Hostname: page-component-76fb5796d-25wd4 Total loading time: 0 Render date: 2024-04-26T09:25:30.268Z Has data issue: false hasContentIssue false
  • English
  • Français

Metacognitive Monitoring in Moderate and Severe Traumatic Brain Injury

Published online by Cambridge University Press:  04 May 2011

Kathy S. Chiou ,
Richard A. Carlson ,
Peter A. Arnett ,
Stephanie A. Cosentino  and
Frank G. Hillary
Kathy S. Chiou*
Affiliation:
Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
Richard A. Carlson
Affiliation:
Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
Peter A. Arnett
Affiliation:
Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
Stephanie A. Cosentino
Affiliation:
Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Columbia University Medical Center; New York, New York
Frank G. Hillary
Affiliation:
Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
*
Correspondence and reprint requests to: Kathy S. Chiou, Department of Psychology, The Pennsylvania State University, 610 Moore Building, University Park, PA 16802. E-mail: ksc167@psu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

The ability to engage in self-reflective processes is a capacity that may be disrupted after neurological compromise; research to date has demonstrated that patients with traumatic brain injury (TBI) show reduced awareness of their deficits and functional ability compared to caretaker or clinician reports. Assessment of awareness of deficit, however, has been limited by the use of subjective measures (without comparison to actual performance) that are susceptible to report bias. This study used concurrent measurements from cognitive testing and confidence judgments about performance to investigate in-the-moment metacognitive experiences after moderate and severe traumatic brain injury. Deficits in metacognitive accuracy were found in adults with TBI for some but not all indices, suggesting that metacognition may not be a unitary construct. Findings also revealed that not all indices of executive functioning reliably predict metacognitive ability. (JINS, 2011, 17, 720–731)

Keywords

AwarenessBrain injuryMetacognitionConfidence judgmentsSelf-monitoringExecutive functioning
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 17 , Issue 4 , 21 June 2011 , pp. 720 - 731
Copyright
Copyright © The International Neuropsychological Society 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Allen, C.C., Ruff, R.M. (1990). Self-rating versus neuropsychological performance of moderate versus severe head-injured patients. Brain Injury, 4, 7–17.Google Scholar
Amador, X.F., Strauss, D.H., Yale, S.A., Flaum, M.M., Endicott, J., Gorman, J.M. (1993). Assessment of insight in psychosis. The American Journal of Psychiatry, 150(6), 873–879.Google Scholar
Anderson, J.W., Schmitter-Edgecombe, M. (2009). Predictions of episodic memory following moderate to severe traumatic brain injury during inpatient rehabilitation. Journal of Clinical and Experimental Neuropsychology, 31(4), 425–438.CrossRefGoogle ScholarPubMed
Army Individual Test Battery. (1944). Manual of directions and scoring. Washington, DC: War Department, Adjutant General's Office.Google Scholar
Augustyn, J.S., Rosenbaum, D.A. (2005). Metacognitive control of action: Preparation for aiming reflects knowledge of Fitt's Law. Psychonomic Bulletin & Review, 12(5), 911–916.Google Scholar
Babinski, J. (1914). Contribution a l’étude des troubles mentaux dans hémiplégie orgnique cérébrale (anosognosie). Revue Neurologique, 27, 845–847.Google Scholar
Bach, L.J., David, A.S. (2006). Self-awareness after acquired and traumatic brain injury. Neuropsychological Rehabilitation, 16(4), 397–414.CrossRefGoogle ScholarPubMed
Barrett, A.M., Eslinger, P.J., Ballentine, N.H., Heilman, K.M. (2005). Unawareness of cognitive deficit (cognitive anosognosia) in probable AD and control subjects. Neurology, 64, 693–699.Google Scholar
Benedict, R.H.B., Schretlen, D., Groninger, L., Brandt, J. (1998). Hopkins Verbal Learning Test-Revised: Normative data and analysis of inter-form and test-retest reliability. The Clinical Neuropsychologist, 12, 43–55.Google Scholar
Bogod, N., Mateer, C.A., MacDonald, S.W. (2003). Self-awareness after traumatic brain injury: A comparison of measures and their relationship to executive function. Journal of the International Neuropsychological Society, 9, 450–458.Google Scholar
Busch, R.M., McBride, A., Curtiss, G., Vanderploeg, R.D. (2005). The components of executive functioning in traumatic brain injury. Journal of Clinical and Experimental Neuropsychology, 27, 1022–1032.CrossRefGoogle ScholarPubMed
Chen, Q., Wei, P., Zhou, X. (2006). Distinct neural correlates for resolving stroop conflict at inhibited and noninhibited locations in inhibition of return. Journal of Cognitive Neuroscience, 18(11), 1937–1946.CrossRefGoogle ScholarPubMed
Chua, E.F., Schacter, D.L., Rand-Giovannetti, E., Sperling, R.A. (2006). Understanding metamemory: Neural correlates of the cognitive process and subjective level of confidence in recognition memory. Neuroimage, 29, 1150–1160.Google Scholar
Chua, E.F., Schacter, D.L., Sperling, R.A. (2009). Neural correlates of metamemory: A comparison of feeling-of-knowing and retrospective confidence judgments. Journal of Cognitive Neuroscience, 21(9), 1751–1765.CrossRefGoogle ScholarPubMed
Ciurli, P., Bivona, U., Barba, C., Onder, G., Silvestro, D., Azicnuda, E., Formisano, R. (2010). Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury. Journal of the International Neuropsychological Society, 16(2), 360–368.CrossRefGoogle ScholarPubMed
Collette, F., Hogge, M., Salmon, E., Van Der Linden, M. (2006). Exploration of the neural substrates of executive functioning by functional neuroimaging. Neuroscience, 139, 209–221.CrossRefGoogle ScholarPubMed
Cosentino, S., Metcalfe, J., Holmes, B., Steffener, J., Stern, J. (in press). Finding the self in metacognitive evaluations: A study of metamemory and agency in non-demented elders. Neuropsychology.Google Scholar
Cosentino, S., Stern, Y. (2005). Metacognitive theory and assessment in dementia: Do we recognize our areas of weakness? Journal of the International Neuropsychological Society, 11(7), 910–919.Google Scholar
de Frias, C.M., Dixon, R.A., Strauss, E. (2006). Structure of four executive functioning tests in healthy older adults. Neuropsychology, 20(2), 206–214.Google Scholar
Delis, D.C., Kaplan, E., Kramer, J.H. (2001). Delis Kaplan Executive Function Systems. San Antonio, TX: The Psychological Corporation.Google Scholar
Dunloskly, J., Baker, J.M., Rawson, K.A., Hertzog, C. (2006). Does aging influence people's metacomprehension? Effects of processing ease of judgments of text learning. Psychology and Aging, 21(2), 390–400.Google Scholar
Dunlosky, J., Metcalfe, J. (2009). Metacognition. Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
Evans, C.C., Sherer, M., Nick, T.G., Nakase-Richardson, R., Yablon, S.A. (2005). Early impaired self-awareness, depression, and subjective well-being following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20(6), 488–500.Google Scholar
Faul, M., Xu, L., Wald, M.M., Coronado, V.G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths 2002–2006. Atlanta, GA: Centers for disease Control and Prevention, National Center for Injury Prevention and Control.Google Scholar
Fernandez-Duque, D., Baird, J.A., Posner, M.I. (2000). Executive attention and metacognitive regulation. Consciousness and Cognition, 9, 288–307.Google Scholar
Flashman, L.A., McAllister, T.W. (2002). Lack of awareness and its impact in traumatic brain injury. Neurorehabilitation, 17, 285–296.Google Scholar
Flavell, J.H. (1979). Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist, 34(10), 906–911.CrossRefGoogle Scholar
Fleming, J.M., Strong, J. (1995). Self-awareness of deficits following acquired brain injury: Considerations for rehabilitation. British Journal of Occupational Theory, 58, 55–58.Google Scholar
Fleming, J.M., Strong, J., Ashton, R. (1996). Self-awareness of deficits in adults with traumatic brain injury: How best to measure? Brain Injury, 10, 1–15.Google Scholar
Gallup, G.G. Jr., Suarez, S.D. (1991). Social responding to mirrors in rhesus monkeys (macaca mulatta): Effects of temporary mirror removal. Journal of Comparative Psychology, 105(4), 376–379.Google Scholar
Garmoe, W., Newman, A.C., O'Connell, M. (2005). Early self-awareness following traumatic brain injury: Comparison of brain injury and orthopedic inpatients using the functional self-assessment scale (FSAS). The Journal of Head Trauma Rehabilitation, 20(4), 348–358.CrossRefGoogle ScholarPubMed
Godfrey, H.P., Partridge, F.M., Knight, R.G., Bishara, S.N. (1993). Course of insight disorder and emotional dysfunction following closed head injury: A controlled cross-sectional follow up study. Journal of Clinical and Experimental Neuropsychology, 15(4), 503–515.Google Scholar
Goldenberg, G., Müllbacher, W., Nowak, A. (1995). Imagery without perception—A case study of anosognosia for cortical blindness. Neuropsychologia, 33(11), 1373–1382.Google Scholar
Gonzalez, R., Nelson, T.O. (1996). Measuring ordinal association in situations that contain tied scores. Psychological Bulletin, 119(1), 159–165.CrossRefGoogle ScholarPubMed
Goodman, L.A., Kruskal, W.H. (1954). Measures of association for cross classifications. Journal of the American Statistical Association, 49(268), 732–764.Google Scholar
Griffin, T.D., Jee, B.D., Wiley, J. (2009). The effects of domain knowledge on metacomprehension accuracy. Memory and Cognition, 37(7), 1001–1013.Google Scholar
Griffin, T.D., Wiley, J., Thiede, K.W. (2008). Individual differences, rereading, and self-explanation: Concurrent processing and cue validity as constraints on metacomprehension accuracy. Mem Cogni, 36(1), 93–103.Google Scholar
Hager, W., Hasselhorn, M. (1992). Memory monitoring and memory performance: Linked closely or loosely? Psychological Research, 54, 110–113.CrossRefGoogle ScholarPubMed
Hart, T., Whyte, J., Kim, J., Vaccaro, M. (2005). Executive function and self-awareness of “real-world” behavior and attention deficits following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20(4), 333–347.CrossRefGoogle ScholarPubMed
Heilman, K.M., Barrett, A.M., Adair, J.C. (1998). Possible mechanisms of anosognosia: A defect in self-awareness. Philosophical Transactions of the Royal Society of London, Series B, Biological Sciences, 353(1377), 1903–1909.Google Scholar
Hertzog, C., Dixon, R.A., Hultsch, D.F. (1990). Relationships between metamemory, memory predictions, and memory task performance in adults. Psychology of Aging, 5(2), 215–227.Google Scholar
Howell, D.C. (1987). Statistical methods for psychology (2nd ed.). Boston, MA: PWS Publishers.Google Scholar
Karpicke, J.D. (2009). Metacognitive control and strategy selection: Deciding to practice retrieval during learning. Journal of Experimental Psychology: General, 138(4), 469–486.CrossRefGoogle ScholarPubMed
Kaszniak, A.W., Zak, M.G. (1996). On the neuropsychology of metamemory: Contributions from study of amnesia and dementia. Learning & Individual Differences, 8(4), 355–381.Google Scholar
Kennedy, M.R.T. (2001). Retrospective confidence judgments made by adults with traumatic brain injury: Relative and absolute accuracy. Brain Injury, 15(6), 469–487.CrossRefGoogle ScholarPubMed
Kennedy, M.R.T. (2004). Self-monitoring recall during two tasks after traumatic brain injury: A preliminary study. American Journal of Speech-Language Pathology, 13, 142–154.Google Scholar
Kennedy, M.R.T., Carney, E., Peters, S.M. (2003). Predictions of recall and study strategy decisions after diffuse brain injury. Brain Injury, 17(12), 1043–1064.Google Scholar
Kennedy, M.R.T., Yorkston, K.M. (2000). Accuracy of metamemory after traumatic brain injury: Predictions during verbal learning. Journal of Speech, Language, and Hearing Research, 43(5), 1072–1086.Google Scholar
Kervick, R.B., Kaemingk, K.L. (2005). Cognitive appraisal accuracy moderates the relationship between injury severity and psychosocial outcomes in traumatic brain injury. Brain Injury, 19(11), 881–889.Google Scholar
Kikyo, H., Ohki, K., Miyashita, Y. (2002). Neural correlates for feeling-of-knowing: An fMRI parametric analysis. Neuron, 36, 177–186.Google Scholar
Koren, D., Seidman, L.J., Poyurovsky, M., Goldsmith, M., Viksman, P., Zichel, S., Klein, E. (2004). The neuropsychological basis of insight in first episode schizophrenia: A pilot metacognitive study. Schizophrenia Research, 70(2), 195–202.Google Scholar
Koriat, A., Helstrup, T. (2007). Metacognitive aspects of memory. In S. Magnussen & T. Helstrup (Eds.), Everyday memory (pp. 251–274). New York, NY: Psychology Press.Google Scholar
Lebrun, Y. (1987). Anosognoisa in aphasics. Cortex, 23(2), 251–263.CrossRefGoogle ScholarPubMed
Lefèvre, N., Lories, G. (2004). Text cohesion and metacomprehension: Immediate and delayed judgments. Memory and Cognition, 32(8), 1238–1254.Google Scholar
Leonesio, R.J., Nelson, T.O. (1990). Do different metamemory judgments tap the same underlying aspects of memory? Journal of Experimental Psychology: Learning, Memory, and Cognition, 16(3), 464–467.Google Scholar
Leritz, E., Loftis, C., Crucian, G., Friedman, W., Bowers, D. (2004). Self-awareness of deficits in Parkinson disease. The Clinical Neuropsychologist, 18, 352–361.Google Scholar
Maki, R.H., Berry, S.L. (1984). Metacomprehension of text material. Journal of Experimental Psychology: Learning, Memory, and Cognition, 10(4), 663–679.Google ScholarPubMed
Markela-Lerenc, J., Ille, N., Kaiser, S., Fiedler, P., Mundt, C., Weisbrod, M. (2004). Prefrontal-cingulate activation during executive control: Which comes first? Cognitive Brain Research, 18, 278–287.Google Scholar
McAvinue, L., O'Keeffe, F., McMackin, D., Robertson, I.H. (2005). Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight. Neuropsychological Rehabilitation, 15(5), 569–597.Google Scholar
McDonald-Miszczak, L., Hertzog, C., Hultsch, D.F. (1995). Stability and accuracy of metamemory in adult and aging: A longitudinal analysis. Psychology of Aging, 10(4), 553–564.CrossRefGoogle ScholarPubMed
McGlynn, S.M., Schacter, D.L. (1997). The neuropsychology of insight: Impaired awareness of deficits in a psychiatric context. Psychiatric Annals, 27(12), 806–811.Google Scholar
Metcalfe, J. (2009). Metacognitive judgments and control of study. Current Directions in Psychological Science, 18(3), 159–163.Google Scholar
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., Wagner, T.D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100.CrossRefGoogle ScholarPubMed
Nelson, T.O. (1984). A comparison of current measures of the accuracy of feeling-of-knowing predictions. Psychological Bulletin, 95(1), 109–133.Google Scholar
Nelson, T.O. (1992). Metacognition: Core readings. Boston: Allyn & Bacon.Google Scholar
Nelson, T.O., Narens, L. (1990). Metamemory: A theoretical framework and new findings. The Psychology of Learning and Motivation, 26, 125–173.Google Scholar
Norman, D.A., Shallice, T. (1986). Attention to action: Willed and automatic control of behavior. In R.J. Davidson, G.E. Schwartz, & D. Sapiro (Eds.), Consciousness and self regulation (pp. 1–17). New York: Plenum.Google Scholar
Ownsworth, T., Fleming, J. (2005). The relative importance of metacognitive skills, emotional status, and executive function in psychosocial adjustment following acquired brain injury. Journal of Head Trauma Rehabilitation, 20(4), 315–332.Google Scholar
Ownsworth, T.L., McFarland, K., Young, R.M. (2002). The investigation of factors underlying deficits in self-awareness and self-regulation. Brain Injury, 16(4), 291–309.Google Scholar
Pannu, J.K., Kaszniak, A.W. (2005). Metamemory experiments in neurological populations: A review. Neuropsychology Review, 15(3), 105–130.CrossRefGoogle ScholarPubMed
Perrotin, A., Belleville, S., Isingrini, M. (2007). Metamemory monitoring in mild cognitive impairment: Evidence of a less accurate episodic feeling-of-knowing. Neuropsychologia, 45(2), 2811–2826.Google Scholar
Perrotin, A., Isingrini, M., Souchay, C., Clarys, D., Taconnat, L. (2006). Episodic feeling-of-knowing accuracy and cued recall in the elderly: Evidence for double dissociation involving executive functioning and processing speed. Acta Psychologica, 122(1), 58–73.Google Scholar
Perrotin, A., Tournelle, L., Isingrini, M. (2008). Executive functioning and memory as potential mediators of the episodic feeling-of-knowing accuracy. Brain and Cognition, 67(1), 76–87.Google Scholar
Pia, L., Tamietto, M. (2006). Unawareness in schizophrenia: Neuropsychological and neuranatomical findings. Psychiatry and Clinical Neurosciences, 60, 531–537.Google Scholar
Prigatano, G.P. (1997). The problem of impaired self-awareness in neuropsychological rehabilitation. In J. Leon-Carrion (Ed.), Neuropsychological rehabilitation: Fundamentals, innovations and directions. Florida: GR/St. Lucie Press.Google Scholar
Prigatano, G.P., Fordyce, D.J. (1986). Cognitive dysfunction and social adjustment after brain Injury. In G.P. Prigatano, D.J. Fordyce, H.K. Zeiner, J.R. Roueche, M. Pepping, & B.C. Wood (Eds.), Neuropsychological rehabilitation after brain injury. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Prigatano, G.P., Klonoff, P.S. (1998). A clinician's rating scale for evaluating impaired self-awareness and denial of disability after brain injury. The Clinical Neuropsychologist, 12(1), 56–67.Google Scholar
Pringle, R.K., Haanstad, M. (1971). Estimating WAIS IQs from progressive matrices and Shipley-Hartford scores. Journal of Clinical Psychology, 27(4), 479–481.Google Scholar
Rawson, K.A., Dunlosky, J., Thiede, K.W. (2000). The rereading effect: Metacomprehension accuracy improves across reading trials. Memory and Cognition, 28(6), 1004–1010.Google Scholar
Redford, J.S. (2010). Evidence of metacognitive control by humans and monkeys in a perceptual categorization task. Journal of Experimental Psychology: Learning, Memory, and Cognition, 36(1), 248–254.Google Scholar
Reitan, R.M., Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Test Battery: Therapy and clinical interpretation. Tucson, AZ: Neuropsychological Press.Google Scholar
Rickelman, B.L. (2004). Anosognosia in individuals with schizophrenia: Toward recovery of insight. Issues in Mental Health Nursing, 25, 227–242.CrossRefGoogle ScholarPubMed
Roche, N.L., Fleming, J.M., Shum, D.H. (2002). Self-awareness of prospective memory failure in adults with traumatic brain injury. Brain Injury, 16(11), 931–945.Google Scholar
Satz, P., Forney, D.L., Zaucha, K., Asarnow, R.R., Light, R., McCleary, C., Becker, D. (1998). Depression, cognition, and functional correlates of recovery outcome after traumatic brain injury. Brain Injury, 12(7), 537–553.Google Scholar
Sawchyn, J.M., Mateer, C.A., Suffield, J.B. (2005). Awareness, emotional adjustment, and injury severity in postacute brain injury. Journal of Head Trauma Rehabilitation, 20(4), 301–314.Google Scholar
Schneyer, D.M., Verfaellie, M., Alexander, M.P., LaFleche, G., Nicholls, L., Kaszniak, A.W. (2004). A role of right medial prefrontal cortex in accurate feeling-of-knowing judgments: Evidence from patients with lesions to frontal cortex. Neuropsychologia, 42, 957–966.Google Scholar
Sherer, M., Hart, T., Nick, T.G., Whyte, J., Thompson, R.N., Yablon, S.A. (2003). Early impaired self-awareness after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 168–176.CrossRefGoogle ScholarPubMed
Shimamura, A.P. (2000). Toward a cognitive neuroscience of metacognition. Consciousness and Cognition, 9, 313–323.Google Scholar
Shipley, W.C. (1946). Institute of Living Scale. Los Angeles, CA: Western Psychological Services.Google Scholar
Souchay, C., Isingrini, M., Clarys, D., Taconnat, L., Eustache, F. (2004). Executive functioning and judgment-of-learning versus feeling-of-knowing in older adults. Experimental Aging Research, 30(1), 47–62.Google Scholar
Souchay, C., Isingrini, M., Espagnet, L. (2000). Aging, episodic feeling-of-knowing, and frontal functioning. Neuropsychology, 14(2), 229–309.Google Scholar
Stuss, D.T., Alexander, M.P. (2000). Executive functions and the frontal lobes: A conceptual view. Psychological Research, 63, 289–298.Google Scholar
Stuss, D.T., Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401–433.Google Scholar
Thiede, K.W., Wiley, J., Griffin, T.D. (2010). Test expectancy affects metacomprehension accuracy. British Journal of Educational Psychology. [Epub ahead of print].Google Scholar
Tiede, H.L., Derksen, C., Leboe, J.P. (2009). An investigation of increases in metamemory confidence across multiple study trials. Memory, 17(3), 288–300.Google Scholar
Trahan, E., Pépin, M., Hopps, S. (2006). Impaired awareness of deficits and treatment adherence among people with traumatic brain injury or spinal cord injury. The Journal of Head Trauma Rehabilitation, 21(3), 226–235.Google Scholar
Trenerry, M.R., Crosson, B., Deboe, J., Leber, W.R. (1989). Stroop Neuropsychological Screening Test. Lutz, FL: Psychological Assessment Resources, Inc.Google Scholar
Wagner, M.T., Spangenberg, K.B., Bachman, D.L., O'Connell, P. (1997). Unawareness of cognitive deficit in Alzheimer disease and related dementias. Alzheimer Disease and Associated Disorders, 11(3), 125–131.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale-III. San Antonio, TX: The Psychological Corporation.Google Scholar
Whyte, J., Rosenthal, M. (1993). Rehabilitation of the patient with brain injury. In J.A. DeLisa (Ed.), Rehabilitation medicine: Principles and practice (2nd ed., pp. 825–860). Philadelphia: J.B. Lippincott Company.Google Scholar