Predictors of social cognition following acquired brain injury in children and adolescents

Introduction Social cognition, encompassing Theory of Mind (ToM) and Affect Recognition (AR), is frequently impaired following pediatric acquired brain injury (ABI). Despite its relevance to social and everyday functioning, the factors underlying social cognition and their combined contribution remain insufficiently understood. Methods This prospective observational study examined the contribution of brain-related (injury severity, etiology, lesion location), developmental (age at injury, time since injury), environmental (socioeconomic status, SES) and cognitive (full scale intellectual quotient, FSIQ) variables to ToM and AR performance in 68 children and adolescents with ABI (M age = 13.27 years; SD = 3.26). Participants completed standardized measures of ToM and AR. Hierarchical linear regressions tested the predictive value of 6 variables at Step 1 (injury severity, etiology, lesion location, age at injury, time since injury and SES), with FSIQ entered at Step 2. Results Injury severity emerged as the strongest predictor of both ToM and AR. SES showed a trend toward significance on AR. In the hierarchical models, FSIQ accounted for additional variance in ToM beyond the 6 initial predictors. Age at injury did not predict outcomes, whereas longer time since injury was associated with lower ToM scores. Neither etiology (TBI vs. non-TBI) nor broad lesion-location (frontal involvement vs. extra-frontal involvement only) significantly predicted socio-cognitive performance. Discussion These findings indicate that socio-cognitive outcomes after pediatric ABI are shaped by multiple factors, with injury severity representing the most consistent predictor. FSIQ contributed uniquely to ToM, whereas SES showed an association with AR. Developmental timing also appeared relevant, with longer time since injury associated with poorer ToM. In contrast, etiology, lesion location and age at injury did not significantly affect outcomes. Overall, the findings highlight the importance of identifying factors associated with socio-cognitive outcomes to improve early identification and monitoring of vulnerabilities and inform targeted interventions throughout development.