Impaired self-awareness after paediatric traumatic brain injury: Liability or protective factor?

Abstract

Background and Objectives: There is preliminary evidence that children and adolescents with traumatic brain injury (TBI) experience impaired self-awareness. This study aimed to examine factors associated with self-awareness and the relationship between self-awareness and functional and psychosocial outcomes following paediatric TBI. Methods: A prospective cohort of 86 children aged 8-16 years with TBI (63.2% male, M age = 12.8 years, SD = 2.6 years) and parents were recruited through the Queensland Children's Hospital. Children completed the Paediatric Awareness Questionnaire (PAQ) and Beck Youth Inventories; parents completed the PAQ, Adaptive Behaviour Assessment System-Third Edition, McMaster Family Assessment Device, Parenting Practices Questionnaire and Child Behaviour Checklist. Results: Poorer self-awareness (i.e., more negative parent-child discrepancy scores) was significantly associated with younger age at injury (r = .39, p < .001) and greater injury severity (r = -.25, p < .05), but not with socio-economic status, family functioning or parenting style (p>.05). Poorer self-awareness was related to lower adaptive function (r = .53, p < .001) and greater behavioural problems (r = -.33, p < .01) and contributed significant unique variance to these outcomes after controlling for demographic and injury-related factors (R2ch = .05-.16, p < .05). However, poorer self-awareness was associated with more positive self-concept (child-rated) after controlling for adaptive function and socio-economic status (R2ch = .25, p < .001). Conclusions: Children injured at a younger age and those with more severe injuries are more likely to have poor self-awareness. Impaired self-awareness can be a liability or protective factor depending on the perspective (parent or child) and outcome of interest (adaptive function/behaviour or self-concept).L6307393262020-02-03 <br />