Social Competence Treatment After Traumatic Brain Injury: A Multicenter, Randomized Controlled Trial of Interactive Group Treatment Versus Noninteractive Treatment.

OBJECTIVE: To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI). DESIGN: Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture. SETTING: Community and veteran rehabilitation centers. PARTICIPANTS: Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury. INTERVENTIONS: The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction. MAIN OUTCOME MEASURES: Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE). RESULTS: Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C. CONCLUSIONS: Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study.

Systematic Review of Behavioral Interventions Targeting Social Communication Difficulties After Traumatic Brain Injury.

OBJECTIVE: To determine whether behavioral interventions are beneficial for adults with social communication difficulties after traumatic brain injury (TBI). DATA SOURCES: Electronic databases were searched through October 2013 to find behavioral intervention trials. Keywords used in our search were intervention, therapy, treatment, and program combined with pragmatic disorder, pragmatic impairment, social communication disorder/impairment, conversation disorder/impairment, social disorder/impairment, cognitive-linguistic and cognitive-communication deficit; adult; and traumatic brain injury, head injury, and brain injury. Hand searches of the reference lists of relevant articles were also conducted. STUDY SELECTION: To be selected for detailed review, articles found in the initial search were assessed by 2 reviewers and had to meet the following criteria: (1) population (adults with TBI); (2) intervention (behavioral intervention); and (3) outcomes (changes in social communication). Articles needed to describe interventions that were delivered directly to adults with TBI with or without other people (such as significant others) involved. Of the 2181 articles initially identified, 15 were selected for detailed review. DATA EXTRACTION: Data were independently extracted by members of the research team, then collated and reviewed by the team. DATA SYNTHESIS: Of the 15 publications that met the study criteria, 7 were single-case design studies, 3 were randomized controlled trials, 1 was a nonrandomized controlled trial, and 4 were cohort studies. The methodological qualities of eligible articles were examined using the Physiotherapy Evidence Database and Single-Case Experimental Design rating scales. The interventions described in the studies fell into 2 broad categories: those addressing a specific impairment in social communication, and context-specific interventions with a holistic focus on social communication skills. Studies using context-sensitive approaches had been published more recently and were generally group studies with higher methodological quality. CONCLUSIONS: Overall, interventions addressing social communication skills for people with TBI were found to be beneficial irrespective of treatment approach used. While the evidence base is small and with varying levels of scientific rigor, there is a body of quality evidence that supports the use of context-sensitive approaches. Further research is still required to determine the role of impairment-specific versus context-specific interventions when treating individuals with social communication difficulties after TBI to inform clinical decision-making.

Cognitive Pragmatic Treatment: A Rehabilitative Program for Traumatic Brain Injury Individuals.

OBJECTIVE: To verify the efficacy of Cognitive Pragmatic Treatment (CPT), a new rehabilitation training program for improving communicative-pragmatic abilities. DESIGN: The CPT program consists of 24 group sessions, concerned with improving several communication modalities, theory of mind (ToM), and cognitive components that can affect pragmatic performance, such as awareness and executive functions. PARTICIPANTS: A sample of 15 adults with severe traumatic brain injury. MAIN MEASURES: Improvements were evaluated before and after training, using the equivalent forms of the Assessment Battery for Communication (ABaCo), a tool for evaluating comprehension and production of a wide range of pragmatic phenomena. A neuropsychological and ToM assessment was also conducted. RESULTS: The patients' performance improved after training, in terms of both comprehension and production, in all the communication modalities assessed by the ABaCo, that is, linguistic, extralinguistic, paralinguistic, and social appropriateness abilities. The follow-up showed that the improvement of patients persists after 3 months from the end of the training. CONCLUSIONS: The results suggest that the CPT program is efficacious in improving communicative-pragmatic abilities in individuals with TBI, and that improvements at this level are still detectable even in chronic patients years after the injury.

Pragmatic communication abilities in children and adults: implications for rehabilitation professionals.

PURPOSE: The purpose of this study is to provide a review of pragmatic communication ability and its disorders, as a resource for rehabilitation team members. This review is a product of the Joint Committee on Interprofessional Relations Between the American Speech-Language-Hearing Association and Division 40: Society for Clinical Neuropsychology of the American Psychological Association. METHOD: Review of the literature and expert opinion. RESULTS: We summarize key theoretical frameworks that guide assessment of pragmatic communication ability, describe the developmental progression of pragmatic skills and expectations for children and adults, provide an overview of pragmatic communication disorders, and discuss current assessment approaches. CONCLUSIONS: An understanding of pragmatic communication disorders may assist all rehabilitation team members, as impairments in this domain may have significant effects on rehabilitation progress and outcomes. Implications for Rehabilitation Pragmatic communication ability is the ability to use language in context, beyond understanding and expressing basic word meanings (semantics) in the correct grammatical forms (syntax). Pragmatic communication deficits have been documented in many of the populations frequently referred for rehabilitation, and can affect both progress during rehabilitation and outcomes from treatment. A broader understanding of pragmatic communication functions can help team members identify a patient's strengths and limitations, inform treatment planning, and improve communication among healthcare professionals, thereby contributing to improved outcomes for patients and their families.

Exploring Expressive Communication Skills in a Cross-Sectional Sample of Children and Young Adults With Angelman Syndrome.

PURPOSE: This study explores data on expressive communication skills of 300 individuals aged 0.0-21.11 years with Angelman syndrome (AS). These data provide a composite portrait of communication skills in a large sample of children and young adults with this rare disorder, specifying new detailed information about expressive communication. METHOD: The database associated with the Communication Matrix assessment (Rowland, 2004, 2011; Rowland & Fried-Oken, 2010) was mined for data regarding individuals with AS. We extracted data on the reasons for communicating, level of communication achieved, and use of various expressive communication modes to convey 24 specific messages. The performance of children and young adults in 5 age groups in the cross-sectional sample were contrasted. RESULTS: Results confirmed earlier studies showing that few individuals with AS use natural speech. However, in addition to using presymbolic modes, many children used alternative symbolic modes such as picture symbols, object symbols, and manual signs. Assessment scores increased slightly with age, F(4, 295) = 2.416, p = .049. CONCLUSIONS: Aggregating data on a large sample of individuals with AS provides a reference point for practitioners and family members and a basis for future investigations.

Design of an Autonomous Social Orienting Training System (ASOTS) for Young Children With Autism.

Social communication is among the core areas of impairment for children with Autism Spectrum Disorders (ASD). The training of social orientation is important for improving social communication of children with ASD. In recent years, technology-assisted ASD intervention had gained momentum due to its potential advantages in terms of precision, sustainability, flexibility and cost. In this paper, we propose a closed-loop autonomous computer system, named ASOTS, for training social orientation skills to young children with ASD. This system is designed to detect and track a child's attention in response to social orientation bids and help the child towards appropriate social orientation when needed. Response to name, an important social orientation skill, was used to demonstrate the functionality of the proposed system. Ten toddlers with ASD participated in a pilot user study to show whether the system could be used on young children who have been diagnosed with ASD. Another pilot user study with 10 TD infants tested whether this system has a potential to be applied for early detection for infants who were younger than the age when ASD diagnoses can be done. This was done intentionally to separately demonstrate utility and functionality for the clinical population of interest and to demonstrate functionality beyond current clinical identification capacity (i.e., infants). The results showed that the proposed system and the protocol were well tolerated by both groups, successfully captured young children's attention, and elicited the desired behavior.

Design of a Physiology-Sensitive VR-Based Social Communication Platform for Children With Autism.

Individuals with autism are often characterized by impairments in communication, reciprocal social interaction and explicit expression of their affective states. In conventional techniques, a therapist adjusts the intervention paradigm by monitoring the affective state e.g., anxiety of these individuals for effective floor-time-therapy. Conventional techniques, though powerful, are observation-based and face resource limitations. Technology-assisted systems can provide a quantitative, individualized rehabilitation platform. Presently-available systems are designed primarily to chain learning via aspects of one's performance alone restricting individualization. Specifically, these systems are not sensitive to one's anxiety. Our presented work seeks to bridge this gap by developing a novel VR-based interactive system with Anxiety-Sensitive adaptive technology. Specifically, such a system is capable of objectively identifying and quantifying one's anxiety level from real-time biomarkers, along with performance metrics. In turn it can adaptively respond in an individualized manner to foster improved social communication skills. In our present research, we have used Virtual Reality (VR) to design a proof-of-concept application that exposes participants to social tasks of varying challenges. Results of a preliminary usability study indicate the potential of our VR-based Anxiety-Sensitive system to foster improved task performance, thereby serving as a potent complementary tool in the hands of therapist.

Using the brief observation of social communication change (BOSCC) to measure autism-specific development.

To date no reliable and objective, change sensitive instrument for autistic symptoms is available. The brief observation of social communication change (BOSCC) was specifically developed to measure change of core autistic symptoms, for example, for use as outcome measure in early intervention trials. This study investigated quality criteria of a preliminary research version of the BOSCC in N = 21 children with autism spectrum disorder (ASD) who had participated for 1 year in the Frankfurt early intervention program (FFIP). BOSCC rating was done on play based ADOS video scenes. Inter-rater agreement on the BOSCC average total was very high. The BOSCC showed a significant decrease of autistic symptoms after 1 year with a medium effect size. Symptom specific improvements were captured by the social communication subscale and most single items. The BOSCC showed comparable change sensitivity to other autism specific instruments. Future studies should focus on the finalized BOSCC version, and replicate findings in a larger sample. Autism Res 2016, 9: 940-950. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

Integrating Language, Pragmatics, and Social Intervention in a Single-Subject Case Study of a Child With a Developmental Social Communication Disorder.

PURPOSE: This clinical focus article presents an illustration of a complex communication intervention, the Social Communication Intervention Programme (SCIP), as delivered to a child who has a social communication disorder (SCD). The SCIP intervention combined language processing and pragmatic and social understanding therapies in a program of individualized therapy activities and in close liaison with families. METHOD: The study used an enhanced AB single-subject design in which an 8-year-old child with an SCD participated in 20 therapy sessions with a specialist speech-language pathologist. A procedure of matching assessment findings to intervention choices was followed to construct an individualized treatment program. Examples of intervention content and the embedded structure of SCIP are illustrated. Observational and formal measurements of receptive and expressive language, conversation, and parent-teacher ratings of social communication were completed before therapy, after therapy, and at a 6-month follow-up session. RESULTS: Outcomes revealed change in total and receptive language scores but not in expressive language. Conversation showed marked improvement in responsiveness, appreciation of listener knowledge, turn taking, and adaptation of discourse style. Teacher-reported outcomes included improved classroom behavior and enhanced literacy skills. Parent-reported outcomes included improved verbal interactions with family members and personal narratives. CONCLUSIONS: This clinical focus article demonstrates the complexity of needs in a child with an SCD and how these can be addressed in individualized intervention. Findings are discussed in relation to the essential nature of language support including pragmatic therapy for children with SCDs. Discussion of the role of formal and functional outcome measurement as well as the proximity of chosen outcomes to the intervention is included.