of consciousness for longer that 15 minutes
Method cont.Method cont.
Measures – Social Problem-Solving Measures – Social Problem-Solving This was assessed by presenting 8 hypothetical This was assessed by presenting 8 hypothetical
situations involving social problems situations involving social problems The interviewer read the situation from a script while the The interviewer read the situation from a script while the
child followed along with a three picture cartoon child followed along with a three picture cartoon depicting the situationdepicting the situation
After the interviewer had finished telling the story they After the interviewer had finished telling the story they would ask the child “What would you do in this would ask the child “What would you do in this situation.” situation.”
Response were coded as assertive, aggressive, avoidant, Response were coded as assertive, aggressive, avoidant, or irrelevant/no response or irrelevant/no response
Assertive responses were the ones that were considered Assertive responses were the ones that were considered relevant and pro-socialrelevant and pro-social
All interviews were audio taped and transcribed All interviews were audio taped and transcribed To insure reliability 30% of subjects responses were To insure reliability 30% of subjects responses were
coded by an independent rater coded by an independent rater
Method cont.Method cont.
Measures – Social Problem-SolvingMeasures – Social Problem-SolvingYou are at a party. An adult at the party stars to give the children bags You are at a party. An adult at the party stars to give the children bags
with all sorts of goodies inside, while she is doing this the phone rings. with all sorts of goodies inside, while she is doing this the phone rings. She goes to answer the phone without giving you a bag and no one She goes to answer the phone without giving you a bag and no one
there seems to care that you are the only child without a bag. there seems to care that you are the only child without a bag.
The Matching Familiar Figures Test (MFFT; Kagan, 1966) The Matching Familiar Figures Test (MFFT; Kagan, 1966) This was used to assess cognitive impulsivityThis was used to assess cognitive impulsivity Children are presented with a figure and asked to find identical Children are presented with a figure and asked to find identical
matches to this figure in and array of similar distractersmatches to this figure in and array of similar distracters Response errors and response latency were recordedResponse errors and response latency were recorded On this test high scores indicate poor self-regulationOn this test high scores indicate poor self-regulation
This was used to assess behavioral self-regulationThis was used to assess behavioral self-regulation Child was put in a room with a bell on a table, one piece of candy was Child was put in a room with a bell on a table, one piece of candy was
placed in front of the bell and two pieces of candy were placed behind placed in front of the bell and two pieces of candy were placed behind the bell.the bell.
The experimenter prepared to leave and the child was told that if they The experimenter prepared to leave and the child was told that if they waited for the experimenter to return they would receive 2 pieces of waited for the experimenter to return they would receive 2 pieces of candy but if they rang the bell to summon the experimenter back into candy but if they rang the bell to summon the experimenter back into the room they would only receive one piece of candy.the room they would only receive one piece of candy.
Children were videotaped Children were videotaped Distraction strategies and time until gratification were recorded Distraction strategies and time until gratification were recorded
Test of Everyday Attention for Children Test of Everyday Attention for Children (TEA-Ch; Manly, Robertson, (TEA-Ch; Manly, Robertson, Anderson, & Nimmo-Smith, 1999) Anderson, & Nimmo-Smith, 1999) Three of the TEA-Ch subscales were Three of the TEA-Ch subscales were
employed in this study to look at various employed in this study to look at various aspects of cognitive self-regulation. aspects of cognitive self-regulation. These are sky search, score, and These are sky search, score, and opposite worlds. opposite worlds.
Children asked to circle spaceships on a paper with and without Children asked to circle spaceships on a paper with and without distractersdistracters
Non-distracter task time was subtracted from distracter task time to Non-distracter task time was subtracted from distracter task time to control for motor speedcontrol for motor speed
Score test assessed unassisted sustained attentionScore test assessed unassisted sustained attention Children were asked to count the number of laser beam sounds in a set Children were asked to count the number of laser beam sounds in a set There were 10 sets that lasted 30-40 seconds each and there were 10-There were 10 sets that lasted 30-40 seconds each and there were 10-
20 sounds per set20 sounds per set Opposite Worlds assessed control and suppression of automatic Opposite Worlds assessed control and suppression of automatic
verbal responseverbal response Child was asked to follow a path on a page that periodically had the Child was asked to follow a path on a page that periodically had the
numerals 1 and 2numerals 1 and 2 On the “same world” trial the child was ask to say “one” upon seeing 1 On the “same world” trial the child was ask to say “one” upon seeing 1
and “two” upon seeing 2and “two” upon seeing 2 On the “opposite world” trail the child was ask to say “two” upon On the “opposite world” trail the child was ask to say “two” upon
seeing 1 and “one” upon seeing 2seeing 1 and “one” upon seeing 2 Only the “opposite world” trail data was used in this studyOnly the “opposite world” trail data was used in this study
Method cont.Method cont.Measures – Social and behavioral functioning Measures – Social and behavioral functioning
Eyberg Child Behavior Inventory (ECBI; Eyberg & Robinson, Eyberg Child Behavior Inventory (ECBI; Eyberg & Robinson, 1983)1983) This assesses the intensity of a variety of behavior problem This assesses the intensity of a variety of behavior problem
children may display at homechildren may display at home This measure was parent ratedThis measure was parent rated High scores reflect poor functioningHigh scores reflect poor functioning
Sutter-Eyberg Student Behavior Inventory – Revised (SESBI-R; Sutter-Eyberg Student Behavior Inventory – Revised (SESBI-R; Funderburk & Eyberg, 1989)Funderburk & Eyberg, 1989) This assesses the intensity of a variety of behavior problem This assesses the intensity of a variety of behavior problem
children may display at schoolchildren may display at school This measure was teacher rated This measure was teacher rated High scores reflect poor functioningHigh scores reflect poor functioning
Social Skills Rating System (SSRS; Gresham & Elliot, 1990)Social Skills Rating System (SSRS; Gresham & Elliot, 1990) This assesses behaviors that allow children to interact effectivelyThis assesses behaviors that allow children to interact effectively This measure was rated by parents and teachersThis measure was rated by parents and teachers High scores reflect better functioning High scores reflect better functioning
Method cont.Method cont.
Measures – Social and behavioral functioningMeasures – Social and behavioral functioning Emotion Regulation Checklist (ERC; Shields Emotion Regulation Checklist (ERC; Shields
Assesses empathy and emotional awarenessAssesses empathy and emotional awareness High scores reflect better functioningHigh scores reflect better functioning
Lability/negativity Lability/negativity Assesses emotional flexibility and negative affectAssesses emotional flexibility and negative affect High scores reflect poor functioningHigh scores reflect poor functioning
Both of these subscales were parent ratedBoth of these subscales were parent rated
Data Analysis Data Analysis
An analysis of covariance (ANCOVA) was ran An analysis of covariance (ANCOVA) was ran between group membership and response between group membership and response to social problem solving taskto social problem solving task
Many correlations were ran between Many correlations were ran between responses, measures of self-regulation, and responses, measures of self-regulation, and parent and teacher rated social and parent and teacher rated social and behavioral functioningbehavioral functioning
Also hierarchal regression analyses were Also hierarchal regression analyses were conducted to determine self-regulation’s conducted to determine self-regulation’s significance as determinants for social significance as determinants for social problem solving and social and behavioral problem solving and social and behavioral outcomesoutcomes
ResultsResultsSocial problem solving taskSocial problem solving task
Children with a TBI gave twice as many avoidant and aggressive Children with a TBI gave twice as many avoidant and aggressive responses, and half as many assertive responses as the controlsresponses, and half as many assertive responses as the controls
Also they were almost four times more likely to give an Also they were almost four times more likely to give an irrelevant/no response answerirrelevant/no response answer
Results cont.Results cont. A significant relationship was found between self regulation and A significant relationship was found between self regulation and
problem solving response but only in experimental groupproblem solving response but only in experimental group Higher level of self regulation predicted more assertive and Higher level of self regulation predicted more assertive and
Results cont.Results cont. Significant relationships were found between Significant relationships were found between
parent and teacher rated social and behavioral parent and teacher rated social and behavioral functioning and aggressive or assertive solutionsfunctioning and aggressive or assertive solutions
DiscussionDiscussion
Results supported the hypothesis Results supported the hypothesis that children with TBI displayed that children with TBI displayed poorer social problem solving skills poorer social problem solving skills than uninjured children.than uninjured children. More avoidant, aggressiveMore avoidant, aggressive Consistent with previous researchConsistent with previous research
Self RegulationSelf Regulation
Taken collectively, better performance Taken collectively, better performance on self regulation measurements on self regulation measurements predicted more pro-social solutions.predicted more pro-social solutions. No individual measure showed significant No individual measure showed significant
variancevariance Measures used were intercorrelatedMeasures used were intercorrelated Partly consistent with previous research Partly consistent with previous research
that failed to find significant relationships that failed to find significant relationships between neuropsychological tests and between neuropsychological tests and social behaviorsocial behavior
Social Problem-SolvingSocial Problem-Solving
Measured skills accounted for Measured skills accounted for significant variance in behavioral significant variance in behavioral functioningfunctioning Aggressive solutions -- poorer functioningAggressive solutions -- poorer functioning Assertive solutions -- better functioningAssertive solutions -- better functioning *Avoidant solutions were not predictive of *Avoidant solutions were not predictive of
behavioral functioning*behavioral functioning* -Measures in this study were more focused -Measures in this study were more focused
on externalized behaviors rather than on externalized behaviors rather than internalized onesinternalized ones
Confounds and ShortcomingsConfounds and Shortcomings
Children without TBI did not have the Children without TBI did not have the stressful experience of a hospital stressful experience of a hospital stay. Children with non-cranial stay. Children with non-cranial orthopedic injuries would have made orthopedic injuries would have made better controls.better controls.
Most children from the TBI sample Most children from the TBI sample were from Australia, while the non-were from Australia, while the non-TBI sample were predominantly from TBI sample were predominantly from New Zealand.New Zealand.
Confounds and ShortcomingsConfounds and Shortcomings
Linguistic abilities were not assessedLinguistic abilities were not assessed Some differences between the samples Some differences between the samples
may have been attributable to ability to may have been attributable to ability to articulate.articulate.
Authors feel that controlling for Authors feel that controlling for language deficits should be addressed in language deficits should be addressed in future research.future research.
