Department of Neuroscience, Monash University, Prahran, VIC, Australia.
Department of Neuroscience, Monash University, Prahran, VIC, Australia; Department of Psychology, University of Calgary, Calgary, AB, Canada.
Exp Neurol. 2019 Apr;314:34-45. doi: 10.1016/j.expneurol.2019.01.007. Epub 2019 Jan 14.
Traumatic brain injury (TBI) during early childhood is associated with a particularly high risk of developing social behavior impairments, including deficits in social cognition that manifest as reduced social interactions, with profound consequences for the individuals' quality of life. A number of pre-injury, post-injury, and injury-related factors have been identified or hypothesized to determine the extent of social behavior problems after childhood TBI. These include variables associated with the individual themselves (e.g. age, genetics, the injury severity, and extent of white matter damage), proximal environmental factors (e.g. family functioning, parental mental health), and more distal environmental factors (e.g. socioeconomic status, access to resources). In this review, we synthesize the available evidence demonstrating which of these determinants influence risk versus resilience to social behavior deficits after pediatric TBI, drawing upon the available clinical and preclinical literature. Injury-related pathology in neuroanatomical regions associated with social cognition and behaviors will also be described, with a focus on findings from magnetic resonance imaging and diffusion tensor imaging. Finally, study limitations and suggested future directions are highlighted. In summary, while no single variable can alone accurately predict the manifestation of social behavior problems after TBI during early childhood, an increased understanding of how both injury and environmental factors can influence social outcomes provides a useful framework for the development of more effective rehabilitation strategies aiming to optimize recovery for young brain-injured patients.
儿童早期的创伤性脑损伤(TBI)与社会行为障碍的发生风险特别高相关,包括社会认知缺陷,表现为社交互动减少,对个体的生活质量有深远影响。已经确定或假设了许多与儿童 TBI 后社会行为问题程度相关的损伤前、损伤后和与损伤相关的因素。这些因素包括与个体自身相关的变量(例如年龄、遗传、损伤严重程度和白质损伤程度)、近端环境因素(例如家庭功能、父母心理健康)以及更远端的环境因素(例如社会经济地位、资源获取)。在这篇综述中,我们综合了现有证据,证明了这些决定因素中哪些因素会影响儿科 TBI 后社会行为缺陷的风险和恢复能力,同时参考了现有的临床和临床前文献。还将描述与社会认知和行为相关的神经解剖区域的损伤相关病理学,重点介绍磁共振成像和弥散张量成像的发现。最后,突出了研究的局限性和建议的未来方向。总之,虽然没有单一的变量可以单独准确预测儿童早期 TBI 后社会行为问题的表现,但增加对损伤和环境因素如何影响社会结果的理解为开发更有效的康复策略提供了一个有用的框架,旨在优化年轻脑损伤患者的康复。