Social cognition broadly refers to the processing of social information in the brain that underlies abilities such as the detection of others' emotions and responding appropriately to these emotions. ...Social cognitive skills are critical for successful communication and, consequently, mental health and wellbeing. Disturbances of social cognition are early and salient features of many neuropsychiatric, neurodevelopmental and neurodegenerative disorders, and often occur after acute brain injury. Its assessment in the clinic is, therefore, of paramount importance. Indeed, the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduced social cognition as one of six core components of neurocognitive function, alongside memory and executive control. Failures of social cognition most often present as poor theory of mind, reduced affective empathy, impaired social perception or abnormal social behaviour. Standard neuropsychological assessments lack the precision and sensitivity needed to adequately inform treatment of these failures. In this Review, we present appropriate methods of assessment for each of the four domains, using an example disorder to illustrate the value of these approaches. We discuss the clinical applications of testing for social cognitive function, and finally suggest a five-step algorithm for the evaluation and treatment of impairments, providing quantitative evidence to guide the selection of social cognitive measures in clinical practice.
Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The ...BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test–retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder characterized by atypical social communication and repetitive behaviors. In this study, we applied a multimodal approach to ...investigate brain structural connectivity, resting state activity, and surface area, as well as their associations with the core symptoms of ASD. Data from forty boys with ASD (mean age, 11.5 years; age range, 5.5–19.5) and forty boys with typical development (TD) (mean age, 12.3; age range, 5.8–19.7) were extracted from the Autism Brain Imaging Data Exchange II (ABIDE II) for data analysis. We found significantly decreased structural connectivity, resting state brain activity, and surface area at the occipital cortex in boys with ASD compared to boys with TD. In addition, we found that resting state brain activity and surface area in the lateral occipital cortex was negatively correlated with communication scores in boys with ASD. Our results suggest that decreased structural connectivity and resting-state brain activity in the occipital cortex may impair the integration of verbal and non-verbal communication cues in boys with ASD, thereby impacting their social development.
•We applied a multimodal approach to investigate the neuropathology of ASD.•ASD showed decreased fALFF and surface area at the occipital cortex.•ASD is associated with decreased FA and track length in left CCG and right UNC.•Functional and structural changes were associated with ASD communication scores.
Purpose: The primary aim of this paper was to identify and describe current social communication assessment tools for adults with traumatic brain injury.
Method: We conducted a state-of-the-art ...review to identify and categorise the range of social communication assessment tools found in the assessment and treatment literature that revealed 42 measures that were coded according to characteristics related to assessment types, psychometrics, and implementation.
Result: Of the 42 assessments, 64% evaluated social cognition and the remaining 36% evaluated communication. Coding of implementation categories revealed that only 18/42 (43%) measures were ecologically grounded and 23/42 (55%) were available to clinicians by purchase or in the public domain. Only three measures incorporated questions or an assessment of the examinee's priorities or concerns.
Conclusion: A number of factors limit current social communication assessment. The lack of tools that objectively and reliably evaluate communication or social cognition in ecologically valid ways remains problematic. Of particular concern is the lack of prioritisation of the individual's communication values and needs. Recommendations include a call to focus research on the development of more contextual, standardised assessments, consider availability and feasibility when tools are being developed, and evaluate assessment processes as well as discrete tools.
Autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD) have been associated with difficulties recognizing and responding to social ...cues. Neuroimaging studies have begun to map the social brain; however, the specific neural substrates contributing to social deficits in neurodevelopmental disorders remain unclear. Three hundred and twelve children underwent structural magnetic resonance imaging of the brain (controls = 32, OCD = 44, ADHD = 77, ASD = 159; mean age = 11). Their social deficits were quantified on the Social Communication Questionnaire (SCQ) and the Reading the Mind in the Eyes Test (RMET). Multivariable regression models were used to examine the structural neuroimaging correlates of social deficits, with both a region of interest and a whole-brain vertex-wise approach. For the region of interest analysis, social brain regions were grouped into three networks: (1) lateral mentalization (e.g., temporal-parietal junction), (2) frontal cognitive (e.g., orbitofrontal cortex), and (3) subcortical affective (e.g., limbic system) regions. Overall, social communication deficits on the SCQ were associated with thinner cortices in the left lateral regions and the right insula, and decreased volume in the ventral striatum, across diagnostic groups (p = 0.006 to <0.0001). Smaller subcortical volumes were associated with more severe social deficits on the SCQ in ASD and ADHD, and less severe deficits in OCD. On the RMET, larger amygdala/hippocampal volumes were associated with fewer deficits across groups. Overall, patterns of associations were similar in ASD and ADHD, supporting a common underlying biology and the blurring of the diagnostic boundaries between these disorders.
Purpose: Social communication deficits are a severely debilitating aspect of traumatic brain injury (TBI), and there is strong clinical and research interest in how social communication interventions ...work for this population. Informed by a companion paper targeting assessment of social communication impairments post-TBI, this paper reviews relevant treatment theories and provides an inventory of social communication treatment components.
Method: We completed a mapping review examining 17 articles from recent literature reviews and 4 updated articles from a literature search to identify treatment targets and ingredients using the Rehabilitation Treatment Specification System (RTSS).
Result: Social communication interventions are primarily based on behavioural and cognitive treatment theories. Common social communication treatment targets include changing skilled behaviours and cognitive or affective representations. We offer a menu of therapeutic ingredients and treatment considerations which represent the current state of social communication interventions.
Conclusion: By reviewing the social communication intervention literature through a theoretical lens, we identify which treatment targets are missing, which targets are being addressed, and which therapeutic ingredients (i.e. clinician activities) are recommended. A hypothetical case study is provided as a supplement to demonstrate how speech-language pathologists may integrate treatment theory, ingredients, and targets into clinical practice.
The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum ...disorder are trained to implement the intervention in order to improve these children’s social-communication and play skills. In this 4-year, multi-site efficacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No significant group differences were found for the primary outcomes of children’s social-communication and play. However, children in the ASAP group showed increased classroom engagement. Additionally, participation in ASAP seemed to have a protective effect for one indicator of teacher burnout. Implications for future research are discussed.
Pragmatic language skills exist across a continuum in typical and clinical populations, and are impaired in many neurodevelopmental disorders, most notably autism. The mechanisms underlying pragmatic ...impairment are poorly understood, although theory suggests dampened vagal tone plays a role. This study investigated the
FMR1
premutation as a genetic model that may lend insight into the relationship between vagal function and pragmatic ability. Participants included 38 women with the
FMR1
premutation and 23 controls. Vagal tone accounted for significant variance in pragmatics across both groups and statistically mediated the effect of
FMR1
premutation status on pragmatic ability. Results support vagal tone as a biophysiological correlate of pragmatic ability, which informs potential mechanistic underpinnings and could have implications for targeted treatment.
We carried out a psychometric assessment of the Social Communication Questionnaire (SCQ) and the Social Responsiveness Scale (SRS-2) in fragile X syndrome (FXS), relative to clinician DSM5-based ...diagnosis of autism spectrum disorder (ASD) in FXS. This was followed by instrument revisions that included: removal of non-discriminating and/or low face validity items for FXS; use of receiver operating characteristic (ROC) curves to determine optimal cut points for the original and revised measures; an exploratory factor analysis to outline subscales better representing ASD in FXS; and creation of a “triple criteria” diagnosis to better delineate ASD subgroups in FXS. These methods improved the sensitivity and/or specificity of the SCQ and SRS-2, but diagnostic accuracy of ASD remains problematic in FXS.
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