Journal of the International Neuropsychological Society

Research Articles

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

Maureen Dennisa1a2 c1, Alba Agostinoa3, H.Gerry Taylora4a5, Erin D. Biglera6a7, Kenneth Rubina8, Kathryn Vannattaa9a10, Cynthia A. Gerhardta9a10, Terry Stancina5a11 and Keith Owen Yeatesa9a10

a1 Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario

a2 Department of Surgery, University of Toronto, Ontario

a3 Department of Psychology, Ryerson University, Toronto, Ontario

a4 Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

a5 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio

a6 Department of Psychology, Brigham Young University, Provo, Utah

a7 Department of Psychiatry, University of Utah, Salt Lake City, Utah

a8 Department of Psychology, University of Maryland, College Park, Maryland

a9 Department of Pediatrics, The Ohio State University, Columbus, Ohio

a10 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

a11 Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio


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)

(Received October 11 2011)

(Revised June 11 2012)

(Accepted June 11 2012)


  • Emotion;
  • Facial expression;
  • Theory of mind;
  • Closed head injury;
  • Test;
  • language comprehension;
  • Social emotional communication


c1 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: