Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment.

Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.

Thinking about other's mistakes: contrasting patterns of performance in groups high or low in autistic or psychopathic traits.

Introduction: Counterfactual thinking refers to thoughts such as, "What if … ?" or "If only … " that hypothesise about how past events might have turned out differently. It is a functional process, allowing us to reflect upon and solve problems, and to evoke appropriate responses. It is thought to involve both cognitive and emotional processes, and is linked to the development of false belief and moral emotions. Methods: The present study compared responses to a novel task, "Counterfactual Judgments", in students who scored high or low on self-report measures of autistic or psychopathic traits, two conditions putatively associated with deficits in empathy. Results: Contrasting patterns of performance were revealed: those with high versus low autistic traits gave harsher ratings of blame for others' mistakes and showed reduced sensitivity to punitive counterfactual alternatives, whereas those with high versus low psychopathic traits gave lower ratings for moral judgments of regret and guilt. A self-report questionnaire measure of empathy also provided some evidence of reduced empathic processing in both the high trait groups. Conclusions: The findings are considered in the light of the possible contributions of cognitive versus emotional processes to counterfactual thinking. The possible implications for managing social dysfunction in clinical populations are also discussed.

Pediatric traumatic brain injury and antisocial behavior: are they linked? A systematic review.

Purpose: Despite growing evidence supporting a link between pediatric traumatic brain injury (TBI) and antisocial behavior, little work has rigorously evaluated this. This review aimed to explore systematically previous literature on the association between TBI before the age of 19 and severe behavioral problems such as violence, aggression and assault. Methods: All articles published from 1990 to 2018 were searched using four major databases, alongside manual searching and cross-referencing. Results: Sixteen articles met the eligibility criteria. Overall, they supported an association between pediatric TBI and antisocial behavior. Factors were identified that might influence this link, such as, for example, TBI severity and substance use. Conclusions: The review identified several issues in the current literature, highlighting key areas for improvement. It is imperative that more attention is paid to gathering detailed information regarding the temporal sequencing of events and TBI severity; evaluating the contribution of biopsychosocial variables co-occurring with TBI and antisocial behavior; disentangling which outcomes are specific to TBI versus any injury. The review has implications for the health and justice systems; regardless of whether TBI is the cause versus a contributing factor to antisocial behavior, increased awareness of their association could lead to more comprehensive assessments, tailored interventions and effective sentencing.

Derailing the trolley: Everyday utilitarian judgments in groups high versus low in psychopathic traits or autistic traits.

Moral decision-making has been linked with empathy. The present study built on previous work examining the relationship between psychopathy or autism spectrum disorder (ASD), two conditions putatively associated with deficits in empathy, and utilitarian decision-making. Students scoring high on self-report measures of psychopathic or autistic traits were presented with a novel task, 'Utilitarian Judgments', and compared to low trait control groups. This study replicated the classic finding that more direct links between the agents' actions and harm to victims mitigated utilitarian decision-making. It also found that participants made more utilitarian decisions when outcomes involved extreme physical versus everyday social harm. Enhanced utilitarian decision-making was not observed in those scoring high for either psychopathic or autistic traits, although both high trait groups reported that they would experience less discomfort than their low trait counterparts. Verbal reasoning differences were observed for the high autistic trait group, but not the high psychopathic trait group. The dilemmas that have been typically used to explore utilitarian decision-making describe extreme, hypothetical events involving physical or serious emotional harm. The present findings suggest that this might limit the generalisability of the existing literature and over-emphasise the tendency to make utilitarian decisions when considering everyday dilemmas.

Great Expectations: The Role of Rules in Guiding Pro-social Behaviour in Groups with High Versus Low Autistic Traits.

Measuring autistic traits in the general population has proven sensitive for examining cognition. The present study extended this to pro-social behaviour, investigating the influence of expectations to help others. A novel task describing characters in need of help was administered to students scoring high versus low on the Autism-Spectrum Quotient. Scenarios had two variants, describing either a 'clear-cut' or 'ambiguous' social rule. Participants with high versus low autistic traits were less pro-social and sympathetic overall towards the characters. The groups' ratings of characters' expectations were comparable, but those with high autistic traits provided more rule-based rationales in the clear-cut condition. This pattern of relatively intact knowledge in the context of reduced pro-social behaviour has implications for social skill training programmes.

Going 'above and beyond': are those high in autistic traits less pro-social?

Few studies have explored how the cognitive differences associated with autistic spectrum disorder translate into everyday social behaviour. This study investigated pro-social behaviour in students scoring high and low on the autism-spectrum quotient (AQ), using a novel scenario task: 'Above and Beyond'. Each scenario involved an opportunity to behave pro-socially, and thus required balancing the needs of a character against participants' own interests. High AQ participants both generated responses and selected courses of action that were less pro-social than those of the low AQ group. For actions of low pro-social value they gave higher self-satisfaction ratings; conversely, they gave lower self-satisfaction ratings for high pro-social actions. The implications for everyday functioning are considered for those with high autistic traits.