Research on the impact of paediatric traumatic brain injury on self-awareness
PhD student and senior paediatric neuropsychologist Owen Lloyd is working with Professor Tamara Ownsworth, THC Research Director, in conducting valuable early childhood research.
Owen’s thesis has recently been examined and was passed without a single revision – a rare feat!
Owen's PhD examined the impact of paediatric traumatic brain injury on self-awareness, in which he developed and validated a new measure of paediatric self-awareness, the Paediatric Awareness Questionnaire.
Recently they published a paper in the acclaimed Journal of Neurotrauma called, Impaired self-awareness after paediatric traumatic brain injury: Protective factor or liability?
The publication addresses the issue of whether it is beneficial for children to develop self-awareness of their abilities after brain injury. In other words, does accurate self-awareness help them to adjust and develop greater independence in the home and at school or does this place them at risk of emotional distress and self-concept problems?
The key findings were:
- Children injured at a younger age and those with more severe injuries were most likely to have poor self-awareness (or rate their functioning in an unrealistically positive way compared to their parents). In particular, children injured during infancy and/or early childhood, typically had poorer self-awareness relative to those injured in later childhood and adolescence. This early vulnerability phenomenon has been attributed to TBI “derailing” children’s neurological and cognitive development and their lack of consolidated skills at the time of the injury. We also found that children were least aware of cognitive difficulties (as compared to ADLs, social, emotional, communication and physical difficulties).
- Poorer self-awareness was associated with worse adaptive functioning (i.e., lower skills in the home, school and community) and greater emotional and behavioural problems as rated by their parents. However, poorer self-awareness was also associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children.
- Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).
The key implications for clinical practice are that:
- The newly developed Paediatric Awareness Questionnaire has utility for measuring self-awareness in children and adolescents with brain injury and may assist clinicians to monitor the emergence of self-awareness over time.
- Assessing children’s self-awareness across multiple domains of functioning may provide valuable information regarding their profile of self-awareness and inform the focus of interventions.
- While reduced self-awareness may be protective against psychological distress and feelings of low self-worth, poor self-awareness may impede children’s ability to develop adaptive skills and manage emotional and behavioural difficulties.
- Clinical decisions regarding the need to treat impaired self-awareness with a view to potentially improving adaptive, emotional and behavioural outcomes need to take into account the possible negative effects on children’s current emotional well-being and feelings of self-worth.
- Parents and other family members may benefit more from education about self-awareness after TBI and how to communicate the functional effects and provide timely and sensitive feedback to children.
Other key publications linked to this body of work are:
Awareness Deficits in Children and Adolescents After Traumatic Brain Injury: A Systematic Review
Development and preliminary validation of the Paediatric Awareness Questionnaire for children and adolescents with traumatic brain injury
Measuring domain-specific deficits in self-awareness in children and adolescents with acquired brain injury: Component analysis of the Paediatric Awareness Questionnaire
Read more about more about Owen's research projects and publications here
