title: Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury.
abstract: Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the 'social brain network' (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2-8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems.
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia, nicholas.ryan@mcri.edu.au.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Ryan
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia, Department of Psychology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Catroppa
authors.affiliation: Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Beare
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Silk
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Crossley
authors.affiliation: Department of Psychology, University of Montreal, Montreal, Canada, Ste-Justine Research Center, Montreal, Quebec, Canada, and.
authors.forename: Miriam H
authors.initials: MH
authors.lastname: Beauchamp
authors.affiliation: Department of Psychology, Hotchkiss, Brain Institute, and Alberta Children's Hospital Research Institute, The University of Calgary, Calgary, Alberta, Canada.
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
authors.affiliation: Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Melbourne, Australia, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia, Department of Psychology, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D001925:Brain Damage, Chronic / Q000503:physiopathology* / Q000523:psychology*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D066128:Gray Matter / Q000293:injuries / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009415:Nerve Net / Q000293:injuries* / Q000503:physiopathology*; D011446:Prospective Studies; D012919:Social Behavior; D056345:Theory of Mind / Q000502:physiology*
keywords: brain injuries; childhood; magnetic resonance imaging; social cognition; theory of mind