Katherine Osborne-Crowley

Development of an observational measure of social disinhibition after traumatic brain injury

ABSTRACT Introduction: This study aimed to validate a new observational measure of socially disinhibited behavior for use in a population of individuals with traumatic brain injury (TBI). Method: Participants were twenty-two adults with severe TBI (mean age = 50.45 years) and 21 healthy comparison participants (mean age = 45.29 years). Ratings of observed social disinhibition were correlated with the disinhibition domain scores of the Neuropsychiatric Inventory–Disinhibition (NPI–D) and with Sydney Psychosocial Reintegration Scale (SPRS) scores. A regression analysis was undertaken to determine whether formal measures of disinhibition could predict observed disinhibition. Results: The interrater absolute agreement for the social disinhibition ratings was good, intraclass correlation coefficient (ICC) = .69. Participants with TBI were rated as significantly more disinhibited than comparison participants, t(25.05) = –2.07, p = .049. The ratings were positively correlated with the NPI frequency score (r = .45, p = .038) and distress score (r = .45, p = .035). The ratings were not related to change in employment or in interpersonal relationships on the SPRS, and formal measures of disinhibition were unable to predict observed social disinhibition. Conclusions: This study demonstrates good interrater reliability and construct validity of the observational measure. The results evidence the usefulness of this measure and the NPI–D for detecting social disinhibition after TBI.

Hyposmia, not emotion perception, is associated with psychosocial outcome after severe traumatic brain injury.

OBJECTIVE The current study aimed to determine whether 2 variables associated with orbitofrontal damage, hyposmia and emotion perception deficits, are associated with socially disinhibited behavior and psychosocial outcome after traumatic brain injury (TBI). METHODS The Brief Smell Identification Test (BSIT), an emotion labeling task, an emotion intensity rating task, and an observational measure of social disinhibition were completed by 23 individuals with severe TBI. The disinhibition domain of the Neuropsychiatric Inventory and the interpersonal relationships subscale of the Sydney Psychosocial Reintegration Scale (SPRS-IR) were completed by a close other. Fifteen control participants provided norms against which to assess performance on the emotion intensity rating task. RESULTS BSIT scores predicted informant-reported change in interpersonal relationships on the SPRS-IR. Hyposmia, though, was not associated with informant-reported or observed social disinhibition. An impairment in accuracy scores on both emotion perceptions tasks was found for participants with TBI, yet intensity ratings did not differ between groups. This suggests that people with TBI are not actually impaired at detecting intensity of emotion but are less likely to perceive the target emotion as the dominant emotion. Emotion perception was not related to disinhibition or change in interpersonal relationships. CONCLUSIONS These results support previous claims that hyposmia has prognostic significance following TBI. On the other hand, emotion perception impairment measured by standardized tasks does not appear to be an important factor in interpersonal outcomes. Finally, these results suggest that standardized emotion perception tasks may underestimate the emotion perception capabilities of people with TBI. (PsycINFO Database Record

Role of reversal learning impairment in social disinhibition following severe traumatic brain injury

OBJECTIVES The current study aimed to determine whether reversal learning impairments and feedback-related negativity (FRN), reflecting reward prediction error signals generated by negative feedback during the reversal learning tasks, were associated with social disinhibition in a group of participants with traumatic brain injury (TBI). METHODS Number of reversal errors on a social and a non-social reversal learning task and FRN were examined for 21 participants with TBI and 21 control participants matched for age. Participants with TBI were also divided into low and high disinhibition groups based on rated videotaped interviews. RESULTS Participants with TBI made more reversal errors and produced smaller amplitude FRNs than controls. Furthermore, participants with TBI high on social disinhibition made more reversal errors on the social reversal learning task than did those low on social disinhibition. FRN amplitude was not related to disinhibition. CONCLUSIONS These results suggest that impairment in the ability to update behavior when social reinforcement contingencies change plays a role in social disinhibition after TBI. Furthermore, the social reversal learning task used in this study may be a useful neuropsychological tool for detecting susceptibility to acquired social disinhibition following TBI. Finally, that the FRN amplitude was not associated with social disinhibition suggests that reward prediction error signals are not critical for behavioral adaptation in the social domain.

Validity and reliability of a questionnaire to assess social skills in traumatic brain injury: A preliminary study

ABSTRACT Objective: To describe the reliability and validity of a new measure, the Social Skills Questionnaire for Traumatic Brain Injury (SSQ-TBI). Methods: Fifty-one adults with severe TBI completed the SSQ-TBI questionnaire. Scores were compared to informant- and self-report on questionnaires addressing frontal lobe mediated behaviour, as well as performance on an objective measure of social cognition and neuropsychological tasks, in order to provide evidence of concurrent, divergent and predictive validity. Results: Internal consistency was excellent at α = 0.90. Convergent validity was good, with informant ratings on the SSQ-TBI significantly correlated with Neuropsychiatric Inventory Disinhibition sub-scales (r = 0.50–63), the Current Behaviour Scale (r = 0.39–0.48) and Frontal Systems Behaviour Scale (r = 0.60–0.83). However, no relationship was seen with an objective measure of social skills or neuropsychological tasks of disinhibition. There was a significant relationship with real-world psychosocial outcomes on the Sydney Psychosocial Reintegration Scale-2 (r = –0.38––0.69) Conclusions: This study provides preliminary findings of good internal consistency and convergent and predictive validity of a social skills questionnaire adapted to be appropriate for individuals with TBI. Further assessment of psychometric properties such as test–re-test reliability and factor structure is warranted.

Emotion recognition depends on subjective emotional experience and not on facial expressivity: evidence from traumatic brain injury

ABSTRACT Background: Recognizing how others feel is paramount to social situations and commonly disrupted following traumatic brain injury (TBI). This study tested whether problems identifying emotion in others following TBI is related to problems expressing or feeling emotion in oneself, as theoretical models place emotion perception in the context of accurate encoding and/or shared emotional experiences. Methods: Individuals with TBI (n = 27; 20 males) and controls (n = 28; 16 males) were tested on an emotion recognition task, and asked to adopt facial expressions and relay emotional memories according to the presentation of stimuli (word and photos). After each trial, participants were asked to self-report their feelings of happiness, anger and sadness. Judges that were blind to the presentation of stimuli assessed emotional facial expressivity. Results: Emotional experience was a unique predictor of affect recognition across all emotions while facial expressivity did not contribute to any of the regression models. Furthermore, difficulties in recognizing emotion for individuals with TBI were no longer evident after cognitive ability and experience of emotion were entered into the analyses. Conclusions: Emotion perceptual difficulties following TBI may stem from an inability to experience affective states and may tie in with alexythymia in clinical conditions.