Executive functioning and the application of social skills following traumatic brain injury

Many adults with a traumatic brain injury (TBI) are less competent conversationalists following their injury. Reduced conversational competency is a clinically significant problem. It is associated with a variety of adverse psychosocial outcomes following TBI. Unfortunately, direct attempts to improve the conversational competency of adults with TBI using social skills training has had limited success. This article applies McFall's (1982) social skills model to conversational competency following TBI. This social skills model is based on two critical assumptions. First, in order to be judged socially competent, a person needs to possess the social skills required in a given social context. Second, that social competence requires the ability to apply social skills flexibly according to the rules of social interaction. It is argued that the inability to flexibly apply behaviour according to rules (executive dysfunction) could account for many characteristics of conversation following TBI. This argument is illustrated through the detailed application of Norman and Shallice's (1986) theory of executive functioning to research on conversational behaviour following TBI. It is concluded that fostering appropriate social environments, and providing support are more likely to be effective than remedial social skills training.