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

Many adults with a traumatic brain injury (TBI) are less competent conversa tionalists following their injury. Reduced conversational competency is a c linically significant problem. It is associated with a variety of adverse p sychosocial outcomes following TBI. Unfortunately, direct attempts to impro ve the conversational competency of adults with TBI using social skills tra ining 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 nee ds to possess the social skills required in a given social context. Second, that social competence requires the ability to apply social skills flexibl y according to the rules of social interaction. It is argued that the inabi lity 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 Sha llice's (1986) theory of executive functioning to research on conversationa l behaviour following TBI. It is concluded that fostering appropriate socia l environments, and providing support are more likely to be effective than remedial social skills training.