Face Processing and Social Functioning in Pediatric Brain Tumor Survivors

Abstract

Objective Pediatric brain tumor survivors (PBTS) experience deficits in social functioning. Facial expression and identity recognition are key components of social information processing and are widely studied as an index of social difficulties in youth with autism spectrum disorder (ASD) and other neurodevelopmental conditions. This study evaluated facial expression and identity recognition among PBTS, youth with ASD, and typically developing (TD) youth, and the associations between these face processing skills and social impairments. Methods PBTS (N = 54; ages 7–16) who completed treatment at least 2 years prior were matched with TD (N = 43) youth and youth with ASD (N = 55) based on sex and IQ. Parents completed a measure of social impairments and youth completed a measure of facial expression and identity recognition. Results Groups significantly differed on social impairments (p < .001), with youth with ASD scoring highest followed by PBTS and lastly TD youth. Youth with ASD performed significantly worse on the two measures of facial processing, while TD youth and PBTS were not statistically different. The association of facial expression recognition and social impairments was moderated by group, such that PBTS with higher levels of social impairment performed worse on the expression task compared to TD and ASD groups (p < .01, η2 = 0.07). Conclusions Variability in face processing may be uniquely important to the social challenges of PBTS compared to other neurodevelopmental populations. Future directions include prospectively examining associations between facial expression recognition and social difficulties in PBTS and face processing training as an intervention for PBTS.

Reduced Fusiform Gyrus Activation During Face Processing in Pediatric Brain Tumor Survivors

“…This is consistent with other studies that used informant reports of survivor social behavior (e.g., Barrera et al, 2017;Bonner et al, 2008;Willard, Berlin, Conklin, & Merchant, 2019) and raises the question about the suitability of these measures with this population given findings of social deficits in studies using more robust sociometric methods (e.g., Desjardins et al, 2019;Salley et al, 2015). However, variability in face processing abilities has been associated with ratings of survivor social behavior in studies from two different research groups (Bonner et al, 2008;Hocking et al, 2021), underscoring the importance of evaluating potential neurobiological factors underlying the variability of face processing in PBTS. Future studies should seek to replicate these findings in larger samples of PBTS to determine if hypoactivation in the fusiform gyrus is a key neurobiological process that contributes to variability in the social behavior of PBTS.…”

“…This finding of increased errors in face processing was recently replicated in youth treated for posterior fossa tumors (Moxon-Emre et al, 2019). Another study, showed face processing to be uniquely important to the social functioning of PBTS (Hocking et al, 2021). Further, recent evidence suggests that PBTS gaze less at faces during social situations than TD youth and in a manner consistent with youth with ASD (Hocking et al, 2020) suggesting reduced experience in processing facial information.…”

Social cognition and adjustment in adult survivors of pediatric central nervous system tumors

“…A few studies have examined specific social cognitive processes that underly and are necessary to successfully perform social tasks, 19 with a focus on facial affect or emotion recognition. [20][21][22][23][24][25] Collectively, CNS tumor survivors demonstrated difficulties identifying and interpreting facial expression of emotions, which in turn were associated with problems with friendships 26 and parent-reported social adjustment difficulties. 25 However, whether difficulties with affect recognition are also present in adult survivors or are associated with the attainment of expected functional outcomes in adulthood remain unknown.…”

“…Notably, deficits in executive functioning (e.g., shifting, working memory) 16,17 and nonverbal reasoning (e.g., visuospatial processing, fine motor skills) 6,18 have been associated with parent‐reported social skills deficits. A few studies have examined specific social cognitive processes that underly and are necessary to successfully perform social tasks, 19 with a focus on facial affect or emotion recognition 20–25 . Collectively, CNS tumor survivors demonstrated difficulties identifying and interpreting facial expression of emotions, which in turn were associated with problems with friendships 26 and parent‐reported social adjustment difficulties 25 .…”

A prospective study of social competence in survivors of pediatric brain and solid tumors

“…Although there is a large body of research examining these domains in youth with ASD, research in survivors of pediatric brain tumors is in its inception 9 . Preliminary studies have found that this group performs significantly worse than youth with juvenile rheumatoid arthritis in identifying adult facial expressions 13 and that survivors of pediatric brain tumors with high levels of social impairment are worse at identifying facial expressions compared with typically developing youth and youth with ASD 14 . Longitudinal research is needed to better understand the social competence of this group over time in order to inform targeted interventions.…”