Thirty years ago, the neuropsychology of emotion started to emerge as a mainstream topic. Careful examination of individual patients showed that emotion, like memory, language, and so on, could be differentially affected by brain disorders, especially in the right hemisphere. Since then, there has been accelerating interest in uncovering the neural architecture of emotion, and the major steps in this process of discovery over the past 3 decades are detailed in this review. In the 1990s, magnetic resonance imaging (MRI) scans provided precise delineation of lesions in the amygdala, medial prefrontal cortex, insula and somatosensory cortex as underpinning emotion disorders. At the same time, functional MRI revealed activation that was bilateral and also lateralized according to task demands. In the 2000s, converging evidence suggested at least two routes to emotional responses: subcortical, automatic and autonomic responses and slower, cortical responses mediating cognitive processing. The discovery of mirror neurons in the 1990s reinvigorated older views that simulation was the means to recognize emotions and empathize with others. More recently, psychophysiological research, revisiting older Russian paradigms, has contributed new insights into how autonomic and other physiological indices contribute to decision making (the somatic marker theory), emotional simulation, and social cognition. Finally, this review considers the extent to which these seismic changes in understanding emotional processes in clinical disorders have been reflected in neuropsychological practice. (JINS, 2017, 23, 719–731)

Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury.

Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia.

Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation.

Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation.

Social cognition refers to the ability to use social cues to infer the meaning and intentions behind the behaviour of others in order to respond in a socially adaptive manner. It is increasingly recognised that disorders of social cognition, including problems with emotion perception, theory of mind, conversational inference, morality judgements, decision making and social inhibition, characterise many developmental and psychiatric disorders and are highly relevant to many with acquired brain injuries or diseases, especially the frontotemporal dementias. This review provides an introduction and overview of the papers in this special edition on social cognition and places these in the context of other recent research. In doing so, several current issues in the clinical management of social cognition are delineated. Given that social cognition seems to be a sensitive predictor of psychosocial function, the assessment of social cognition is seen by many clinicians to be important although which profession is responsible is yet to be resolved. Issues in how social cognition are assessed are discussed, including the importance of context to social cognition, its interactive nature and the need to recognise influences such as family upbringing, gender and emotional state on social cognitive performance. There also needs to be development of tests that address all aspects of social cognition, including decision making and inhibition. Finally, this review discusses intervention research. Interventions are especially well developed in relation to schizophrenia, and less well developed in brain injury. These appear to be generally effective although treatments for emotional self-awareness are yet to be developed.

Social disinhibition difficulties are common following traumatic brain injury (TBI). However, clinically sensitive tools to objectively assess the difficulties are lacking. This study aimed to pilot a new clinical measure of social disinhibition, the social disinhibition task (SDT). Whether social disinhibition is dependent on the type of social information judgements required and whether disinhibited responses can be adjusted with additional guidance were also examined. Participants were 31 adults (25 Male) with moderate-to-severe TBI and 22 adult (17 Male) healthy control participants. Participants viewed scenes of complex social situations and were asked to describe a character in them (Part A), describe a character while inhibiting inappropriate or negative responses (Part B), and describe a character while not only inhibiting negative responses, but also providing positive responses (Part C). One-half of the items contained a faux pas requiring participants to make inferences about a character's mental state. TBI and control participants responded similarly to Part A, although control participants responded less positively than TBI participants in the faux pas items. TBI participants were significantly impaired on Part B indicating they experienced difficulties in inhibiting automatic responding. TBI participants were however able to adjust their responding in Part C so that they respond similarly to the control participants. Between group differences were not detected in reaction time. Overall, the SDT appears to be suitable to detect social inhibition difficulties in clinical settings and provides a new direction for remediation of the difficulties in individuals with TBI.

Little is known about clinicians’ experiences in rehabilitation for people with traumatic brain injury (TBI). This survey study aimed to investigate clinicians’ scope of practice, perceived barriers to practice, factors influencing confidence levels and professional development preferences. Participants included 305 clinicians (88% female, 97% aged 20–60 years) from psychology (28%), occupational therapy (27%), speech pathology (15%), physiotherapy (11%), social work (6%), rehabilitation medicine (3%) and nursing (3%) disciplines. Survey results indicated that goal setting, client or family education, and assessment for rehabilitation, were the most common activities across all disciplines (>90%). Client-related barriers, family-related barriers and client–therapist relationship barriers were more frequently selected than workplace context and professional skill barriers (p < .05). Clinicians working with clients with mild TBI reported significantly fewer barriers (p < .05); yet, they were less confident in overcoming barriers than clinicians working with clients with more severe TBI (p < .001). Clinicians with fewer years of experience (<2 years) reported significantly lower confidence in overcoming barriers than clinicians with 2–10 years and >10 years of experience (p < .01). The most commonly selected professional development areas included new interventions and therapies, translating rehabilitation research into everyday practice and client specific topics. These findings provide a unique multidisciplinary perspective on clinicians working in TBI rehabilitation in Australia. Understanding of the perceived barriers to practice and professional development needs may guide training and support initiatives for clinicians which, in turn, may enhance the quality of brain injury rehabilitation.

Objectives: The current study aimed to determine whether reversal learning impairments and feedback-related negativity (FRN), reflecting reward prediction error signals generated by negative feedback during the reversal learning tasks, were associated with social disinhibition in a group of participants with traumatic brain injury (TBI). Methods: Number of reversal errors on a social and a non-social reversal learning task and FRN were examined for 21 participants with TBI and 21 control participants matched for age. Participants with TBI were also divided into low and high disinhibition groups based on rated videotaped interviews. Results: Participants with TBI made more reversal errors and produced smaller amplitude FRNs than controls. Furthermore, participants with TBI high on social disinhibition made more reversal errors on the social reversal learning task than did those low on social disinhibition. FRN amplitude was not related to disinhibition. Conclusions: These results suggest that impairment in the ability to update behavior when social reinforcement contingencies change plays a role in social disinhibition after TBI. Furthermore, the social reversal learning task used in this study may be a useful neuropsychological tool for detecting susceptibility to acquired social disinhibition following TBI. Finally, that the FRN amplitude was not associated with social disinhibition suggests that reward prediction error signals are not critical for behavioral adaptation in the social domain. (JINS, 2016, 21, 303–313)

Primary objective: Social cognition underlies social skills and can be disrupted in numerous developmental and acquired brain disorders during childhood and adolescence. Despite this, there are few tools to assess social cognition clinically in this age group. This study examined adolescent performance on The Awareness of Social Inference Test (TASIT), a valid measure of social cognition in adults.

Design: Cross-sectional design examining performance on Parts 1, 2 and 3 of TASIT (and alternate forms) in Australian girls and boys with varying levels of English familiarity.

Methods: 665 schoolchildren from private and government schools were administered TASIT subtests. Of these, 464 students aged 13–15 were selected to provide normative data. Scores from a further 97 provided information about the effects of lack of English familiarity.

Results: The two Forms of TASIT were statistically equivalent for two of the three parts. Adolescents performed lower than adults, although the differences were not large. Some incremental effects were seen for chronological age. Gender effects were apparent on all subtests. Lack of English familiarity (i.e., English not spoken at home) reduced scores a further 6–13% relative to high English proficiency.

Conclusions: TASIT appears to be suitable for adolescents. Norms are best aggregated across ages in adolescence and stratified according to gender.

An important aspect of cognitive functioning that is often impaired following traumatic brain injury (TBI) is visuospatial learning and memory. The Austin Maze task is a measure of visuospatial learning that has a long history in both clinical neuropsychological practice and research, particularly in individuals with TBI. The aim of this study was to evaluate visuospatial learning deficits following TBI using a new computerised version of the Austin Maze task. Twenty-eight individuals with moderate-to-severe TBI were compared to 28 healthy controls on this task, together with alternative neuropsychological measures, including the WAIS-III Digit Symbol and Digit Span subtests, the Trail Making Test, WMS-III Logical Memory, and Rey Osterrieth Complex Figure Test. The results demonstrated that TBI individuals performed significantly more poorly on the Austin Maze task than control participants. The Austin Maze task also demonstrated good convergent and divergent validity with the alternative neuropsychological measures. Thus, the computerised version of the Austin Maze appears to be a sensitive measure that can detect visuospatial learning impairments in individuals with moderate-to-severe TBI. The new computerised version of the task offers much promise in that it is more accessible and easier to administer than the conventional form of the test.

Many individuals who sustain moderate–severe traumatic brain injuries (TBI) are poor at recognizing emotional expressions, with a greater impairment in recognizing negative (e.g., fear, disgust, sadness, and anger) than positive emotions (e.g., happiness and surprise). It has been questioned whether this “valence effect” might be an artifact of the wide use of static facial emotion stimuli (usually full-blown expressions) which differ in difficulty rather than a real consequence of brain impairment. This study aimed to investigate the valence effect in TBI, while examining emotion recognition across different intensities (low, medium, and high).

Method: Twenty-seven individuals with TBI and 28 matched control participants were tested on the Emotion Recognition Task (ERT). The TBI group was more impaired in overall emotion recognition, and less accurate recognizing negative emotions. However, examining the performance across the different intensities indicated that this difference was driven by some emotions (e.g., happiness) being much easier to recognize than others (e.g., fear and surprise). Our findings indicate that individuals with TBI have an overall deficit in facial emotion recognition, and that both people with TBI and control participants found some emotions more difficult than others. These results suggest that conventional measures of facial affect recognition that do not examine variance in the difficulty of emotions may produce erroneous conclusions about differential impairment. They also cast doubt on the notion that dissociable neural pathways underlie the recognition of positive and negative emotions, which are differentially affected by TBI and potentially other neurological or psychiatric disorders. (JINS, 2014, 20, 1–10)

Traumatic brain injuries (TBI) in children and adolescents can impair social cognition and communication skills but there are few assessment tools suitable for adolescents. The Awareness of Social Inference Test (TASIT) uses professionally enacted audiovisual vignettes of everyday conversational exchanges and is a valid measure of social perception disorders in adults. This study examined its utility for assessing impairments in social cognition in a group of 16 adolescents with TBI, compared to a group of 16 typically developing (TD) adolescents. Adolescents with TBI were, on average, no different to their TD peers on TASIT 1 (emotion recognition) and TASIT 3 (recognizing lies and sarcasm when provided with additional cues) but performed more poorly on TASIT 2 which required them to interpret sarcastic and sincere conversational exchanges with few cues other than the demeanor of the speakers. Within the TBI group, poor performance on TASIT correlated to both relative and self-reported communication difficulties at home. It also correlated with IQ, face recognition and severity of injury as indexed by duration of post-traumatic amnesia. Overall, this study suggests TASIT is a valid measure for adolescents although it raised questions as to how effective normative data is for comparing performance in social cognition during childhood and adolescence. (JINS, 2013, 19, 1–11)

The object of this study was to evaluate the combined effect of body and facial feedback in adults who had suffered from a severe traumatic brain injury (TBI) to gain some understanding of their difficulties in the regulation of negative emotions. Twenty-four participants with TBI and 28 control participants adopted facial expressions and body postures according to specific instructions and maintained these positions for 10 s. Expressions and postures entailed anger, sadness, and happiness as well as a neutral (baseline) condition. After each expression/posture manipulation, participants evaluated their subjective emotional state (including cheerfulness, sadness, and irritation). TBI participants were globally less responsive to the effects of body and facial feedback than control participants, F(1,50) = 5.89, p = .02, η2 = .11. More interestingly, the TBI group differed from the Control group across emotions, F(8,400) = 2.51, p = .01, η2 = .05. Specifically, participants with TBI were responsive to happy but not to negative expression/posture manipulations whereas control participants were responsive to happy, angry, and sad expression/posture manipulations. In conclusion, TBI appears to impair the ability to recognize both the physical configuration of a negative emotion and its associated subjective feeling. (JINS, 2013, 19, 1–13)

Severe traumatic brain injury (TBI) leads to physical, neuropsychological, and emotional deficits that interfere with the individual's capacity to return to his or her former lifestyle. This review focuses on social cognition, that is, the capacity to attend to, recognize and interpret interpersonal cues that guide social behavior. Social cognition entails “hot” processes, that is, emotion perception and emotional empathy and “cold” processes, that is, the ability to infer the beliefs, feelings, and intentions of others (theory of mind: ToM) to see their point of view (cognitive empathy) and what they mean when communicating (pragmatic inference). This review critically examines research attesting to deficits in each of these domains and also examines evidence for theorized mechanisms including specific neural networks, the role of simulation, and non-social cognition. Current research is hampered by small, heterogeneous samples and the inherent complexity of TBI pathology. Nevertheless, there is evidence that facets of social cognition are impaired in this population. New assessment tools to measure social cognition following TBI are required that predict everyday social functioning. In addition, research into remediation needs to be guided by the growing empirical base for understanding social cognition that may yet reveal how deficits dissociate following TBI. (JINS, 2013, 19, 1–16)

Severe traumatic brain injury (TBI) is the most common cause of brain injury in the Western world and leads to physical, cognitive and emotional deficits that reduce independence. Changes to psychosocial function are the most disruptive, resulting in vocational difficulties, family stress and deteriorating relationships, and are a major target for remediation. But rehabilitation is expensive and its evidence base is limited. Thus, new collaborative initiatives are needed. This article details the development of ‘Moving Ahead’, a model for a Centre of Research Excellence (CRE) for Traumatic Brain Injury Rehabilitation. This CRE offers several major innovations. First, it provides an integrated, multi-faceted approach to addressing psychosocial difficulties embracing different clinical standpoints (e.g., psychological, speech pathology, occupational therapy) and levels of investigation (e.g., basic science to community function) across the lifespan. It is based upon a close relationship with clinicians to ensure transfer of research to practice and, conversely, to ensure that research is clinically meaningful. It provides an integrated platform with which to support and train new researchers in the field via scholarships, postdoctoral fellowships, websites, meetings, mentoring and across-site training, and thus build workforce capacity for individuals with TBI and their families. It has input from the international community to contextualise research more broadly and ensure scientific rigour. Finally, it provides collaboration across sites to facilitate research and data collection.

Right hemisphere damage (RHD) following unilateral stroke is often associated with impairment of pragmatic language, specifically, the ability to comprehend inferences that arise from language used in context. Three kinds of cognitive deficits have been proposed to explain the pragmatic deficits in RHD individuals, impaired Theory of Mind (TOM), weak central coherence (CC), and impaired executive function (EF). This study aims to evaluate the explanatory ability of these theories in relation to the comprehension of nonliteral (ironic) jokes versus literal lies. Twenty-one RHD patients and 21 age-matched controls were assessed on tasks tapping TOM, CC processing and general inference ability (EF) and the comprehension of irony. Second-order TOM and EF were found to play a significant role. However, neither construct, either in isolation or combined, completely explained the poor performance of RHD patients on this task compared to control participants.

This study investigated cognitive flexibility as indexed by the Written and Oral Trail Making Test (TMT) in sixteen persons with dementia and 60 normal elderly. Written and Oral TMT performances were significantly correlated with each other and with other tests of cognitive flexibility providing an index of the convergent construct validity of these tests. Part B of the Written TMT was influenced by psychomotor ability although this was diminished by the use of a ratio score B/A rather than simply Part B performance. The Oral test was not related to visual or motor skills, providing evidence for its divergent validity. Both parts of the Written and Oral TMT were found to be sensitive to cognitive decline in dementia. Performance on both Oral and Written TMT was also influenced by age, gender, education and intellectual ability. Previous norms (e.g., MOANS) for the Written TMT which are based on relatively educated elderly, tended to provide deflated scores for the community group tested here. Some additional, preliminary normative data for both tests were compiled which take into account the influences of each of these variables.

This article reports on the design of a three-arm, nonrandomised controlled trial of interventions targeting social communication skills following traumatic brain injury (TBI) in adult participants. People with severe TBI were allocated to one of the three groups: the TBI group, where only the person with TBI was trained, the JOINT group where both the everyday communication partner (ECP) and the person with TBI were trained together, and a delayed treatment control condition. The trial is comparing whether including everyday communication partners in the training process provide additional benefit when compared to training the person with TBI alone; and additionally, whether training the person with TBI alone is more effective than no training. A range of primary and secondary outcome measures will be used to evaluate outcomes. Publishing the protocol prior to the results of the trial being available has several important benefits (Godlee, 2001). The original hypotheses and intentions of the research are made explicit to ensure that the process of conducting this clinical trial is transparent to readers, and so that comments may be made before results are finalised. It provides the opportunity to outline a detailed description of this intervention and methodology, or to acknowledge changes to methodology, which may assist with eventual clinical application of the intervention. This article also informs the research community of the work that is underway to promote opportunities for collaboration and reduce unnecessary duplication of research. The protocol for this trial has previously been registered on Current Controlled Trials (http://www.controlled-trials.com/ISRCTN57815281).

Primary objective: Recent research studies attest to the presence of deficits in emotion perception following severe traumatic brain injury (TBI). Additionally, a growing number of studies report significant levels of alexithymia (disorder of emotional cognition) following TBI. This research aimed to examine the relation between the two, while assessing the influence of posttraumatic stress disorder (PTSD). Design: Cross-sectional study examining levels of alexithymia, emotion perception disorders and PTSD and their association, in 20 people with severe, chronic TBI and 20 adults without brain injuries. Methods: Participants were assessed on the Toronto Alexithymia — 20 Scale, the Posttraumatic Diagnostic Scale and on two emotion perception tasks: matching and labelling of photos depicting the 6 basic emotions. Results: The group with TBI were impaired relative to controls when matching facial expressions. Their performance on ‘fear’ was especially poor. Performance on labelling was similar in pattern, although failed to reach significance. There was no association between poor performance on fear, or other negative expressions, and either PTSD or alexithymia symptoms in the TBI group. Conclusions: Alexithymia, as assessed by the TAS-20, taps a constellation of difficulties that do not appear to include difficulties with emotion perception in people with traumatic brain injuries.