The Predictive Utility Of Social Cognitive Measures In .
The Predictive Utility of Social Cognitive Measures in Determining FunctionalOutcomes After Acquired Brain InjuryA report submitted as a partial requirement for the degree of Bachelor ofPsychological Science with Honours in Psychology at the University of Tasmania,2016.
Statement of SourcesI declare that this report is my own original work and that the contributions of othershave been duly acknowledged/ /Madelaine LodgeDateii
AcknowledgementsFirstly, I would like to thank Dr Christine Padgett, for your supervision, guidanceand support throughout the year. Thank you for your patience, answering my manyquestions and your advice. Secondly, I would like to thank Dr Cynthia Honan, foryour consultation and input into my thesis, and for the use of the Awareness ofSocial Inferences Test Shortened.Thirdly, thank you to the staff at the Tasmanian Acquired Brain InjuryService (TABIS); Paul, Kim, Steve and Leanne. The current study would not havebeen possible without your assistance with recruiting participants. Thank youespecially to Paul, for finding the majority of the ABI sample, even outside of theLaunceston area. I would also like to thank the TABIS staff for your time, beingpresent while testing some participants, for transport when testing in the community,and for the use of your office as a testing location.Fourthly, I would like to thank my friends and family. Thank you Caitlin,Nikki and Sarah, for your friendship, support and for making the 16-hour days at Unibearable.Lastly, thank you to all those who participated. Thank you for making mytesting experience interesting and enjoyable. In addition, thank you for your time,without your participation, the present study would not have been possible.iii
Table of ContentsList of Tables. viList of Figures . viiList of Acronyms . viiiAbstract . 1Introduction . 11.1 Acquired Brain Injury . 21.2 Impairments and Functional Outcomes After ABI . 61.3 Social Outcomes . 91.4 Social Cognition . 101.5 Justification for the Current Study . 151.6 Aims and Hypotheses . 17Method . 182.1 Participants . 182.2 Materials . 222.2.1 Demographic Questionnaire. 222.2.2 The Test of Premorbid Functioning (TOPF) . 232.2.3 The Hospital Anxiety and Depression Scale (HADS) . 242.2.4 Interpersonal Reactivity Index (IRI) . 242.2.5 The Awareness of Social Inference Test Shortened (TASIT-S) . 252.2.6 Social Emotional Questionnaire (SEQ) . 262.2.7 The Sydney Psychosocial Reintegration Scale (SPRS) . 27iv
2.3 Procedure . 282.4 Design and Analyses . 29Results . 303.1 Data Screening . 303.2 Group Comparisons on Social Cognitive Measures . 313.3 Discrepancy Scores Between Informant and Participant Responses . 313.4 Hierarchical Regressions for Predicting Functional Outcomes . 34Discussion . 374.1 Interpretation of Findings . 374.2 Clinical Implications . 414.3 Strengths and Limitations . 424.4 Future Research . 474.5 Conclusions . 47References . 49Appendices . 63Appendix A . 64Appendix B . 66Appendix C . 78v
List of TablesTable 1.Demographic Information .20Table 2.Injury-Related Data .21Table 3.Medication Use and Prevalence of Mental Illness in ABI Sample .22Table 4.t-tests Comparing the Results on Social Cognitive Measures 32Table 5.Paired Samples t-tests for Comparing Discrepancies .33Table 6.Regression Models for Predicting Participant SPRS Scores .35Table 7.Regression Models for Predicting Informant SPRS Scores 36vi
List of FiguresFigure 1.Classification of ABI . 5Figure 2.The Elements of Social Cognition . .12vii
List of AcronymsABIAcquired Brain InjuryEEMEmotion Evaluation TaskHADSHospital Anxiety and Depression ScaleIRIInterpersonal Reactivity IndexPTAPost-traumatic AmnesiaSEQSocial Emotional QuestionnaireSIESocial Inferences EnrichedSIMSocial Inferences MinimalSPRQSydney Psychosocial Reintegration ScaleTABISTasmanian Acquired Brain Injury ServiceTAIST-SThe Awareness of Social Inferences Test ShortenedTBITraumatic Brain InjuryToMTheory of MindTOPFTest of Premorbid Functioningviii
The Predictive Utility of Social Cognitive Measures in Determining FunctionalOutcomes After Acquired Brain InjuryWord Count: 9,962Madelaine Lodgeix
1AbstractPrevious studies indicate that social cognition is impaired after an acquiredbrain injury (ABI). Social cognition refers to the ability to interpret and understandemotions, social settings and interpersonal exchanges. The present study examinedimpairments in social cognitive ability, and the predictive utility of social cognitionin determining functional outcomes after an ABI. Thirty participants with an ABI(m 18, f 12) were recruited, and 30 healthy controls matched for similar sex, ageand premorbid IQ. A series of independent samples t-tests compared the ABI andcontrol participants on social cognitive measures. The relationship between the ABIparticipant’s social cognitive ability and their functional outcomes were examinedusing eight hierarchical regressions. t-test results indicated that the ABI groupperformed significantly worse on the objective and informant measures of socialcognition, while no significant differences on the self-reported social cognitionmeasures were observed. Social cognition significantly predicted 43.5% of thevariance in living skills on the participants rated outcome measure. The otherregression models showed trends where social cognition predicted functionaloutcomes, however were non-significant. Clinical implications of the current studyinclude facilitating assessments, by identifying individuals and their families whowould benefit from more assistance and education.
2Acquired brain injury (ABI) can result in physical, neuropsychological, social, andpsychosocial deficits (Lezak, 1987). Such factors can affect lifestyle adjustments andcommunity reintegration post-injury (McDonald, 2013). Psychosocial refers to aninterrelation of individual, psychological and social factors, which influence thoughtsand behaviour (Hellawell, Taylor & Pen, 1999). Psychosocial changes after an ABIcan occur in multiple domains, from occupational activities, interpersonalrelationships to independent functional living skills (Tate et al., 2011), and are thefocus of the current study. These problems are well documented in studies thatmonitor short and long term functioning after ABI (Ponsford, Draper & Schonberger,2008; Zumstein et al., 2011). Psychosocial difficulties are important to recognise inABI populations, as they often persist longer than physical impairments, and canimpact receptiveness and participation in rehabilitation (Morton & Wehmant, 1995).ABI is also associated with poor social skills, which have associations with poorsocial outcomes in regards to relationships, social isolation and internalisingdisorders, such as depression (McDonald et al., 2006; Morton & Wehmant, 1995).Research has focused on psychosocial outcomes and social abilities in ABIpopulations, however, less research has examined whether social abilities arepredictive of functional sequelae.1.1 Acquired Brain InjuryABI is a term that includes a wide range of individuals with various types anddegrees of damage, and associated deficits. ABI refers to cerebral impairment, asopposed to a head injury alone (Cattelani, Zettin & Zoccolotti, 2010). ABI occursafter birth and can result from sudden insult or injury, for example, traumatic braininjury (TBI), cerebral vascular accident or oxygen deprivation to the brain, such as
3hypoxia (Taub, Maino & Bartuccio, 2012). Alternatively, ABI can have an insidiousonset, from causes such as prolonged alcohol or substance abuse, brain tumours ordegenerative neurological disease (Man, Soong, Tam & Hui-Chan, 2006).ABI can be further classified into primary and secondary injuries. Primaryinjuries are caused by the initial moment of trauma, which result in a direct impacton the skull and intracranial contents (Murthy, Bhatia, Sandhu, Prabhakar, & Gogna,2005). The initial neurological and vascular damage has potential to lead to furtherimpairments and deterioration of condition. Damage after the initial trauma is aconsequence of a secondary injury, which refers to indirect injury effects (Murthy etal., 2005). For example, increased intracranial pressure, cerebral oedema, which mayresult in damage to the blood-brain barrier, and cerebral ischemia, where blood flowis restricted (Moore & Stambrook, 1995; Murthy et al., 2005). An ABI withtraumatic aetiology, for example, motor vehicle accidents and assaults, are oftencharacterised by primary and secondary injuries. However, many types of ABI suchas, hypoxia, encephalitis and toxicity can occur in gradual processes (see Figure 1;Man, Soong, Tam & Hui-Chan, 2006).Brain injuries can result in focal and diffused neuropathy, which havepotential to affect many of the different brain regions (McDonald, 2013). Focal braininjuries refer to an insult to a specific location, whereas diffused injuries havewidespread damage (Lezak et al., 2012). Despite the centrality of focal injuries,deficits tend to be inconsistent due to the intercommunicating system (Lezak et al.,2012). This potentially results in a complex interplay of deficits, with permutationsto cognitive, emotional, linguistic, physical, behavioural and psychosocialfunctioning (McDonald, Togher & Code, 2014).
4In some circumstances, defining ABI is difficult due to it beingheterogeneous and overlapping with other disabilities. For example, a brain injuryattained during birth or at a young age may be classified as an intellectual disability(Fortune & Wen, 1999). The scope and overlap also make it difficult to estimate theprevalence of ABI. Fortune and Wen (1999) estimated that approximately 100 to 377individuals per 100,000, sustain an ABI per year in Australia. These figures arebased on data from hospitalisations, which has the potential for underestimation, asnot all individuals who sustain an ABI seek medical attention, especially those withmild injuries (Flanagan, Cantor & Ashman, 2008). Alternatively, the opposite canoccur, where the same individuals repeatedly present to hospitals with multiple braininjuries. Furthermore, hospital admission data is prone to local differences insocioeconomic status, which influence prevalence and type of ABI (Fortune & Wen,1999). Thus, while determining ABI prevalence rates is challenging, the estimatescited above nonetheless indicate that ABI is relatively common.
5Figure 1. Classification of ABI
6There are demographic factors, such as age and gender, which are generallyassociated with the prevalence and aetiology of ABI (Fortune & Wen, 1999). Withinthe Australian population, the proportion of males with an ABI is higher than infemales (2.2% and 1.6%, respectively; Fortune & Wen, 1999). There are alsosignificant differences, where males are more likely to sustain an ABI across all agegroups, except for children aged 0-4 and those over 75 (Helps, Henley & Harrison,2008). Hospital separation data indicates that the highest prevalence of traumaticinjuries occurs for individuals aged 15 to 19 years old (284 per 100,000), followedby children aged under four (244 per 100,000; Fortune & Wen, 1999). In olderindividuals, stroke is the most commonly occurring ABI in developed countries, withbetween 160-200 individuals per 100,000, each year, experiencing their first stroke(Fortune & Wen, 1999). In Australia, a diagnosis of TBI is predominantly caused by;falls (42%), motor accidents (29%) and assault (14%; Helps et al., 2008). Theprevalence estimations of non-traumatic brain injuries are more difficult to obtaindue to many injuries being undiagnosed. For example, alcohol related ABI, which ismost common in middle-adult years, but are not diagnosed until autopsy (Fortune &Wen, 1999).1.2 Impairments and Functional Outcomes After ABIABI is commonly associated with impairments to social cognition, forexample, difficulties detecting social cues, understanding social situations andnorms, and recognise the intentions of others (Milders, Fuchs, & Crawford, 2003).These deficits may affect an individual’s integration into the community andconsequently their psychological adjustment (Milders et al., 2003). Difficulties inadjustment after an ABI may be indicated by less social interaction, fewer
7friendships, changes to employment status and disengagement in leisure activities(Man, et al., 2006). These social cognitive deficits may impact communication skills,which can in turn lead to ineffective interpersonal exchanges. Finset et al. (1995)found that 57% of individuals with a TBI reported a decline in their social networks,which demonstrates an outcome of social deficits. Furthermore, this is a problem asmany individuals’ lack insight into their adjustment difficulties and are often unableto recognise their social cognition deficits and consequently the actions of theirbehaviour (Powell, Al-Adawi, Morgan, & Greenwood, 1996).ABI can result in deterioration of mental, physical, and independentfunctioning, which can be temporary or permanent, and potentially result in partial ortotal disability (Fortune & Wen, 1999). ABI is associated with changes in cognition,mood and behaviour, which may remain after somatic and physical recovery(Cattelani et al., 2010). Medical professionals generally focus upon physicalimpairments after an ABI, while disabling cognitive and behavioural factors may notbe recognised (Flanagan et al., 2008). An individual’s cognitive, social andbehavioural impairments are important to recognise, as they are likely to influencetheir receptiveness to treatment and rehabilitation.ABI can result in a variety of pathophysiological changes and impairments.Such changes, among other direct and indirect effects, influence functional status,disability and limitations in everyday life (Temkin, Corrigan, Dikmen, & Machamer,2009). Functional impairments after an ABI can have significant implication incognitive, physical and psychosocial domains of life. Cognitive impairments include:memory deficits, poor planning and problem solving, difficulties in concentration,slowed processing speed, lack of insight, and depleted motivation (Felmingham,Baguley, & Green, 2004; McDonald, Flashman & Saykin, 2002; Prigatano, 1991).
8Physical functional outcomes refer to impairments to motor skills, sense perceptionand balance (Basford et al., 2003; Biernaskie, Chernenko & Corbett, 2004).Psychosocial outcomes impaired after an ABI include, difficulties with inhibition andimpulsivity, understanding what is socially appropriate and regulating theirbehaviour and emotions (Beer, Heerey, Keltner, Scabini, & Knight, 2003; Honan,McDonald, Sufanic, Hined & Kumfore, 2016). In addition, functional outcomesinclude aspects of social functioning, for instance, capacity to learn and understandnew information, communicating and interacting with others (Hall, Bushnik, LakisicKazazic, Wright & Cantagallo, 2001; Temkin et al., 2009).As multiple domains of functioning can be affected by an ABI, a range ofnegative outcomes may result. From simple activities of daily life, including basicliving skills, personal care and mobility, to higher order skills and abilities, such aspsychosocial functioning, employment status, engagement in leisure activities,wellbeing, independence and self-regulation (Man et al., 2006; Temkin et al. 2009).Individuals with an ABI often self-report challenges with psychosocialoutcomes post injury (Hoofien et al., 2001). Temkin (2009) found that TBIparticipants rated their level of social functioning much lower than their abilities onnon-social domains of functioning. The main difficulties individuals with a TBIreported were in areas of communication, alertness, emotional behaviour, and socialinteraction (Temkin et al., 2009). Functional outcomes after an ABI tend to be poorerthan other acquired disabilities (Temkin et al., 2009). For example, individuals withan ABI were likely to cease work, and if they returned, it was to a less skilledposition (Temkin et al., 2009). Temkin et al. also found that one year after a TBI,psychosocial problems were more prominent than issues with basic living activities.
9This highlights the need to identify functional impairments early, so intervention andrehabilitation can maximise outcomes.The ability to predict functional outcomes from an individual’s performanceon social cognitive measures has potential to help rehabilitation, communitysettlement and integration. This knowledge could potentially help professionals andservice providers in making more sustainable goals, treatment plans andimplementing lifestyle changes. Vogenthaler, Smith a
emotions, social settings and interpersonal exchanges. The present study examined impairments in social cognitive ability, and the predictive utility of social cognition in determining functional outcomes after an ABI. Thirty participants with an ABI (m 18, f 12) were recruited, and 30 healthy controls matched for similar sex, age and .
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