The mentalizing network and theory of mind mediate adjustment after childhood traumatic brain injury.

Cynthia A Gerhardt,Erin D Bigler,H Gerry Taylor,Kathryn Vannatta,Keith Owen Yeates,Kenneth Rubin,Kristen R Hoskinson,Maureen Dennis,Terry Stancin,Tracy J Abildskov

doi:10.1093/scan/nsaa006

Abstract

Childhood traumatic brain injury (TBI) affects over 600 000 children per year in the United States. Following TBI, children are vulnerable to deficits in psychosocial adjustment and neurocognition, including social cognition, which persist long-term. They are also susceptible to direct and secondary damage to related brain networks. In this study, we examine whether brain morphometry of the mentalizing network (MN) and theory of mind (ToM; one component of social cognition) mediates the effects of TBI on adjustment. Children with severe TBI (n = 15, Mage = 10.32), complicated mild/moderate TBI (n = 30, Mage = 10.81) and orthopedic injury (OI; n = 42, Mage = 10.65) completed measures of ToM and executive function and underwent MRI; parents rated children’s psychosocial adjustment. Children with severe TBI demonstrated reduced right-hemisphere MN volume, and poorer ToM, vs children with OI. Ordinary least-squares path analysis indicated that right-hemisphere MN volume and ToM mediated the association between severe TBI and adjustment. Parallel analyses substituting the central executive network and executive function were not significant, suggesting some model specificity. Children at greatest risk of poor adjustment after TBI could be identified based in part on neuroimaging of social brain networks and assessment of social cognition and thereby more effectively allocate limited intervention resources.

Highlights

Traumatic brain injury (TBI) is one of the most common childhood brain disorders
We examine whether brain morphometry of the mentalizing network (MN) and theory of mind (ToM; one component of social cognition) mediates the effects of traumatic brain injury (TBI) on adjustment
Ordinary least-squares path analysis indicated that right-hemisphere MN volume and ToM mediated the association between severe TBI and adjustment

Summary

Introduction

Traumatic brain injury (TBI) is one of the most common childhood brain disorders. In 2013 alone, the Centers for Disease Control and Prevention reported an estimated 640 000 TBIrelated visits to hospital emergency departments and nearly 20 000 TBI-related inpatient hospitalizations, clearly demonstrating a significant public health burden in the United States (Centers for Disease Control and Prevention, 2018). One component of successful navigation of the social world is the ability to correctly identify, interpret and make inferences about the mental states of others This ability, termed ‘theory of mind’ (ToM), develops most rapidly during the pre-school years (Wellman et al, 2001; Surian et al, 2007; Sodian, 2011), but continues to evolve into middle adolescence. Regions subsumed by the MN include the dorsomedial prefrontal cortex, superior temporal sulcus, temporoparietal junction and temporal pole These frontal and anterior temporal regions are especially vulnerable to TBI, with damage to these regions often resulting in reduced brain volume, pronounced lesion burden (Wilde et al, 2005, 2006, 2007; Bigler, 2007) and diffuse microstructural abnormalities in underlying white matter (Levin et al, 2011)

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