Social Functioning
It is not possible to totally separate social functioning from executive function; however, separate comment on this important area will be undertaken here. A child's ability to effectively function within his or her social milieu is often significantly affected by TBI.
Emotional lability is common (159). Often, children have difficulty interpreting social cues from others or recognizing the emotions being expressed (160,161). Janusz et al. (159) reported on social problem-solving skills in children with TBI. They found that although the children were able to articulate the social dilemmas, they chose less developmentally mature strategies as the best means to solve them and also used low-level reasoning to evaluate whether the strategies were effective. Social participation is also reported to be decreased in children with TBI compared to their typically developing peers. Bedell and Dumas (162) reported that 30% to 73% of the children with acquired brain injuries that they studied were restricted in at least one of the participation domains they evaluated. Family-reported institutional, social, and attitudinal barriers were more often contributing to this restriction than physical environmental barriers (162).
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