'We manage, but yeah, it's challenging': A mixed-methods study of enablers and barriers to hearing assessments for parents of children in metropolitan and regional Australia.

BACKGROUND: Early identification and intervention for hearing loss is important for supporting language development. Despite this, parents are required to overcome barriers to access hearing assessments for their children. AIMS: To identify the enablers and barriers to accessing hearing assessments for Australian children identified by their parents, and to compare between metropolitan, regional and rural areas. METHODS & PROCEDURES: This sequential, explanatory mixed-methods study was undertaken online and included participants in metropolitan, regional and rural area of Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory. A total of 56 participants participated in the surveys, and 10 participated in semi-structured interviews. OUTCOMES & RESULTS: Participants in metropolitan areas were more likely to have services in their area; however, access to hearing assessment was related more to individual circumstances (including health literacy skills) rather than geographical location. Many participants experienced long wait times, reduced flexibility, and a lack of audiologists experienced in working with children. CONCLUSIONS & IMPLICATIONS: Barriers to hearing assessments (which assist with early identification and intervention for hearing loss) should be addressed so that children have access to clear auditory information to assist with their speech and language development. WHAT THIS PAPER ADDS: What is already known on the subject Poor audiological input can lead to poor speech, language and literacy outcomes for children. What this paper adds to the existing knowledge Although previous research indicates that people in regional and remote locations experience difficulty accessing health services within a reasonable timeframe, in this study barriers were experienced regardless of geographical location, and were dependent on individual circumstances. Many parents are unaware of the impact of hearing on speech and language. What are the potential or actual clinical implications of this work? Further research might examine how health literacy affects access to hearing assessment. Parents shared several potential solutions to these access barriers which should be considered by service providers.

'We know the lack of services': Service lead's perspective of enablers and barriers to hearing assessment for children in metropolitan, regional and rural Australia: A qualitative study.

OBJECTIVE: To explore potential enablers and barriers to accessing paediatric hearing assessment from the perspective of Australian service leads, extending previous studies on this topic from the perspectives of two other stakeholder groups - parents and speech pathologists. DESIGN: This qualitative study, expanding upon previous mixed-methods studies, applied a pragmatism paradigm. SETTING: The study was undertaken online via Zoom and included participants who were service leads of organisations that offer hearing assessment in metropolitan, regional, rural and remote parts of Australia. PARTICIPANTS: Eight Australian service leads participated in semi-structured interviews. RESULTS: Barriers identified were similar to barriers in previous studies. Three main themes were identified. First, children with hearing loss in Australia are well identified at birth. The second theme focused on the reduced and inconsistent hearing assessment services available after this age. Finally, service leads discussed the importance of embracing technology to solve service access difficulties. CONCLUSION: Consultation with key stakeholders, to consider the needs of different communities within Australia, will be crucial when identifying new service delivery options.

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review.

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

Language disorder and internalizing mental health problems in youth offenders: A systematic review.

BACKGROUND: The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth. AIMS: To explore the co-occurrence of language disorder and anxiety and depression in youth offenders. METHODS & PROCEDURES: A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative. MAIN CONTRIBUTION: Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation. CONCLUSIONS & IMPLICATIONS: Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling). WHAT THIS PAPER ADDS: What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

Is interprofessional education a valued contributor to interprofessional practice and collaboration within allied health in Australia and New Zealand: A scoping review.

Research on the value of interprofessional education (IPE), collaboration and practice in the health sector at both a pre- and post-registration level has increased in recent years. A scoping review of Australian and New Zealand studies was conducted on the value of IPE to interprofessional practice in allied health professionals from 2013 to 2019. A scoping review framework was used to identify 109 studies. Twenty-one articles met the eligibility criteria. The studies were grouped into undergraduate students in academic and WIL settings, allied health professionals and clinical educators. Results suggest that IPE is necessary for the maintenance of interprofessional practice and that it is strongly connected to the development of successful communication within the interprofessional environment. Authentic IPE experience and socialization opportunities appear to be major facilitators of interprofessional practice but no consensus regarding the ideal length of time or timing of IPE was found. The studies also provided an insight into facilitators and barriers to successful implementation of IPE and interprofessional practice in rural environments. As IPE has been shown to contribute to improved interprofessional practice and patient outcomes, future research should explore how to create IPE opportunities for implementation within rural communities where adequate resourcing is most challenged.

Validation of Affective Sentences: Extending Beyond Basic Emotion Categories.

We use nonverbal and verbal emotion cues to determine how others are feeling. Most studies in vocal emotion perception do not consider the influence of verbal content, using sentences with nonsense words or words that carry no emotional meaning. These online studies aimed to validate 95 sentences with verbal content intended to convey 10 emotions. Participants were asked to select the emotion that best described the emotional meaning of the sentence. Study 1 included 436 participants and Study 2 included 193. The Simpson diversity index was applied as a measure of dispersion of responses. Across the two studies, 38 sentences were labelled as representing 10 emotion categories with a low degree of diversity in participant responses. Expanding current databases beyond basic emotion categories is important for researchers exploring the interaction between tone of voice and verbal content, and/or people's capacity to make subtle distinctions between their own and others' emotions.

Community awareness of speech pathology: A regional perspective.

OBJECTIVE: Speech pathology has a history of low public awareness and in the absence of current research it is unclear if community awareness has changed in recent years. This study sought to explore a regional community's awareness of speech pathology as the impetus for considering future directions pertaining to awareness and understanding of the scope of practice of this profession. DESIGN: An anonymous online survey was created using questions from previously validated surveys on this topic, and then distributed via snowball sampling using social media. SETTING: Data are from residents of the Central Queensland community in Australia. PARTICIPANTS: Two hundred and seven adults who live in Central Queensland completed the survey. MAIN OUTCOME MEASURES: Comparisons were drawn between the responses from this survey to those from earlier studies. RESULTS: The majority of respondents had heard of speech pathology mostly due to personal contact, but they indicated that they did not know 'a lot' about speech pathology. Knowledgeable individuals had higher levels of education and were better able to identify speech pathologists' scope of practice. Personal contact with a speech pathologist also significantly contributed to self-rated knowledge and accurate identification of scope of practice of speech pathologists. CONCLUSION: While regional Central Queensland community members have heard of speech pathology, their self-reported knowledge of the profession continues to be low. In order to optimise service access and consumer outcomes it is recommended that the profession aims to improve community awareness of speech pathology.

Scoping review: Language assessment practices for Aboriginal and Torres Strait Islander children in Australia and guidelines for clinical practice.

INTRODUCTION: Speech pathologists play an important role in differentiating language difference from disorder in Aboriginal and Torres Strait Islander children. However, speech pathologists report that they lack culturally appropriate resources and feel under-prepared, which suggests that culturally safe ways of working and available evidence often do not align. OBJECTIVE: The aim of this scoping review was to explore how the language abilities of Aboriginal and Torres Strait Islander children are being assessed, the ways in which assessments are being adapted and the context in which results are being interpreted within the published literature. The studies were also evaluated for components of cultural safety using the Cultural Formulation model. DESIGN: A comprehensive and systematic search of the literature was undertaken; hand searching was also conducted. To be eligible for inclusion, studies needed to have been conducted in Australia and include receptive and/or expressive language assessment of Aboriginal and Torres Strait Islander children. FINDINGS: Combined, the identified studies included 438 Aboriginal and Torres Strait Islander children, though only 419 were independent samples. A total of 352 studies were initially identified, 10 of which were retained for this review. Data extraction included participant characteristics, assessment tools and procedures, reported outcomes and factors related to cultural safety according to the Cultural Formulation model. CONCLUSION: Overall, studies showed that standardised language assessments do not accurately represent the language abilities of Aboriginal and Torres Strait Islander children. If used, they should be used alongside other non-standardised tasks and/or scoring should be adapted. Considerations for increasing cultural safety when assessing the language abilities of Aboriginal and Torres Strait Islander children are outlined.

Sex Differences in Emotional Insight After Traumatic Brain Injury.

OBJECTIVE: To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls. DESIGN: Cross-sectional study. SETTING: TBI rehabilitation facility in the United States and a university in Canada. PARTICIPANTS: Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Toronto Alexithymia Scale-20 (TAS-20). RESULTS: Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P<.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI. CONCLUSIONS: Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.

Empathic Responses to Affective Film Clips Following Brain Injury and the Association With Emotion Recognition Accuracy.

OBJECTIVE: To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and controls, and examine associations with affect recognition. DESIGN: Cross sectional study using a quasi-experimental design. SETTING: Multi-site study conducted at a postacute rehabilitation facility in the United States and a university in Canada. PARTICIPANTS: Adults (N=120) with moderate to severe TBI (n=60) and those without TBI (n=60), frequency matched for age and sex. Average time postinjury was 14 years (range: .5-37). MAIN OUTCOME MEASURES: Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling. RESULTS: Participants with TBI had lower emotion recognition scores (P=.007) and fewer empathic responses than controls (67% vs 79%; P<.001). Participants with TBI accurately identified and empathically responded to characters' emotions less frequently (65%) than controls (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to controls. Affect recognition was associated with empathic responses in both groups (P<.001). When participants with TBI accurately recognized characters' emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions. CONCLUSIONS: Participants with TBI were less likely to recognize and respond empathically to others' expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.

Sex differences in response to emotion recognition training after traumatic brain injury.

OBJECTIVE: To examine sex differences in the effectiveness of a Stories intervention for teaching affect recognition in people with a traumatic brain injury (TBI). SETTING: Post-acute rehabilitation facilities. PARTICIPANTS: 203 participants (53 women and 150 men) with moderate to severe TBI were screened. 71 were eligible and randomized to one of three treatment conditions: two affect recognition conditions and an active control (cognition). This paper examines sex differences between the Stories intervention (n = 23, 5 women and 18 men) and the cognitive treatment control (n = 24, 8 women and 16 men). DESIGN: Randomized controlled trial with immediate, 3- and 6-month follow-up post-tests. Interventions were 9 hours of computer-based training with a therapist. MEASURES: Facial Affect Recognition (DANVA2-AF); Emotional Inference from Stories Test (EIST). RESULTS: A significant treatment effect was observed for the Stories intervention for women, who demonstrated and maintained improved facial affect recognition. In contrast, males in our sample did not benefit from the Stories intervention. CONCLUSION: This positive finding for the Stories intervention for females contrasts with our conclusions in a previous paper, where an analysis collapsed across sex did not reveal an overall effectiveness of the Stories intervention. This intervention warrants further research and development.

A randomized controlled trial of emotion recognition training after traumatic brain injury.

OBJECTIVE: To examine the effectiveness of 2 affect recognition interventions (Faces and Stories) in people with a traumatic brain injury. SETTING: Postacute rehabilitation facilities. PARTICIPANTS: A total of 203 participants with moderate to severe traumatic brain injury were screened; 71 were eligible and randomized to the Faces (n = 24), Stories (n = 23), and Control interventions (n = 24). Participants were an average of 39.8 years of age and 10.3 years postinjury; 74% of participants were male. DESIGN: Randomized controlled trial with immediate, 3-month, and 6-month follow-up posttests. Interventions were 9 hours of computer-based training with a therapist. MEASURES: Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces; Emotional Inference From Stories Test; Empathy (Interpersonal Reactivity Index); and Irritability and Aggression (Neuropsychiatric Inventory). RESULTS: The Faces Intervention did significantly better than the Control Intervention on the Diagnostic Assessment of Nonverbal Accuracy 2-Adult Faces (P = .031) posttreatment; no time effect or group interaction was observed. No other significant differences were noted for the Faces Intervention. No significant differences were observed between the Stories and the Control Interventions; however, a significant time effect was found for the Emotional Inference From Stories Test. CONCLUSION: The Faces Intervention effectively improved facial affect recognition in participants with chronic post-traumatic brain injury, and changes were maintained for 6 months. Future work should focus on generalizing this skill to functional behaviors.

Exploration of a new tool for assessing emotional inferencing after traumatic brain injury.

OBJECTIVE: To explore validity of an assessment tool under development-the Emotional Inferencing from Stories Test (EIST). This measure is being designed to assess the ability of people with traumatic brain injury (TBI) to make inferences about the emotional state of others solely from contextual cues. METHODS AND PROCEDURES: Study 1: 25 stories were presented to 40 healthy young adults. From this data, two versions of the EIST (EIST-1; EIST-2) were created. Study 2: Each version was administered to a group of participants with moderate-to-severe TBI-EIST 1 group: 77 participants; EIST-2 group: 126 participants. Participants also completed a facial affect recognition (DANVA2-AF) test. Participants with facial affect recognition impairment returned 2 weeks later and were re-administered both tests. MAIN OUTCOMES: Participants with TBI scored significantly lower than the healthy group mean for EIST-1, F(1,114) = 68.49, p < 0.001, and EIST-2, F(1,163) = 177.39, p < 0.001. EIST scores in the EIST-2 group were significantly lower than the EIST-1 group, t = 4.47, p < 0.001. DANVA2-AF scores significantly correlated with EIST scores, EIST-1: r = 0.50, p < 0.001; EIST-2: r = 0.31, p < 0.001. Test-re-test reliability scores for the EIST were adequate. CONCLUSIONS: Both versions of the EIST were found to be sensitive to deficits in emotional inferencing. After further development, the EIST may provide clinicians valuable information for intervention planning.

Affect recognition in traumatic brain injury: responses to unimodal and multimodal media.

OBJECTIVES: To compare affect recognition by people with and without traumatic brain injury (TBI) for (1) unimodal and context-enriched multimodal media; (2) positive (happy) and negative emotions; and (3) neutral multimodal stimuli. PARTICIPANTS: A total of 60 people with moderate to severe TBI and 60 matched controls. MEASURES: (1) facial affect, (2) vocal affect, and (3) multimodal affect. RESULTS: Compared with controls, people with TBI scored significantly lower on both unimodal measures but not on the multimodal measure. Within- group comparisons for people with TBI revealed that they were better at recognizing affect from multimodal than unimodal stimuli. As a group, participants with TBI who were categorized as having impaired facial/vocal affect recognition were less accurate at recognizing all emotions, including happy, than unimpaired participants. Neutral stimuli were more poorly identified by participants with TBI than by those with controls. CONCLUSION: Context-enriched multimodal stimuli may enhance affect recognition for people with TBI. People with TBI who have impaired affect recognition may have problems identifying both positive (happy) and negative expressions. Furthermore, people with TBI may perceive affect when there is none.

Relationships between alexithymia, affect recognition, and empathy after traumatic brain injury.

OBJECTIVES: To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition. PARTICIPANTS: Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls. PROCEDURES: Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively). RESULTS: Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy. CONCLUSIONS: Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.

Recognition of facial and vocal affect following traumatic brain injury.

OBJECTIVE: Studies of facial affect recognition by people with traumatic brain injury (TBI) have shown this to be a significant problem. Vocal affect recognition also appears to be challenging for this population, but little is known about the degree to which one modality is impaired compared to the other. This study compared facial and vocal affect recognition of high and low intensity emotion expressions in people with moderate-to-severe TBI. METHODS: The Diagnostic Analysis of Nonverbal Accuracy-2 (Adult Faces; Voices) was administered to 203 participants with TBI. RESULTS: Adults with TBI identified vocal emotion expressions with greater accuracy than facial emotion expressions. Facial affect recognition impairment was identified in 34% of participants, 22% were classified as having vocal affect recognition impairment and 15% showed impairment in both modalities. Participants were significantly less accurate at identifying low vs high intensity emotion expressions in both modalities. Happy facial expressions were significantly better identified than all other emotions. Errors were distributed across the emotion categories for vocal expressions. CONCLUSIONS: The degree of facial affect impairment was significantly greater than vocal affect impairment in this sample of people with moderate-to-severe TBI. Low intensity emotion expressions were particularly problematic and an advantage for positively valenced facial emotion expressions was indicated.

"The barriers are plentiful." Speech-language pathologists' perspectives of enablers and barriers to hearing assessment for children in metropolitan, regional, and rural Australia: A mixed methods study.

PURPOSE: Access to hearing assessment is important for children, as poor auditory information can lead to poor speech and oral language development. This study aims to identify enablers and barriers to accessing hearing assessments for Australian children from the perspective of speech-language pathologists (SLPs), comparing access in metropolitan, regional, and rural areas. METHOD: This is a sequential, explanatory mixed-methods study. Forty-nine participants completed the quantitative survey and 14 participated in semi-structured interviews. The study was undertaken online and included participants from metropolitan, regional, and rural parts of Australian states and territories. RESULT: Similar accessibility issues were experienced across geographic locations and access to hearing assessment was related to the complexity of individual contexts. Speech-language pathologists felt that awareness and knowledge of hearing loss was low in parents and health professionals. Participants discussed barriers such as long wait times, complex criteria, and inefficient services that lead to compromised outcomes for clients. CONCLUSION: Barriers to hearing assessment are extensive and multifaceted. Future research might examine the accessibility of the health system in light of the barriers discussed in this research, and whether policies and procedures could be adapted to allow more easily accessible services.

The relationship between facial affect recognition and cognitive functioning after traumatic brain injury.

PRIMARY OBJECTIVE: There is considerable evidence suggesting facial affect recognition and cognitive functions are impaired in many people with moderate-to-severe traumatic brain injury (TBI). However, little is known about the relationship between these two domains in the TBI population. RESEARCH DESIGN: This study investigated the relationship between facial affect recognition and cognitive functioning in 75 adults with moderate-to-severe TBI. METHODS AND PROCEDURES: Participants were administered three facial affect recognition tests and a computerized cognitive test battery that assessed seven cognitive domains. MAIN OUTCOMES AND RESULTS: Deficits in facial affect recognition were significantly correlated with impairments in non-verbal memory, working memory, speed of processing, verbal memory and verbal delayed memory. No significant relationship was found between executive dysfunction and facial affect recognition impairments. Non-verbal memory, working memory and speed of processing significantly predicted overall facial affect recognition performance. CONCLUSIONS: It is concluded that impairment in several cognitive processes may contribute to facial affect recognition deficits in TBI, in particular non-verbal memory, working memory and speed of processing. Furthermore, executive functioning may not be a critical factor in facial affect recognition, but would most likely be important in deciding what to do once facial affect is perceived.

Emotion perception from vocal cues: Testing the influence of emotion intensity and sex on in-group advantage.

The present study examined individuals' ability to identify emotions being expressed in vocal cues depending on the accent of the speaker as well as the intensity of the emotion being expressed. Australian and Canadian participants listened to Australian and Canadian speakers express pairs of emotions that fall within the same emotion family but vary in intensity (e.g., anger vs. irritation). Accent of listener was unrelated to emotion recognition. Instead, performance varied more based on emotion intensity and sex; Australian and Canadian participants generally found high intensity emotions easier to recognize compared to low intensity emotions as well as emotion conveyed by females compared to males. Participants found it particularly difficult to recognize the expressed emotion of Australian males. The results suggest the importance of considering the context in which emotion recognition is embedded. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Affect recognition, empathy, and dysosmia after traumatic brain injury.

OBJECTIVE: To investigate if olfaction is associated with affect recognition and empathy deficits after traumatic brain injury (TBI). Prior research has shown that TBI often leads to loss of smell. We hypothesized a relationship with emotion perception, because the neural substrates of the olfactory system overlap with the ventral circuitry of the orbital frontal cortex, which play a critical role in affective responses, such as empathy. DESIGN: Comparative study investigating differences between participants with TBI who had impaired olfaction (dysosmia) with those with normal olfaction (normosmia). SETTING: Postacute rehabilitation facilities in the United States, Canada, and New Zealand. PARTICIPANTS: Participants (N=106) in the current study were a convenience sample of adults with moderate to severe TBI who were tested for olfactory function as part of a larger, related study on affect recognition. On average, participants were 11.5 years postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Olfaction (Brief Smell Identification Test), facial affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Faces [DANVA2-AF]), vocal affect recognition (Diagnostic Assessment of Nonverbal Affect 2-Adult Paralanguage [DANVA2-AP]), emotional inference (Emotional Inference from Stories Test [EIST]), and empathy (Interpersonal Reactivity Index [IRI]). RESULTS: Fifty-six percent of participants were dysosmic and only 36% of these participants were aware of their deficit. Participants with dysosmia performed significantly poorer on the DANVA2-AF (P=.003), DANVA2-AP (P=.007), EIST (P=.016), and IRI (P=.013). Medium effect sizes were found for all measures. Dysosmia had a sensitivity value of 86.4% for detecting facial affect recognition impairments and 67.8% for vocal affect recognition impairments. CONCLUSIONS: This study shows that olfactory deficits may be indicative of affect recognition impairments and reduced empathy. Early knowledge of affect recognition and empathy deficits would be valuable so that treatment could be implemented predischarge.