Childhood Head Injury

Developmental and Recovery Variables: A Special Double Issue of Developmental Neuropsychology

Maureen Dennis, Harvey S. Levin, Maureen Dennis, Harvey S. Levin

• Publisher: Psychology Press
• Year: 2016
• eBook ISBN: 9781135066406
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Childhood head injuries differ from adult head injuries in some significant respects. They occur against a background of ongoing physical and cognitive development. Cognitive capacities often change with time post-injury. But for children changes are affected by two processes of functional plasticity, one concerned with recovery, one with development. The impact of the injury is moderated by age/developmental stage.

In recent years there has been a new focus on the longitudinal comparison of children post-injury with appropriate control groups. Advances in neuropsychological assessment have permitted evaluation with reference to more developmentally suitable norms; expanded definitions of outcome have broadened our understanding of consequences; and neuroimaging techniques have enabled the more precise delineation of injury severity, the study of structure-function outcome relations, and the investigation of reorganization of function.

This special issue offers an overview of cutting-edge approaches to the analysis of childhood head injury.

Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury

Bond Chapman Sandra and Garen Sparks

Center for BrainHealth
The University of Texas, Dallas

Harvey S. Levin

Cognitive Neuroscience Laboratory
Departments of Physical Medicine and Rehabilitation,
Neurosurgery, and Psychiatry and Behavioral Sciences
Baylor College of Medicine
Houston, TX

Maureen Dennis and Caroline Roncadin

Department of Psychology
Hospital for Sick Children
Toronto, Ontario, Canada

Lifang Zhang

Cognitive Neuroscience Laboratory
Department of Physical Medicine and Rehabilitation
Baylor College of Medicine
Houston, TX

James Song

Department of Biometry
Bayer Pharmaceuticals
West Haven, CT

The purpose of this study was to determine if discourse macrolevel processing abilities differed between children with severe traumatic brain injury (TBI) at least 2 years postinjury and typically developing children. Twenty-three children had sustained a severe TBI either before the age of 8 (n = 10) or after the age of 8 (n = 13). The remaining 32 children composed a control group of typically developing peers. The groups’ summaries and interpretive lesson statements were analyzed according to reduction and transformation of narrative text information. Compared to the control group, the TBI group condensed the original text information to a similar extent. However, the TBI group produced significantly less transformed information during their summaries, especially those children who sustained early injuries. The TBI and control groups did not significantly differ in their production of interpretive lesson statements. In terms of related skills, discourse macrolevel summarization ability was significantly related to problem solving but not to lexical or sentence level language skills or memory. Children who sustain a severe TBI early in childhood are at an increased risk for persisting deficits in higher level discourse abilities, results that have implications for academic success and therapeutic practices.

One of the most formidable tasks to improving the long-term cognitive-linguistic outcome in pediatric brain injury is to better understand the paradox of recovery for many of these children. For example, why is it that many children with severe brain injury show remarkable recovery on standardized language and cognitive measures, yet fail in the classroom? Whereas the answer to this quandary is certainly multifaceted, new evidence suggests that discourse macrolevel deficits may contribute to learning difficulties that persist at later stages post brain injury. This study examines discourse macrolevel abilities in children with severe traumatic brain injury (TBI) in relation to the moderating effect of age at injury.

DISCOURSE MACROLEVEL PROCESSING

Definition

Discourse macrolevel processing is conceptualized as extracting the most important information from connected language (Ulatowska & Chapman, 1994; van Dijk, 1995). Measures of macrolevel processing are those that require processes of reduction and transformation of information while preserving the central meaning. Types of macrolevel texts include summaries, main ideas, outlines, titles, and interpretative statements. These texts are shorter versions of the original discourse text, recursively conveying the same general meaning but containing less detail (van Dijk, 1995). Discourse macrolevel processing is contrasted with microlevel processing, in which the focus is on the isolated details, number of words and word types, and grammatical proficiency in conveying information.

Development

The cognitive abilities underlying the development of discourse macrolevel processing have been classified as executive functions (Brown & Day, 1983; Chapman, Levin, & Lawyer, 1999). These executive functions include processes such as judgment and problem solving (involved in sorting information according to importance), manipulating information in working memory, selective retrieval of important information from memory, and inhibition of less important or irrelevant details. The linguistic prerequisites of discourse macrolevel processing include comprehension of the discourse content, adequate vocabulary skills, and syntactic proficiency to convey the ideas. High-level vocabulary skills and the use of more complex syntactic structures have also been associated with conveying information at more generalized levels as required in macrolevel texts (Johnson, 1983; Ulatowska & Chapman, 1994). Pediatric TBI has been associated with impairments in all of these cognitive and linguistic domains (Levin, Ewing-Cobbs, & Eisenberg, 1995).

The majority of studies on the summary skills focus on normally developing children and show that macrolevel processing becomes refined with increasing age (Brown & Day, 1983; Johnson, 1983; Kinnunen & Vauras, 1995; Revelle, Wellman, & Karabenick, 1985; Vauras, Kinnunen, & Kuusela, 1994). When elementary school-age children (first through fifth grade) summarize information, they rely predominantly on the strategy of simple deletion of less important details with retention of important information. More mature summarizers, typically high school and college age, combine ideas across paragraphs and transform information into more generalized-transformed statements. As a result, they are able to convey more information in fewer words when compared to younger children (Brown, Day, & Jones, 1983). Nonetheless, even elementary school age children (6 to 10 years of age) use transformational strategies in summaries approximately 30% of the time as compared to a sixty percent ratio in college students when the content is within their knowledge base (Johnson, 1983).

Discourse Macrolevel Abilities in Children With TBI

Studies of macrolevel processing have served to elucidate the dissociations that can occur between macro and microlevel processing in adult populations (Chapman, Ulatowska, et al., 1997; Chapman, Ulatowska, King, Johnson, & McIntire, 1995; Chapman et al., in press; Ulatowska & Chapman, 1994). For example, patients with aphasia and relatively intact cognition exhibit preserved macrolevel processing but marked disruption in microlevel details.

Studies of macrolevel processing in children have emerged to examine the full scope of cognitive-communicative problems in children with TBI, which has gone unidentified with the use of standardized cognitive and linguistic tests (Chadwick, Rutter, Brown, Shaffer, & Traub, 1981; Chapman, Levin, & Lawyer, 1999; Levin & Eisenberg, 1979). New evidence suggests that discourse macrolevel processing may be particularly vulnerable to the effects of severe TBI, especially the earlier the injury, and recovers slower than microlevel abilities (Brookshire, Chapman, Song, & Levin, 2000; Chapman et al., 1992; Chapman et al., 1998; Chapman et al., 2001; Chapman, Watkins, et al., 1997; Dennis, Barnes, Donnelly, Wilkinson, & Humphreys, 1996; Dennis, Barnes, Wilkinson, & Humphreys, 1998; Dennis, Guger, Roncadin, Barnes, Schacter, 2001; Dennis, Purvis, Barnes, Wilkinson, & Winner, 2001; Yorkston, Jaffe, Polissar, Liao, & Fay, 1997). Specifically, children with severe TBI show a marked reduction in recall of the gist information and on formulating a synthesized, interpretative statement (Chapman, Watkins, et al, 1997), although they may remember a great deal of the isolated facts, depending on the task demand on memory (Chapman et al., 1992; Chapman et al., 1998; Chapman et al., 1999).

Limitations in Macrolevel Discourse Processing Research

There are two major limitations in previous research concerning macrolevel discourse processing in pediatric TBI. First, the discourse tasks were not specifically designed to require macrolevel processing. For example, the discourse tasks asked for verbal and written retells rather than summaries (Brookshire et al., 2000; Chapman et al., 1992; Chapman et al., 1998; Chapman, Levin, Matejka, Harward, & Kufera, 1995; Chapman, Watkins, et al., 1997; Yorkston, et al., 1997; Yorkston, Jaffe, Liao, & Polissar, 1999). Second, the discourse tasks utilized brief narrative texts that placed minimal demands on condensing information (Ulatowska & Chapman, 1994). In fact, short texts are harder to reduce and transform because the information is already condensed.

It remains unclear whether children with severe brain injury fail to convey the most important, macrolevel meaning due to an inability to distinguish the most important points from the details. Alternatively, the reduced expression of important information may result from processing overload on tasks that emphasize the recall of details. Our team has speculated that children with brain injury may focus on the microdetails at the expense of macrolevel processing (Chapman et al., 1999). Because facility in macrolevel processing is related to learning achievement in the classroom setting (Kinnunen & Vauras, 1995), identification of poor discourse macrolevel processing by children with TBI could serve as a useful diagnostic and intervention guideline at subsequent, long-term recovery intervals (Johnson, 1983; Malone & Mastropieri, 1992; Stein & Kirby, 1992; Ulatowska & Chapman, 1994).

Purpose of Study

The primary purpose of this study was to determine the long-term consequences of severe TBI in childhood on discourse macrolevel processing as compared to typi cally developing peers through the elicitation of a summary and a lesson statement after listening to a narrative. A secondary goal was to ...

Table of contents

• Cover
• Half Title
• Title Page
• Table of Contents
• New Perspectives on Cognitive and Behavioral Outcome After Childhood Closed Head Injury
• Prospective Memory in Pediatric Traumatic Brain Injury: A Preliminary Study
• Working Memory After Mild, Moderate, or Severe Childhood Closed Head Injury
• Discourse Macrolevel Processing After Severe Pediatric Traumatic Brain Injury
• Components of Executive Function in Typically Developing and Head-Injured Children
• Childhood Head Injury and Metacognitive Processes in Language and Memory
• Modeling of Longitudinal Academic Achievement Scores After Pediatric Traumatic Brain Injury
• Ecological Assessment of Executive Function in Traumatic Brain Injury
• Attention Deficit Hyperactivity Disorder in Children and Adolescents Following Traumatic Brain Injury
• Attention Deficit Hyperactivity Disorder Symptoms and Response Inhibition After Closed Head Injury in Children: Do Preinjury Behavior and Injury Severity Predict Outcome?
• Research on Outcomes of Pediatric Traumatic Brain Injury: Current Advances and Future Directions