Traumatic brain injury (TBI) is a common cause of childhood disability, and is associated with elevated
risk for long-term social impairment. Though social (pragmatic) communication deficits may be among
the most debilitating consequences of childhood TBI, few studies have examined very long-term communication
outcomes as children with TBI make the transition to young adulthood. In addition, the extent
to which reduced social function contributes to externalizing behaviors in survivors of childhood TBI
remains poorly understood. The present study aimed to evaluate the extent of social communication
difficulty among young adult survivors of childhood TBI (n = 34, injury age: 1.0–7.0 years; M time since
injury: 16.55 years) and examine relations among aspects of socialfunctionincluding emotionperception,
social communication and externalizing behaviors rated by close-other proxies. Compared to controls
the TBI group had significantly greater social communication difficulty, which was associated with more
frequent externalizing behaviors and poorer emotion perception. Analyses demonstrated that reduced
social communication mediated the association between poorer emotion perception and more frequent
externalizing behaviors. Our findings indicate that socio-cognitive impairments may indirectly increase
the risk for externalizing behaviors among young adult survivors of childhood TBI, and underscore the
need for targeted social skills interventions delivered soon after injury, and into the very long-term