Self-awareness assessment during cognitive rehabilitation in children with acquired brain injury: a feasibility study and proposed model of child anosognosia
Disability and Rehabilitation
Purpose: to compare three ways of assessing self-awareness in children with traumatic brain injury and to propose a model of child anosognosia • Method: five single cases of children with severe traumatic brain injury, aged 8 to 14, undergoing metacognitive training. Awareness was assessed using three different measures: two measures of metacognitive knowledge/intellectual awareness (a questionnaire and illustrated stories where child characters have everyday problems related to their executive
... to their executive dysfunction) and one measure of on-line/emergent awareness (post-task appraisal of task difficulty). • Results: All three measures showed good feasibility. Analysis of awareness deficit scores indicated large variability (1%-100%). Three children showed dissociated scores. • Conclusions: Based on these results, we propose a model of child self-awareness and anosognosia and a framework for awareness assessment for rehabilitation purposes. The model emphasizes (1) the role of on-line error detection in the construction of autobiographical memories that allow a child to build a self-knowledge of of his/her strengths and difficulties; (2) the multiple components of awareness that need to be assessed separately; (3) the implications for rehabilitation: errorless versus error-full learning, rehabilitation approaches based on metacognition, rationale for rehabilitation intervention based on child's age and impaired awareness component, ethical and developmental consideration of confrontational methods.