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Emotional Expression and Socially Modulated Emotive Communication in Children with Traumatic Brain Injury

Published online by Cambridge University Press:  19 November 2012

Maureen Dennis*
Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario Department of Surgery, University of Toronto, Ontario
Alba Agostino
Department of Psychology, Ryerson University, Toronto, Ontario
H.Gerry Taylor
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
Erin D. Bigler
Department of Psychology, Brigham Young University, Provo, Utah Department of Psychiatry, University of Utah, Salt Lake City, Utah
Kenneth Rubin
Department of Psychology, University of Maryland, College Park, Maryland
Kathryn Vannatta
Department of Pediatrics, The Ohio State University, Columbus, Ohio Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
Cynthia A. Gerhardt
Department of Pediatrics, The Ohio State University, Columbus, Ohio Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
Terry Stancin
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio
Keith Owen Yeates
Department of Pediatrics, The Ohio State University, Columbus, Ohio Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
Correspondence and reprint requests to: Maureen Dennis, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON. Canada, M5G 1X8. E-mail:


Facial emotion expresses feelings, but is also a vehicle for social communication. Using five basic emotions (happiness, sadness, fear, disgust, and anger) in a comprehension paradigm, we studied how facial expression reflects inner feelings (emotional expression) but may be socially modulated to communicate a different emotion from the inner feeling (emotive communication, a form of affective theory of mind). Participants were 8- to 12-year-old children with TBI (n = 78) and peers with orthopedic injuries (n = 56). Children with mild–moderate or severe TBI performed more poorly than the OI group, and chose less cognitively sophisticated strategies for emotive communication. Compared to the OI and mild–moderate TBI groups, children with severe TBI had more deficits in anger, fear, and sadness; neutralized emotions less often; produced socially inappropriate responses; and failed to differentiate the core emotional dimension of arousal. Children with TBI have difficulty understanding the dual role of facial emotions in expressing feelings and communicating socially relevant but deceptive emotions, and these difficulties likely contribute to their social problems. (JINS, 2013, 18, 1–10)

Research Articles
Copyright © The International Neuropsychological Society 2012

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