National Rehabilitation Hospital

Self Awareness after Brain Injury: Emotional Distress and Executive Functioning

Judith McBrinn

Impaired awareness of deficit is a common consequence of acquired brain injury and is related to important functional outcome variables. The first objective of this study was to examine two questionnaires used to measure impaired self awareness by comparing patient report to the reports of clinicians and significant others. The second objective was to identify neuropsychological tests that are predictive of impaired self awareness. The third objective was to look at the relationship of awareness and time since injury on emotional distress. A multivariate cross sectional design was employed, including regression analyses, correlations and analyses of variance.

Fifty-four participants with acquired brain injury completed the Awareness Questionnaire and the Dysexecutive Questionnaire, the Hospital Anxiety and Depression Scales and a battery of neuropsychological tests including tests of executive functioning, IQ tests and the National Adult Reading Test. Clinicians and significant others of each participant completed the Awareness Questionnaire and the Dysexecutive Questionnaire in relation to the participant.

Results provide support for the convergent validity of the two questionnaires; however there were a number of differences in the response patterns on each questionnaire. Findings from the regressions indicated that Full Scale and Verbal IQ scores accounted for a greater amount of the variance than executive functioning test scores. Skills identified as predicting self awareness included concept formation, cognitive flexibility and divided attention, though the amount of variance accounted for by executive functioning tests was low. A main effect of awareness was identified such that participants with better awareness of their difficulties had higher emotional distress regardless of time since injury. These findings highlight the need to understand both the clinician and significant other report when assessing patient self awareness. They provide some support for cognitive neuropsychological models of self awareness while emphasising the role of intellectual ability in the phenomenon. Finally, the findings highlight the importance of understanding a patient’s level of self awareness when assessing and treating symptoms of emotional distress.

Final Report presented to the NRH Ethics Committee –  January 2007