A case of severe TBI: Recovery?

Chronic stage neuropsychological assessments of children with severe TBI typically center around a referral question and focus on assessing cognitive, behavioral, and emotional functioning, making differential diagnoses, and planning treatment. When severe TBI-related neurological deficits are subtle and fall outside commonly assessed behavioral indicators, as can happen with theory of mind and social information processing, they can go unobserved and subsequently fail to be assessed. Additionally, should chronic stage cognitive, behavioral, and emotional assessment findings fall within the average to above average range, a child experiencing ongoing significant unassessed severe TBI-related subtle deficits could be mistakenly judged to have "recovered" from their injury; and to be experiencing no significant ongoing residual neurological deficits. To illustrate how this could happen, and how subacute neuroimaging and brain network theory might be early indicators of emergent chronic stage neuropsychological deficits, we present a child with a severe TBI and average to above average cognitive, behavioral, and emotional assessment findings who has comorbid significant deficits in theory of mind and social functioning.