Article

PURPOSE: To compare three ways of assessing self-awareness in children with
traumatic brain injury (TBI) and to propose a model of child anosognosia. METHOD:
Five single cases of children with severe TBI, aged 8-14, 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 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 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-based 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.
IMPLICATIONS FOR REHABILITATION: Self-awareness has multiple components that need
to be assessed separately, to better adapt cognitive rehabilitation. Using
questionnaires and discrepancy scores are not sufficient to assess awareness,
because it does not include on-line error detection, which can be massively
impaired in children, especially those with impaired executive functions. On-line
error detection is important to promote and error-based learning is useful to
allow a child to build a self-knowledge of his/her strengths and difficulties, in
the absence of severe episodic memory problems. Metacognitive trainings may not
be appropriate for younger children who have age appropriate developmentally
immature self-awareness, nor for patients with brain injury if they suffer
anosognosia because of their brain injury.

Langue : ANGLAIS