Although childhood traumatic brain injury (TBI) has been linked to heightened risk of impaired social skills and behavior, current evidence is weakened by small studies of variable methodological quality. To address these weaknesses, this international multi-cohort study involved synthesis of data from two large observational cohort studies of complicated mild-severe child TBI in Australia and North America. Both studies adopted a unified approach to data collection and coding procedures, providing the opportunity to merge datasets from multiple, well-characterized cohorts for which gold standard measures of social outcomes were collected during the chronic recovery phase. The study involved 218 children, including 33 children with severe TBI, 83 children with complicated mild-moderate TBI, 59 children with orthopedic injury, and 43 age- and sex-matched typically developing control children. All injured children were recruited from academic children's hospitals and underwent direct cognitive assessments including measures of theory of mind (ToM) at least 1-year post- injury. Parents rated their child's social adjustment using standardized measures of social skills, communication and behavior. Results showed a brain-injury specific effect on ToM abilities, such that children with both complicated mild to moderate and severe TBI displayed significantly poorer ToM than children without TBI. In mediator models, poorer ToM predicted poorer parent-rated self-direction and social skills, as well as more frequent behavioral symptoms. The ToM mediated the effect of severe TBI on parent ratings of communication and social skills, as well as on overall behavior symptoms. The findings suggest that deficits in ToM are evident across the spectrum of TBI severity and represent one mechanism linking severe child TBI to long-term social adjustment difficulties. The findings underscore the value of large-scale data harmonization projects to increase the quality of evidence regarding the outcomes of TBI. Clinical and scientific implications are discussed.

中文翻译：

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使用通用数据元素描述儿童创伤性脑损伤后社会功能障碍的性质和相关性：来自国际多队列研究的证据。

尽管儿童创伤性脑损伤 (TBI) 与社交技能和行为受损的风险增加有关，但目前的证据因方法学质量参差不齐的小型研究而被削弱。为了解决这些弱点，这项国际多队列研究综合了来自澳大利亚和北美的两项针对复杂轻度-重度儿童 TBI 的大型观察性队列研究的数据。这两项研究都采用了统一的数据收集和编码程序方法，提供了合并来自多个特征明确的队列的数据集的机会，这些队列在慢性恢复阶段收集了社会结果的黄金标准衡量标准。该研究涉及218名儿童，其中重度TBI儿童33名，复杂轻中度TBI儿童83名，骨科损伤儿童59名，和 43 名年龄和性别匹配的典型发育对照儿童。所有受伤的儿童都是从学术儿童医院招募的，并在受伤后至少 1 年接受了直接的认知评估，包括心理理论 (ToM) 的测量。父母使用社交技能、沟通和行为的标准化衡量标准来评估孩子的社会适应能力。结果显示脑损伤对 ToM 能力的特定影响，因此患有复杂轻度至中度和重度 TBI 的儿童的 ToM 显着低于没有 TBI 的儿童。在中介模型中，较差的 ToM 预测较差的父母评价的自我指导和社交技能，以及更频繁的行为症状。ToM 介导了严重 TBI 对父母对沟通和社交技能的评分以及对整体行为症状的影响。研究结果表明，ToM 缺陷在 TBI 严重程度的范围内都很明显，并且代表了将严重儿童 TBI 与长期社会适应困难联系起来的一种机制。研究结果强调了大规模数据协调项目的价值，以提高有关 TBI 结果的证据质量。讨论了临床和科学意义。